• F Le Bacq and A Rietsema.
• Kasama District Health Services, Zambia.
• Int J Epidemiol. 1997 Apr 1; 26 (2): 357-63.

BackgroundMaternal mortality ratios in Kasama and Kaputa Districts, two remote rural areas of Northern Province, Zambia, were suspected to be very high. In order to evaluate the impact of a referral system baseline maternal mortality levels and additional maternal mortality risk arising from poor accessibility were estimated.MethodsThe sisterhood method was applied to a random population sample of 3123 respondents in Kasama District and to 2953 in Kaputa District during May and June 1995. For Kasama also hospital-based maternal mortality was calculated from record analysis from 1 January 1991 up to 31 December 1995. Population attributable risk and population etiological fraction were calculated for Kasama District.ResultsMaternal mortality ratio for Kasama District was 764 per 100,000 live births and 1549 for Kaputa District. Kasama hospital-based maternal mortality was 543 per 100,000 live births. In Kasama District population attributable risk of maternal mortality from poor accessibility was 220 maternal deaths per 100,000 live births, and the population etiological fraction was 29%. In Kaputa District population attributable risk was 1006 maternal deaths per 100,000 live births, and the population etiological fraction was 65%.ConclusionsThis study suggests that solving the accessibility problem would decrease the mortality burden from maternal causes with at least 29% in Kasama District and 65% in Kaputa District.

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