Trends and Associated Factors of Maternal Mortality in Zambia: Analysis of Routinely Collected Data (2015-April 2019)

Introduction: Reduction of maternal mortality is a global priority. Based on one of Sustainable Development Goal target, Zambia aims to improve maternal health and one of the top priorities is to reduce maternal mortality ratio (MMR) to less 70 per 100,000 live births by 2030. Tracking progress towards set targets remains critical to guide policy and program implementation. This study aimed at assessing the trends and associated factors of maternal mortality in Zambia from April 2015 to April 2019. Methods: Data on maternal deaths was collected from the maternal surveillance database from April 2015-April 2019 from the 9 provinces of Zambia. Data was aggregated and coded in excel then merged. Incident rate ratios were reported using Zero Truncated Poisson (ZTP) regression. All analysis was done in 2021 using STATA version 14.2. Results: A total of 1,461 maternal deaths were reviewed. The trends of maternal deaths in the four-year period have not been consistently high or low but steadily following an upward trend with no significant downward trend. A multivariable ZTP model showed that women in Luapula (IRR 0.21 95% CI; 0.07-0.58), Western (IRR 0.44 95% CI; 0.24-0.81) and Lusaka (IRR 0.07 95% CI; 0.001-0.51) provinces had a reduced IRR of maternal deaths compared to women in Central province (P<0.05). The findings also showed that the age group 20-29 and 30 – 39 years had an increased IRR of maternal death compared to the age group less than 20 years (p<0.05). Sepsis, (aIRR 0.14 95% CI; 0.3-0.57), Hypertensive disorders (aIRR 0.20 95% CI; 0.07-0.61) and indirect causes (aIRR 0.22 95% CI; 0.08-0.63) in the study had a reduced IRR compared to women who had abortions (P<0.05). However, women who had live births controlling for other variables had an increased IRR (aIRR 4.75 95% CI; 1.56-14.43) compared to those who had abortions (P<0.05). There was no sufficient evidence to suggest HIV was associated with maternal deaths (P=0.24). Conclusion: The findings in this study shows that, in Zambia, maternal deaths over the years have not had a significant decline, thus provides evidence for re-strategizing, planning, policy formulation and implementation for reproductive health programmes to reduce maternal deaths in Zambia.