Le Bacq F, Rietsema A
Kasama District Health Services, Zambia.
Int J Epidemiol. 1997 Apr;26(2):357-63. doi: 10.1093/ije/26.2.357.
Maternal 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.
The 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.
Maternal 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%.
This 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.
赞比亚北部省两个偏远农村地区卡萨马区和卡普塔区的孕产妇死亡率被怀疑非常高。为了评估转诊系统的影响，估算了孕产妇死亡率基线水平以及因交通不便导致的额外孕产妇死亡风险。
1995年5月和6月，对卡萨马区3123名受访者以及卡普塔区2953名受访者的随机人口样本采用姐妹法。对于卡萨马区，还通过分析1991年1月1日至1995年12月31日的记录计算了基于医院的孕产妇死亡率。计算了卡萨马区的人群归因风险和人群病因分数。
卡萨马区的孕产妇死亡率为每10万活产764例，卡普塔区为1549例。卡萨马区基于医院的孕产妇死亡率为每10万活产543例。在卡萨马区，因交通不便导致的孕产妇死亡人群归因风险为每10万活产220例孕产妇死亡，人群病因分数为29%。在卡普塔区，人群归因风险为每10万活产1006例孕产妇死亡，人群病因分数为65%。
本研究表明，解决交通不便问题将减轻孕产妇原因导致的死亡负担，在卡萨马区至少降低29%，在卡普塔区至少降低65%。
