Investigating Maternal Mortality at Regina Pacis Hospital Mutengene and the Government Health Centre Mutengene, South West Region, Cameroon

Background: One target under sustainable Development Goal 3 is to reduce the global maternal mortality ratio to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average. So there is a need to identify ways to reduce maternal mortality which is a top priority in development of the management of pregnant women and invention of equipment in procedures (caesarian section) to provide a maternal health and increase life survival. Objective: This study aimed to investigate the prevalence and causes of maternal mortality at Regina Pacis Hospital and Government Health Center Mutengene. Method: This study was a retrospective study, where Data from 2007 to 2017 were collected from the hospital files using a checklist, descriptive and inferential statistics were used to analyse the data. Conclusion: From the finding, maternal mortality is at a pace of increase in the Regina Pacis Hospital and Government Health Centre Mutengene and How to cite this paper: Ambe, N.F., Bobga, T.P., Isah, M., Ketum, A.S., Sama, C.B., Therese, A.A., Beuadou, N.C., Gabriel, E.S.E. and Ayafor, T.P. (2020) Investigating Maternal Mortality at Regina Pacis Hospital Mutengene and the Government Health Centre Mutengene, South West Region, Cameroon. Journal of Biosciences and Medicines, 8, 163-176. https://doi.org/10.4236/jbm.2020.85016 Received: January 31, 2020 Accepted: May 17, 2020 Published: May 20, 2020


Background
According to the World Health Organization (2014) [1], maternal death is defined as the death of a woman while pregnant or within 42 days of termination of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Generally, there is a distinction between direct factors that causes maternal mortality and indirect factors.
Direct factors include complication resulting from pregnancy, delivery, management of the two (mother and baby). While indirect factors are malaria, anaemia, and hypertension all of which may complicate pregnancy [2].
Worldwide, maternal mortality is unacceptably high; approximately 800 women die every day from preventable causes related to pregnancy and delivery. In 2009, WHO (World Health Organization) established a set of criteria for severe acute maternal morbidity and maternal near miss in order to standardized data and calculate indicators for comparing different settings and identify cases of interest.
Furthermore, maternal mortality ratio in Brazil is about 60.1/100,000 lives birth (LB) and a total of 1,719 deaths were occurred in 2010. Also in Brazil, the main causes of maternal deaths in 2014 were hypertension (21.1%), hemorrhage (11.9%), complications of labor (8.6%) and HIV and infectious diseases (5%) [3].
However, between 1990 and 2013, the global maternal mortality ratio (that is, the number of maternal death per 100,000 live births) declined by only 2.65 per year [4], this is far from the annual decline of 5.5% required to achieve Millennium Development Goal 5 (MDG 5) [4].
During the United Nations General Assembly 2015, in New York, UN Secretary-General Ban Ki-moon launched the Global Strategy for Women's, Children's and Adolescents' Health, between 2016-2030 [6]. Seeing that it is possible to accelerate the decline, countries have now united behind a new target to reduce maternal mortality even further. One target under Sustainable Development Goal 3 is to reduce the global maternal mortality ratio to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average. The Strategy is a road map for the post-2015 agenda as described by the Sustainable Development Goals and seeks to end all preventable deaths of women, children and adolescents and create an environment in which these groups not only survive, but thrive, and see their environments, health and wellbeing transformed. So there is a need for further investment in medical staff training, construction of more medical district hospital and evidence-based management and prevention standards.
Maternal health is improving and maintaining wellbeing and development of mothers before, during and after delivery. In Cameroon, the prevalence of maternal mortality is still challenging in health services. According to the statistics from the United Nations, World Bank in 2010-2015 [7], Cameroon was not among the 9 countries that achieve the MDG5 although the government development vision under health policy 1 of its strategy is reducing burden of maternal mortality and increasing life through the improvement of health services to all people [5]. So if more effective measures are not taken, the prevalence of maternal mortality will continue to worsen the burden in health systems and economic growth of the country [8] and Cameroon might not meet the Sustainable Development Goal 3 to reduce the global maternal mortality ratio to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average. So there is a need to identify ways to reduce maternal mortality which is a top priority in development of the management of pregnant women and invention of equipment in procedures (Caesarian section) to provide a maternal health and increase life survival [5]. Many mothers also forget the fact that, they must not only be knowledgeable through clinic sections, but to seek information from different sources such as the media, books and the internet about safe motherhood. To assess the achievement of MDG 5, planners as well as policy makers did estimated number of maternal mortality, without the substantial information from MDG 5, with these results the target for SDG 3 might not be achieved. Thus, it prompt us to carry out a research on maternal mortality to continue the trend if the SDG 3 goal will be met by 2030.

Research Design
This study was a retrospective study, where supposed files of women of reproductive age that consulted at the Regina Pacis Hospital and Government Health Center Mutengene were utilised for the study. At enrolment, checklist was used

Study Area
This study was carryout in Mutengene, on the prevalence of maternal mortality at

Study Population
The target population were women of reproductive age who consulted at Regina

Sampling Technique
We used convenient sampling to study the files, from 2007 to 2017.

Sample Size
This study included all files of pregnant women from the selected areas: Regina Pacis Hospital Mutengene and Government Health Centre Mutengene from 2007 to 2017 to give a reasonable conclusion over the 10-year period.

Inclusion Criteria
All women of reproductive age who delivered in the maternity at the Regina Pacis Hospital Mutengene and Government Health Centre Mutengene were included in this study.

Exclusion Criteria
All women who were not pregnant and women whose files had incomplete valuable information as stipulated by the checklist were excluded from the study.

Data Collection
The instrument we used was a checklist to collect data from past records of women

Validation of Instrument
A checklist was design according to the study objectives presented to the supervisor for scrutiny. After which a pilot study was used in a study area to get challenges in collecting data.
Necessary corrections were then effected together with the supervisor thereby respecting face and content validity.

Ethical Consideration
Names of patients were notmentioned; just record numbers were used in order to maintain confidentiality. The information we collected was used strictly for academic purposes. A letter of authorization was collected from SMU, Delegation of Public Health and from the administration of two Hospitals. An ethical clearance for this research was obtained from the Institutional Review Board (IRB) of the Faculty of Health Sciences (FHS) of the University of Buea.

Data Analysis
Data was collected with the use of a checklist which was later keyed into a Statistical Package for Social Sciences (SPSS) version 20 and Microsoft Excel 2013.
Findings were presented in pie charts and frequency distribution tables.

Number of Cases with Respondents Less than 18 and Greater than 35 Years
In this study, majority of the cases less than 18 years of age were from Regina Pacis Hospital Mutengene (53.3%, n = 122), with a minority from the Government Health Centre Mutengene (46.7%, n = 107). Out of the 276 cases greater than 35 years recorded, 176 (63.8%) were from Regina Pacis hospital and 100 (36.2%) were from Government Health Centre Mutengene as shown below (Table 1).

Presentation of Respondents According to Parity
Of 1537 Prime Cases recorded in this study, majority 1049 (68%) were from Re-

The Prevalence of Maternal Mortality at the Study Area
Based on the table below on babies, the total value 3696 were babies that lived and 105 were babies that died in Regina Pacis Mutengene while in Government Health Centre Mutengene, 2019 babies lived and 42 babies died (Table 3).

The Maternal Mortality Rate at Regina Pacis
The prevalence of maternal death at Regina Pacis Hospital was determined to be 255 per 100,000 live births from 2007 to 2017, with a total live birth of 5111 and 13 deaths out of 5124 mothers in the study. There was a higher prevalence of infant mortality of 28,410 per 100.000 live births within the same specified period of study (Table 3).  (Table 3).

Most Prominent Cause of Maternal Mortality at Regina Pacis
Hospital and Government Health Centre Mutengene.  (Table 4).

Investigating the Causes and Number of Deaths at the Study Area
Haemorrhage was the most related factor of death associated with 1 (100%) death at the Government Health Centre Mutengene. Also, It was associated with 3 (46%) of the 13 recorded maternal mortality. prolonged labour and Malaria associated with 2 (15%) respectively of the 13 recorded death while Anaemia, Abortion, Sepsis and HIV/AIDS were associated with 1(6%) deaths each at the Regina Pacis Mutengene (Table 5).

Discussion
In this study, it was noticed that out Health Centre Mutengene. This is in contrast with the research carryout in Nigeria by lorretta F Ntoimo et al. [10] were minority (31%) were Prime (nulliparous) and Majority (37%) were multiparous. Parity is positively associated with outcomes such as anaemia, low maternal weight gain and low-birth weight. According

Conclusion
The study sought to investigate the prevalence and causes of maternal mortality

Recommendations
Pregnant women should be educated and encouraged by nurses of the Regina Pacis Hospital Mutengene and Government Health Centre Mutengene to attained antenatal clinics aiding identification of complications like compromised immune system as early as possible. Pregnant women should be sensitized by nurses at Regina Pacis Hospital Mutengene and Government Health Centre Mutengene to seek more information from different sources such as the media, books and the internet about safe motherhood, and causes of maternal ill health and death to help them participate in optimising their health and improve birth outcomes.
Nurses at Regina Pacis Hospital Mutengene and Government Health Centre Mutengene need to improve on their filing and clerking system and try to upgrade their professional standard to better manage pregnant women especially during delivery.
The ministry of public health should train and provide more staff competent to manage pregnant women.

Limitation of the Study
This study need to be carryout in different regions of the country, to but understand the risk factors of maternal mortality.

Availability of Data and Materials
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.