Maternal Mortality and Morbidity Will Not Reduce in Low Resource Countries without the Anaesthetists’ Involvement


Background: Maternal and foetal mortality is unacceptably high in most resource-limited countries and the practice of obstetric anaesthesia has an important influence on outcome for both mother and baby. The much needed close co-operation and collaboration between obstetricians and obstetric anaesthetist providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. The current global maternal mortality is approximately 400 per 100,000 deliveries, with a range of 7 - 740 deaths per 100,000, demonstrating the inequality between the rich and poor countries. Many of the deaths could have been prevented by better essential obstetrics services including safe anaesthesia and surgery, provided such services are made available in a timely manner. Conclusion: Maternal mortality in low resource countries has its basis complex social, economic and political factors, underpinned by a lack of resources. Many of these factors are difficult and slow to resolve and are not specific to maternal health. Comprehensive essential obstetric care services at the district hospital level (first referral level) should include all the above plus safe surgery, safe anaesthesia, and blood transfusion. Government, donor agencies and all stakeholders must recognize the crucial role of anaesthesia in providing emergency obstetric care in hospitals. Advocacy by all concerned will help direct the scarce resources to the appropriate areas of need which includes provision of adequate facilities and manpower for safe anaesthesia.

Share and Cite:

Ogboli-Nwasor, E. (2014) Maternal Mortality and Morbidity Will Not Reduce in Low Resource Countries without the Anaesthetists’ Involvement. Open Journal of Obstetrics and Gynecology, 4, 228-233. doi: 10.4236/ojog.2014.45037.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Sombie, I., Meda, N. and Ky-Serbo, O. (2005) Maternal Mortality in Rural Burkina Faso. British Medical Journal, 331, 779.
[2] Graham, W. and Hussein, J. (2004) The Right to Count. Lancet, 363, 67-68.
[3] Centre for Maternal and Child Enquiries (CMACE) (2011) Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG, 118, 1-203.
[4] Maternal Mortality (2006) World Health Organization Fifty-Ninth World Health Assembly A 59/9. Provisional Agenda Item 11.4.
[5] Mavalankar, D.V. and Rosenfield, A. (2005) Maternal Mortality in Resource-Poor Settings: Policy Barriers to Care. American Journal of Public Health, 95, 200-203. 2003.036715
[6] Begum, S., Aziz, N. and Begum, I. (2003) Analysis of Maternal Mortality in a Tertiary Care Hospital to Determine Causes and Preventable Factors. Journal of Ayub Medical College Abbottabad, 15, 49-52.
[7] Graham, W.J., Fitzmaurice, A.E., Bell, J.S., et al. (2004) The Familial Technique for Linking Maternal Death with Poverty. Lancet, 363, 23-27.
[8] (2011) The Millennium Development Goals Report 2011. New York, United Nations.
[9] WHO, UNICEF and UNAIDS (2011) Global HIV/AIDS Response: Epidemic Update and Health Sector Progress towards Universal Access Progress Report 2011. World Health Organization, Geneva.
[10] The Association of Anaesthetists of Great Britain and Ireland (1998) The Obstetric Anaesthetists Association. Guidelines for Obstetric Anaesthesia Services. AAGBI, OAA, London.
[11] Costello, A., Azad, K. and Barnett, S. (2006) An Alternative Strategy to Reduce Maternal Mortality. Lancet, 368, 1477-1479.
[12] Clyburn, P., Morris, S. and Hall, J. (2007) Anaesthesia and Safe Motherhood. Anaesthesia, 62, 21-25.
[13] Kushner, A., Cherian, M.N., Noel, L., Spiegel, D.A., Groth, S., et al. (2010) Addressing the Millennium Development Goals from a Surgical Perspective. Essential Surgery and Anaesthesia in 8 Low- and Middle-Income Countries. Archives of Surgery, 145, 154-159. 2009.263
[14] Debas, H.T., Gosselin, R., McCord, C., et al. (2006) Surgery. In: Jamison, D.T., Breman, J.G., Measham, A.R., et al., Eds., Disease Control Priorities in Developing Countries, 2nd Edition, Oxford University Press, New York, 1245-1260.
[15] (2013) Essential Obstetric Care. World Health Organization Fact Sheet No. 245.
[16] Ronsmans, C., Holtz, S. and Stanton, C. (2006) Socioeconomic Differentials in Caesarean Rates in Developing Countries: A Retrospective Analysis. Lancet, 368, 1516-1523. S0140-6736(06)69639-6
[17] Hodges, S.C., Mijumbi, C., Okello, M., McCormick, B.A., Walker, I.A. and Wilson, I.H. (2007) Anaesthesia Services in Developing Countries: Defining the Problems. Anaesthesia, 62, 4-11.
[18] Nordberg, E. (1990) Surgical Operations in Eastern Africa: A Review with Conclusions Regarding the Need for Further Research. East African Medical Journal, 67, 1-28.
[19] Heywood, A.J., Wilson, I.H. and Sinclair, J.R. (1989) Perioperative Mortality in Zambia. Annals of the Royal College of Surgeons (England), 71, 354-358.
[20] Hansen, D. and Gausi, S.C. (2000) Anaesthesia in Malawi: Complications and Deaths. Tropical Doctor, 30, 146-149.
[21] Fenton, P.F., Whitty, C.J.W. and Reynolds, F. (2003) Caesarean Section in Malawi: Prospective Study of Maternal and Perinatal Mortality. British Medical Journal, 327, 587-590. 1136/bmj.327.7415.587
[22] McKenzie, A.G. (1998) Operative Mortality at Harare Central Hospital 1992-94: An Anaesthetic View. International Journal of Obstetric Anesthesia, 7, 237-241. 80045-9
[23] Tomta, K., Ouro-Bang’na Maman, A.F., Ahouaangbevi, S. and Chobli, M. (2005) Deaths Associated with Anaesthesia in Togo, West Africa. Tropical Doctor, 35, 220-222. 004947505774938666
[24] Tomta, K., Maman, F.O., Agbétra, N., Baeta, S., Ahouangbévi, S. and Chobli, M. (2003) Mortalité Maternelle: Implication Anesthésique au CHU de Lomé (Togo). Sante, 13, 77-80.
[25] Lawn, J.E., Tinker, A., Munjanja, S.P. and Cousens, S. (2006) Where Is Maternal and Child Health Now? Lancet, 368, 1474-1477.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.