53

In Madagascar, maternal deaths remain a major public health problem. The aim of this study is to examine the factors that explain in-hospital maternal mortality in Toliara. Methods: A case-control study was conducted over a four-year period. Data were collected from obstetric records, and logistic regression analysis was performed to assess the determinants of maternal death. Results: Four risk factors for maternal death were identified: the presence of a life-threatening condition (OR=5.4 [95% CI=2.0–15.9]), cesarean delivery (OR=2.6 [95% CI=1.2–5.5]), as well as the presence of a hypertensive disorder (OR=4.0 [95% CI=1.3–13.5]) and hemorrhage (OR=3.3 [95% CI=0.9–12.7]) associated with the pregnancy. Having received prenatal care (OR=0.1 [95% CI=0.0–0.2]) was the only protective factor identified. Discussion: These findings underscore the importance of early and effective management of obstetric complications upon hospital admission. They also highlight the critical role of antenatal care in reducing the risk of maternal death. Additionally, preventive measures and appropriate management of cesarean sections can contribute to improving maternal health outcomes. Conclusions: This study sheds light on the main factors associated with maternal mortality in Toliara, Madagascar, emphasizing the importance of prevention strategies and targeted interventions to combat this major public health issue.