Abstract:
Maternal mortality has traditionally been the key measurement In the monitoring of
maternal health and adequacy of obstetric services around the world including Sri Lanka. In
Sri Lanka and other developed countries , the ability of maternal mortality to serve this
purpose is reduce because of the rarity of maternal mortality, reflected in low maternal
mortality ratios. Internationally, there has been increasing interest in severe maternal
morbidity as an indicator to maternal health and maternity services. The objectives of the
present study were to assess the proportion of severe maternal morbidity out of total number
of deliveries , risk factors and consequences of severe maternal morbidity and to determine
the morbidity: mortality ratio in the Central Province, Sri Lanka. A cross sectional study
was carried out in the Central province to assess the incidence of severe maternal morbidity.
Total number of deliveries in the study sites of the Central Province during study period
were taken as the denominator to calculate the proportion of SMM in this phase of the
study. Total number of Severe Maternal Morbidity cases which occurred in the study period
were taken as the numerator to calculate proportion. Information was collected from Bed
Head Tickets and with the help of relevant documents using a check-list . The severe morbid
conditions were defined using criteria developed by other countries and with the assistance
of relevant specialists. An un matched case control study was conducted to assess the risk
factors for severe maternal morbidity among the mothers in the three districts in the Central
Province, which consisted of 165 cases and 330 controls. Data collection of this component
of the study was done by principal investigator and three research assistants using an
interviewer administered questionnaire. To find out the selected health consequence of
severe maternal morbidity a prospective cohort study was conducted among 121 mothers
exposed to severe maternal morbidity and 121 non exposed mothers. The case -control study
revealed that following variables were the risk factors of Severe Maternal Morbidity in the
Central Province, Sri Lanka; nationality other than Sinhala , religion other than Buddhism
,partners nationality other than Sinhala, partners religion other than Buddhism, no education
or stl1died up to grade 5 only ,partner of mothers either with no education or studied lip to
grade 5 only ,employed before admission, partner unemployed status , monthly family
income less than 10000 Rs, living in nuclear families ,previous no contraceptive history, not
taken preconception folic acid, not taken rubella immunization, p history of illegal abortion,
previous history of still births, age more than 36 years, ,distance to hospital more than 5 Km,
mode of transport to nearest hospital by estate lorry, registration during current pregnancy
by PHMM other than mothers home, POA of registration after 12 weeks of gestation, no
ante natal home visits by PHMM, ante-natal care at hospital clinic compare to the field
clinic, and less than three ante natal clinic visit. However, after adjusting for confounding
factors using logistic regression analysis, distance to medical facility being more than 5 Km
(adjusted OR 4.35 (CI 2.7-7.1), not taking contraceptive prior to the index pregnancy
(adjusted OR 1.9 (CI 1.2-3.1) ,. Site of Registration other than mothers home (adjusted OR
1.7 (CI 1.04-2.78) and older age (adjusted OR 1.12 (CI 1.061.18 )were emerged as the risk
factors for severe maternal morbidity