Introduction: To identify determinants of maternal death, which consisted of close determinants (obstetric complications), intermediary determinants (maternal age, parity, gestational distance, nutritional status, three of delays), and remote determinants (education, employment, and income) in Boyolali district.
Materials and methods: This was an observational analysis with case–control study with 21 cases and 42 controls with simple random sampling technique. Data analysis was done with univariate, bivariate with chi-square test, and multivariate with multiple logistic regression.
Results: Results showed a significant association between pregnancy complications (p < 0.001), maternal complications (p < 0.001), puerperal complications (p < 0.001), maternal age (p = 0.011), and gestational range (p = 0.035). There was no significant correlation between parity (p = 0858), nutritional status (p = 0.593), delay in decision-making (p = 0.848), and delay of place of reference (p = 0.530) to maternal deaths. There was no significant correlation between parity (p = 0.858), maternal education (p = 0.363), maternal employment (p = 0.814), and family income (p = 0.373) to maternal deaths. The probability of a maternal death by having the above-mentioned risk factor is 85.5%.
Conclusion: Pregnancy complication, labor complication, and parturition complication are related to an increase of maternal deaths, while maternal age and range of pregnancy are only slightly related to maternal deaths.
Clinical significance: We hope that this study may improve awareness and service of health practitioners toward pregnant mothers so that we can reduce the number of maternal deaths in Indonesia.
Kemenkes, RI. Profil Kesehatan Indonesia tahun 2014. Jakarta: Kementerian Kesehatan RI, 2015.
Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2016 Jan;387(10017): 462-474.
WHO. Maternal mortality. Geneva: WHO; 2016. [cited 2017 Feb 21]. Available from: http://www.who.int/mediacentre/ factsheets/fs348/en/.
WHO. Trends in maternal mortality: 1990 to 2015, Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: WHO; 2015. [cited 2017 Feb 21]. Available from: http://www.who.int/reproductivehealth/ publications/monitoring/maternal-mortality- 2015/en/.
Jateng Gayeng. Profil Kesehatan Provinsi Jawa Tengah. Semarang: Dinas Kesehatan Propinsi Jawa Tengah; 2015.
Epuu, KG. Determinants of maternal morbidity and mortality, Turkana District, Kenya. Amsterdam: Royal tropical institute (KIT); 2010.
Handriani I, Melaniani S. Pengaruh Proses Rujukan Dan Komplikasi Terhadap Kematian Ibu. Jurnal Berkala Epidemiologi 2015 Sep;3(3):400-411.
Muthoharoh NA, Purnomo I, NurLatif V. Faktor—Faktor Yang Berhubungan Dengan Kematian Maternal Di Kabupaten Batang. Jurnal Pena Medika 2016 Jun;6(1):1-18.
Aeni N. Faktor Risiko Kematian Ibu. Jurnal Kesehatan Masyarakat Nasional 2013 May;7(10):453-459.
Shennan AH, Green M, Chappell LC. Maternal deaths in the UK: pre-eclampsia deaths are avoidable. Lancet 2017 Feb;389(10069):582-584.
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, Subramaniam H, Peipert JF, Bierut LJ. Maternal age and risk of labor and delivery complications. Matern Child Health J 2015 Jun;19(6):1202-1211.
Smith, JR. Postpartum hemorrhage. Medscape; 2016. [cited 2017 Feb 20]. Available from: http://emedicine.medscape. com/article/275038-overview.
Acosta CD, Knight M. Sepsis and maternal mortality. Curr Opin Obstet Gynecol 2013 Apr;25(2):109-116.
Kozuki N, Lee AC, Silveira MF, Sania A, Vogel JP, Adair L, Barros F, Caulfield LE, Christian P, Fawzi W, et al. The associations of parity and maternal age with small-forgestational- age, preterm, and neonatal and infant mortality: a meta-analysis. BMC Public Health 2013 Sep;13(Suppl 3):S2.
Depkes, RI. Undang-Undang Lindungi Hak Anak Untuk Dapatkan Pelayanan Kesehatan. Jakarta: Departemen Kesehatan RI; 2016. [cited 2017 Feb 18]. Available from: http:// www.depkes.go.id/article/print/16051800001/undangundang- lindungi-hak-anak-untuk-dapatkan-pelayanan-kesehatan. html.
Kusmiyati, Y.; dkk. Perawatan Ibu Hamil. Yogyakarta: Fitramaya; 2008.
Ojofeitimi EO, Ogunjuyigbe PO, Sanusi RA, Orji EO, Akinlo A, Liasu SA, Owolabi OO. Poor dietary intake of energy and retinol among pregnant women: implications for pregnancy outcome in Southwest Nigeria. Pak J Nutr 2008 Mar;7(3): 480-484.
Kemenkes, RI. Riset Kesehatan Dasar. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI; 2013.
Bauserman M, Lokangaka A, Thorsten V, Tshefu A, Goudar SS, Esamai F, Garces A, Saleem S, Pasha O, Patel A, et al. Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis. Reprod Health 2015 Jun;12(Suppl 2):S5.