Anaesthesia associated mortality in a district hospital in Zimbabwe: 1994 to 2001

Abstract

Objective: To describe anaesthetic associated mortality in a district hospital in Zimbabwe. Design: A retrospective descriptive study of anaesthesia associated mortality over an eight year period. Setting: Murambinda Mission Hospital: a 120 bed rural district hospital in Zimbabwe. Subjects: All patients who died within 24 hours of receiving an anaesthetic. Main Outcome Measures: The overall mortality rate (OMR), being all deaths up to 24 hours after an anaesthetic. Avoidable anaesthetic mortality rate (AMR), are deaths in which correctable anaesthetic factors played a major role. Results: An overall mortality rate (OMR) of 1:344 (2.9 deaths/1 000 anaesthetics) and avoidable mortality rate (AMR) for anaesthesia of 1:482 (2.1 deaths/1 000 anaesthetics) are reported. Factors under the control of the anaesthetist accounted for 72% of mortalities (AMR:OM R). Ail were emergency obstetric patients and had emergency surgery. The hospital maternal mortality rate of 360 per 100 000 and an operative obstetric mortality of 1:293 (3.4 deaths/1 000) are reported. Conclusions: Most of the anaesthetic factors are preventable. These results, although very poor, are consistent with reports from hospitals in the region. By comparison, developed countries are at least 10 times better. Improving the provision, skills, support and profile of anaesthesia providers in the care of peri operative patients, would reduce anaesthesia-associated factors in peri operative mortality. A system of national audit data collection comparable to the CEPOD or Confidential Enquiry into Maternal Deaths is overdue in Zimbabwe.