by Fassou Mathias Grovogui, Aline Semaan, Hawa Manet, Karifa, Kourouma, Thérèse Delvaux and nine others
BMJ Global Health, Vol 11, Issue 5, 14 May 2026. Open access
Abstract
Introduction Despite global efforts to reduce maternal mortality, progress has stalled, particularly in sub-Saharan Africa, where the maternal mortality ratio remains high. This study aims to assess in-facility maternal mortality, maternal and foetal complications, and stillbirths in referral hospitals at different levels of the health system in Guinea.
Methods This was a cross-sectional study conducted at three urban referral hospitals in Guinea at the district (Hôpital de district de Forécariah or HD), regional (Hôpital Régional de Mamou or HR) and national (Hôpital National Ignace Deen or HN) levels from May 2021 to April 2023. Key indicators assessed included in-facility maternal mortality ratio (IMMR), maternal and foetal complication rates and stillbirth rates.
Results A total of 25 235 women were admitted to the three hospitals over the 24-month period for maternal indications. The highest IMMR was recorded at HN (1264 per 100 000 live births), followed by HD (376) and HR (245). Postpartum haemorrhage was the leading cause of maternal death, accounting for 37% of cases at HR and 58% at HN. At HN, the other frequent causes included anaemia, postpartum sepsis and pre-eclampsia/eclampsia, whereas at HR, obstructed labour, anaemia and pre-eclampsia/eclampsia were frequently reported. Maternal and foetal complications were observed in 23% of deliveries at HD, 24% at HR and 40% at HN. Caesarean section rates were 35% at HD, 29% at HR and 54% at HN. Stillbirth rates ranged from 77 to 103 per 1 000 across the hospitals, with fresh stillbirths accounting for 40–50% of cases.
Conclusions This study highlights the pressing need to strengthen emergency obstetric care and referral systems at district, regional and national hospitals. Investing in healthcare workers’ capacity, ensuring timely transport for referrals and enhancing data quality systems for evidence-based decision-making are essential steps to reduce maternal and perinatal mortality and to achieve the sustainable development goals.
How this study might affect research, practice or policy
- The findings highlight important delays in access to appropriate care within the referral system, which contributes substantially to maternal deaths.
- Policy makers and health system planners should give priority to strengthening emergency obstetric care, improving referral and transport mechanisms and building the capacity of health workers at all levels of the health system.
- Improving the quality and use of routine data is essential for making informed decisions and monitoring progress towards the maternal and newborn health targets set out in the sustainable development goals (SDGs).
PHOTO: Healthcare Snapshots.com
