Maternal deaths associated factors in the Conflict-Affected North West Region of Cameroon. Lessons from a cross-sectional survey
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Background
Maternal mortality is a significant ongoing global public health crisis, particularly in sub-Saharan Africa and conflict-affected regions. Cameroon’s maternal mortality ratio is high at 406 deaths per 100,000 live births, while the ongoing Anglophone conflict has further exacerbated maternal healthcare delivery in the North West Region (NWR). Despite the evidence-based interventions like partographs, obstetric kits, birth preparedness plans, and active management of the third stage of labour, implementation gaps persist across health facilities.
Objective
The study aimed to assess factors related to preventable maternal deaths in the NWR of Cameroon by exploring maternal health service usage, implementation of obstetric measures, demand-side challenges, accessibility barriers, and health system weaknesses.
Methodology
The study employed a quantitative descriptive cross-sectional survey design. Data was collected with structured questionnaires from postpartum women and healthcare workers in selected health facilities and catchment communities in the NWR. Also, a multistage sampling technique was adopted, and Cochran’s formula generated a sample size of 109 respondents. In addition, data were analysed with SPSS v. 27 and STATA v. 18 via descriptive and inferential statistics.
Results
In this study,while 70.64% of females attended at least 4 ANC visits, only 38.53% met WHO ANC adequacy requirements. Facility delivery was 96.33%, yet only 38.46% received completed delivery plans. Conflict-related challenges affected access, with 44.95% reporting insecurity-associated movement difficulties, while 44.95% reported increased transportation expenses due to the conflict. Near-miss complications were reported among 27.52% of participants. Delivery record reviews indicated that obstetric kits were utilised in 81.76% of deliveries, partographs were accessible in 86.49% of records but correctly filled in just 60.81%, while oxytocin administration was 95.95%. Integrated Health Centres showed poorer adherence with intrapartum interventions compared with District/Regional Hospitals (p < 0.05).
Conclusion
In the NWR, maternal mortality was associated with accessibility, interconnected demand-side, conflict-related, and health-system determinants. While utilization of some maternal interventions was high, major implementation gaps such as weak referral systems, insufficient BEmONC readiness, poor partograph compliance, and conflict disruptions, continually compromise neonatal and maternal outcomes. Strengthening lower-level facilities, enhancing emergency referral systems, and improving implementation of evidence-based obstetric interventions are crucial for minimising maternal mortality in the NWR.
