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Birabwa C, Banke-Thomas A, Semaan A, van Olmen J, Kananura RM, Arinaitwe ES, Waiswa P, Beňová L. The quality of routine data for measuring facility-based maternal mortality in public and private health facilities in Kampala City, Uganda. Popul Health Metr 2024; 22:22. [PMID: 39180044 PMCID: PMC11342531 DOI: 10.1186/s12963-024-00343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Routine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. METHODS We reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016-2019 and 2020-2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership. RESULTS We included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021. CONCLUSIONS Routine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Rornald Muhumuza Kananura
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Busoga Health Forum, Jinja, Uganda
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Samara A, Hanton T, Khalil A. Evidence-based interventions to address persistent maternal mortality rates. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024. [PMID: 39005146 DOI: 10.1002/uog.27712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/25/2024] [Accepted: 06/07/2024] [Indexed: 07/16/2024]
Affiliation(s)
- A Samara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- FUTURE, Center for Functional Tissue Reconstruction, University of Oslo, Oslo, Norway
| | - T Hanton
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Royal College of Obstetricians and Gynaecologists, London, UK
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Zhou X, Fang J, Wu Y, Gao J, Chen X, Wang A, Shu C. Risk factors for maternal near-miss in an undeveloped province in south-central China, 2012-2022. BMC Public Health 2024; 24:1526. [PMID: 38844895 PMCID: PMC11157777 DOI: 10.1186/s12889-024-18970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach. METHODS Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM. RESULTS Our study included 780,359 women with 731,185 live births, a total of 2461 (0.32%) MNMs, 777,846 (99.68%) non-MNMs, and 52 (0.006%) maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23-3.50). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). Results of multivariate logistic regression analysis showed risk factors for MNM: maternal age > = 30 years old (aOR > 1, P < 0.05), unmarried women (aOR = 2.21, 95%CI: 1.71-2.85), number of pregnancies > = 2 (aOR > 1, P < 0.05), nulliparity (aOR = 1.51, 95%CI: 1.32-1.72) or parity > = 3 (aOR = 1.95, 95%CI: 1.50-2.55), prenatal examinations < 5 times (aOR = 1.13, 95%CI: 1.01-1.27), and number of cesarean sections was 1 (aOR = 1.83, 95%CI: 1.64-2.04) or > = 2 (aOR = 2.48, 95%CI: 1.99-3.09). CONCLUSION The MNM ratio was relatively low in Hunan Province. Advanced maternal age, unmarried status, a high number of pregnancies, nulliparity or high parity, a low number of prenatal examinations, and cesarean sections were risk factors for MNM. Our study is essential for improving the quality of maternal health care and preventing MNM.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Yinglan Wu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China.
| | - Jie Gao
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Xiaoying Chen
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China.
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Chuqiang Shu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
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Tholandi M, Zethof S, Kim YM, Tura AK, Ket J, Willcox M, van den Akker T, Ilozumba O. Approaches to improve and adapt maternal mortality estimations in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 165:94-106. [PMID: 37712620 DOI: 10.1002/ijgo.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND In the absence of robust vital registration systems, many low- and middle-income countries (LMICs) rely on national surveys or routine surveillance systems to estimate the maternal mortality ratio (MMR). Although the importance of MMR estimates in ending preventable maternal deaths is acknowledged, there is limited research on how different approaches are used and adapted, and how these adaptations function. OBJECTIVES To assess methods for estimating maternal mortality in LMICs and the rationale for these modifications. SEARCH STRATEGY A literature search with the terms "maternal death", "surveys" and "low- and middle-income countries" was performed in Medline, Embase, Web of Science, Scopus, CINAHL, APA PsycINFO, ERIC, and IBSS from January 2013 to March 17, 2023. SELECTION CRITERIA Studies were eligible if their main focus was to compare, adapt, or assess methods to estimate maternal mortality in LMICs. DATA COLLECTION AND ANALYSIS Titles and abstracts were screened using Rayyan. Relevant articles were independently reviewed by two reviewers against inclusion criteria. Data were extracted on mortality measurement methods, their context, and results. MAIN RESULTS Nineteen studies were included, focusing on data completeness, subnational estimates, and community involvement. Routinely generated MMR estimates are more complete when multiple data sources are triangulated, including data from public and private health facilities, the community, and local authorities (e.g. vital registration, police reports). For subnational estimates, existing (e.g. the sisterhood method and reproductive-age mortality surveys [RAMOS]) and adapted methods (e.g. RAMOS 4 + 2 and Pictorial Sisterhood Method) provided reliable confidence intervals. Community engagement in data collection increased community awareness of maternal deaths, provided local ownership, and was expected to reduce implementation costs. However, most studies did not include a cost-effectiveness analysis. CONCLUSION Household surveys with community involvement and RAMOS can be used to increase data validity, improve local awareness of maternal mortality estimates, and reduce costs in LMICs.
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Affiliation(s)
- Maya Tholandi
- Faculty of Science, Athena Institute, VU University, Amsterdam, The Netherlands
| | - Siem Zethof
- Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Johannes Ket
- Medical Library, VU University, Amsterdam, The Netherlands
| | - Merlin Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Onaedo Ilozumba
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Shafiq Y, Caviglia M, Juheh Bah Z, Tognon F, Orsi M, K Kamara A, Claudia C, Moses F, Manenti F, Barone-Adesi F, Sessay T. Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts' maternal death surveillance and response data. BMJ Open 2024; 14:e076256. [PMID: 38216175 PMCID: PMC10806740 DOI: 10.1136/bmjopen-2023-076256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Sierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care and regional disparities in accessing quality care. This paper presents the first comprehensive analysis of the burden of different causes of maternal deaths reported in the Maternal Death Surveillance and Response (MDSR) system at the district level from 2016 to 2019. METHODS The MDSR data are accessed from the Ministry of Health and Sanitation, and the secondary data analysis was done to determine the causes of maternal death in Sierra Leone. The proportions of each leading cause of maternal deaths were estimated by districts. A subgroup analysis of the selected causes of death was also performed. RESULTS Overall, obstetric haemorrhage was the leading cause of maternal death (39.4%), followed by hypertensive disorders (15.8%) and pregnancy-related infections (10.1%). Within obstetric haemorrhage, postpartum haemorrhage was the leading cause in each district. The burden of death due to obstetric haemorrhage slightly increased over the study period, while hypertensive disorders showed a slightly decreasing trend. Disparities were found among districts for all causes of maternal death, but no clear geographical pattern emerged. Non-obstetric complications were reported in 11.5% of cases. CONCLUSION The MDSR database provides an opportunity for shared learning and can be used to improve the quality of maternal health services. To improve the accuracy and availability of data, under-reporting must be addressed, and frontline community staff must be trained to accurately capture and report death events.
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Affiliation(s)
- Yasir Shafiq
- Department of Translational Medicine and Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Piemonte, Italy
- Center of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Pakistan
| | - Marta Caviglia
- Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Zainab Juheh Bah
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | | | - Michele Orsi
- Doctors with Africa CUAMM, Padova, Veneto, Italy
| | - Abibatu K Kamara
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | | | - Francis Moses
- Reproductive Health and Family Planning Programme, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | | | - Francesco Barone-Adesi
- CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Piemonte, Italy
| | - Tom Sessay
- Bombali District Ebola Response - Surveillance Team, Sierra Leone Ministry of Health and Sanitation, Bombali District, Makeni, Bombali, Sierra Leone
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Willis B, Church K, Perttu E, Thompson H, Weerasinghe S, Macias-Konstantopoulos W. The preventable burden of mortality from unsafe abortion among female sex workers: a Community Knowledge Approach survey among peer networks in eight countries. Sex Reprod Health Matters 2023; 31:2250618. [PMID: 37712508 PMCID: PMC10506426 DOI: 10.1080/26410397.2023.2250618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Previous studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraption, safe abortion, and post-abortion care.
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Affiliation(s)
- Brian Willis
- Director, Global Health Promise, Portland, OR, USA
| | - Kathryn Church
- Independent Consultant, London, UK; Honorary Assistant Professor, Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Perttu
- Director of Data Analysis, Global Health Promise, Portland, OR, USA
| | - Heather Thompson
- Maternal Health Advisor, Global Health Promise, Portland, OR, USA; Adjunct Professor, Schulich School of Medicine, McMaster Faculty of Medicine; & Obstetrician/Gynecologist, Grey Bruce Health Services, Hamilton, Ontario, Canada
| | - Swarna Weerasinghe
- Biostatistician, Global Health Promise, Portland, OR, USA; Associate Professor, Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Wendy Macias-Konstantopoulos
- Global Policy Advisor, Global Health Promise, Portland, OR, USA; Director, Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Ranzani OT, Marinho MDF, Bierrenbach AL. Usefulness of the Hospital Information System for maternal mortality surveillance in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230007. [PMID: 36629619 PMCID: PMC9838231 DOI: 10.1590/1980-549720230007.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To evaluate the capability of hospital records in the Hospital Information System (SIH) to add valuable and complementary information to the Mortality Information System (SIM) in studies on maternal mortality. We calculated and compared the maternal mortality ratio from the SIH and SIM databases, by age group and region, to highlight differences between groups and assess the coverage of maternal deaths using SIH compared with SIM. METHODS Obstetric hospitalizations were defined based on three sources (codes ICD-10 in diagnoses; procedures; billing information). Hospital and SIM mortality ratios were calculated by dividing maternal deaths in hospitals affiliated to the Unified Brazilian Health System (SUS) per live births (SINASC) in the same hospitals. RESULTS In 2019, we identified 2,497,957 obstetric admissions, 0.04% (946) with in-hospital mortality as outcome. The presence of three criteria identified 98% of obstetric hospitalizations and 83% of obstetric hospitalizations with death as outcome. The comparison of mortality ratios between SIH (45.5 MMR; 95%CI 42.7 - 48.5) and SIM (49.7 MMR; 95%CI 46.7 - 52.8) was not statistically significant (p-value: 0.053). CONCLUSION The analysis of SIH was able to provide additional information for the monitoring and surveillance of maternal health in Brazil. Although there are differences between the mortality rates, the SIH, as a complementary information system to the SIM, may be valid in studies on maternal mortality and morbidity.
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Willis B, Perttu E, Fitzgerald M, Thompson H, Weerasinghe S, Macias-Konstantopoulos W. Causes of mortality among female sex workers: Results of a multi-country study. EClinicalMedicine 2022; 52:101658. [PMID: 36313149 PMCID: PMC9596307 DOI: 10.1016/j.eclinm.2022.101658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The vast majority of studies on female sex workers (FSW) focus on causes of morbidity while data on causes of mortality are scarce. In low- and middle-income countries, where civil registry and vital statistics data are often incomplete and FSW may not be identified as such in official registries, identifying causes of mortality among FSW has proven challenging. METHODS As part of a larger investigation on the maternal health of FSW, the current study used the Community Knowledge Approach (CKA) to identify causes of mortality among FSW in LMIC across three global regions in 2019. The CKA, validated to identify maternal, neonatal, and jaundice-associated deaths among women living in a community, was employed to identify deaths of any cause among communities of FSW. Study participants, recruited by in-country partner non-governmental organizations (NGOs) working with local FSW, provided detailed information about FSW deaths in their communities. FINDINGS 1280 FSW participated in 165 group meetings through which 2112 FSW deaths were identified. Of these reported deaths, 57·9% occurred in 2019 and 57·2% were among women aged 20-29. Causes of death included abortion (35·5%), other maternal causes (16·6%), suicide (13·6%), murder (12·5%), unclassified causes (11·6%), HIV/AIDS (7·9%), and accidents (3·2%). A total of 3659 children lost their mothers. INTERPRETATION Maternal death comprised the leading cause of FSW mortality in our sample. This methodology can be used by local governments and NGOs to identify unrecognized patterns and clusters of FSW deaths in near-real time and urgently steer targeted preventative strategies. FUNDING New Venture Fund.
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Affiliation(s)
- Brian Willis
- Global Health Promise, Portland, OR, United States
- Corresponding author.
| | - Emily Perttu
- Global Health Promise, Portland, OR, United States
| | - Meghan Fitzgerald
- Global Health Promise, Portland, OR, United States
- U.S. Overseas Cooperative Development Council, Washington DC, United States
| | - Heather Thompson
- Global Health Promise, Portland, OR, United States
- Schulich School of Medicine, McMaster Faculty of Medicine, Grey Bruce Health Services, Hamilton, Ontario, Canada
| | - Swarna Weerasinghe
- Global Health Promise, Portland, OR, United States
- Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Wendy Macias-Konstantopoulos
- Global Health Promise, Portland, OR, United States
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Dheresa M, Yadeta TA, Dingeta T, Shore H, Dessie Y, Daraje G, Tura AK. Why mothers die: Analysis of verbal autopsy data from Kersa Health and Demographic Surveillance System, Eastern Ethiopia. J Glob Health 2022; 12:04051. [PMID: 35976002 PMCID: PMC9302037 DOI: 10.7189/jogh.12.04051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Despite registering tremendous improvement as part of the Millennium Development Goals, Ethiopia has still one of the highest numbers of maternal mortality. Although maternal mortality is one of the commonest indicators for comparison or measuring progress, its measurement remained a challenge. In a situation where, vital registration is not in place and only few women gave birth in facilities, alternative data sources from population-based surveys are essential to describe maternal deaths. In this paper, we reported estimates of maternal mortality and causes in a predominantly rural setting in eastern Ethiopia. Methods Data were used from the ongoing prospective open cohort of Kersa Health and Demographic Surveillance System (HDSS), located in eastern Ethiopia. At enrolment, detailed sociodemographic and household conditions were recorded for every member, followed by household visit every six months to identify any vital events: births, deaths, and migration. Whenever a death was reported, additional information about the deceased - age, sex, pregnancy status, and perceived cause of deaths - were collected through interview of the closest family member(s). Then, the probable cause of death was assigned using an automated verbal autopsy system (InterVA). In this paper, we included all deaths among women during pregnancy, childbirth or within 42 days of termination of pregnancy. To describe the trends, we calculated annual maternal mortality ratio (MMR) along with their 95% Confidence Interval (CI). Results From 2008 to 2019, a total of 32 680 live births and 720 deaths among reproductive age women were registered. Of the 720 deaths, 158 (21.9%) were during pregnancy or within 42 days of termination of pregnancy, corresponding with an MMR of 484 per 100 000 live births. The three leading causes of deaths were pregnancy related sepsis, obstetric haemorrhage and anaemia of pregnancy. There was non-significant reduction in the MMR from 744 in 2008 to 665 in 2019, with three lowest ratios recorded in 2013 (172 per 100 000 live births), 2009 (280 per 100 000 live births) and 2016 (285 per 100 000 live births). Conclusions There was no significant decrement of MMR during the study period. Most deaths occurred at home from pregnancy related sepsis and haemorrhage implicating the unfinished agenda of ensuring skilled delivery and appropriate postnatal management.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Kersa Health and Demographic Surveillance Systems, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gamachis Daraje
- Kersa Health and Demographic Surveillance Systems, Harar, Ethiopia,Department of Statistics, College of Computing and Informatics, Haramaya University, Haramaya
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Dona A, Tulicha T, Arsicha A, Dabaro D. Factors influencing utilization of early postnatal care services among postpartum women in Yirgalem town, Sidama Regional State, Ethiopia. SAGE Open Med 2022; 10:20503121221088098. [PMID: 35342635 PMCID: PMC8943538 DOI: 10.1177/20503121221088098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Providing postnatal care services at right time could help to reduce maternal
and newborn deaths. Thus, this study aimed to assess the factors influencing
the utilization of early postnatal care services among postpartum women in
Yirgalem town, Sidama Regional State, Ethiopia. Methods: A community-based cross-sectional study was done using structured and
interviewer-administered questionnaires among randomly selected 306
postpartum women. Data were cleaned, coded, and entered into EpiData-3.1,
and exported to Statistical Package for Social Science-21 for analysis.
Descriptive statistics, bivariable, and multivariable logistic regression
analysis were done. A p-value ⩽ 0.05 was used to consider statistically
significant variables. Results: Generally, 202 (66.7%) visited a health facility for postpartum care. The
prevalence of early postnatal care service utilization was 45.5% (95%
confidence interval = 39.9–50.5). Mainly practiced services were physical
examination (37%) and family planning (31%) services. Having formal
education (adjusted odds ratio = 3.6; 95% confidence interval = 1.7–7.4),
having antenatal care (adjusted odds ratio = 3.5; 95% confidence
interval = 1.6–7.6), institutional delivery (adjusted odds ratio = 2.3; 95%
confidence interval = 1.2–4.7), and getting advice from healthcare provider
(adjusted odds ratio = 18.69; 95% confidence interval = 9.19–37.99) were
factors significantly associated with early postnatal care service
utilization. Conclusion: The practice of early postnatal care needs more attention in the study area.
Improving the educational status of the women, strengthening healthcare
providers’ counseling on the benefits of postnatal care, and inspiring
pregnant women to use antenatal care and institutional delivery services
will improve the use of postnatal care services on time.
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Affiliation(s)
- Aregahegn Dona
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Tsedeke Tulicha
- College of Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Admasu Arsicha
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Desalegn Dabaro
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
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Singh K, Li Q, Ahsan KZ, Curtis S, Weiss W. A comparison of approaches to measuring maternal mortality in Bangladesh, Mozambique, and Bolivia. Popul Health Metr 2022; 20:5. [PMID: 35033093 PMCID: PMC8760829 DOI: 10.1186/s12963-022-00281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background Many low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality. Objective The objective is to inform on potential options for measuring maternal mortality. Methods This paper uses a case study approach to compare methodologies and estimates of pregnancy-related mortality ratio (PRMR)/maternal mortality ratio (MMR) obtained from four different data sources from similar time periods in Bangladesh, Mozambique, and Bolivia—national population census; post-census mortality survey; household sample survey; and sample vital registration system (SVRS). Results For Bangladesh, PRMR from the 2011 census falls closely in line with the 2010 household survey and SVRS estimates, while SVRS’ MMR estimates are closer to the PRMR estimates obtained from the household survey. Mozambique's PRMR from household survey method is comparable and shows an upward trend between 1994 and 2011, whereas the post-census mortality survey estimated a higher MMR for 2007. Bolivia's DHS and post-census mortality survey also estimated comparable MMR during 1998–2003. Conclusions Overall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia. It also outlines recommendations to estimate maternal mortality based on the advantages and disadvantages of several approaches. Contribution Recommendations in this paper can help health administrators and policy planners in prioritizing investment for collecting reliable and contemporaneous estimates of maternal mortality while progressing toward a complete civil registration system. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-022-00281-8.
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Affiliation(s)
- Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Qingfeng Li
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Karar Zunaid Ahsan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sian Curtis
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William Weiss
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Public Health Institute, Oakland, CA, USA
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12
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Manik H, Triyoga RS, Siregar MFG, Rochadi RK, Poddar S. Sustainability in transformation of maternal mortality by interaction based approach in Dairi, Indonesia. J Public Health Res 2021; 10. [PMID: 34964570 PMCID: PMC9131488 DOI: 10.4081/jphr.2021.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Health and mortality problems are closely related to the maternal mortality
rate (MMR). Efforts to reduce MMR have been carried out by many countries,
including the Indonesian government. Design and Methods This research was conducted using two approaches, namely quantitative and
qualitative or mixed methods and 149 respondents and 26 informants, to
reduce MMR in Dairi Regency. This study was also carried out to determine
the dominant variable that affects mother's behavior in an effort to reduce
MMR in accordance with the existing theory. Result Mother's intention to contribute to the reduction of MMR in this study was
influenced by the good factor directly or indirectly. This is indicated by
the score p<0.005. The study also shows that it is very important for the
health workers to be able to communicate well with individuals and
communities. Conclusion The present study will help to reduce maternal fatalities, and will help to
build systems and processes that will allow control the behaviour of the
pregnant women and determine the cause of death as well as its contributing
factors.
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Affiliation(s)
- Henry Manik
- Faculty of Public Health, University of North Sumatra.
| | | | | | - R Kintoko Rochadi
- Faculty of Social Science and Political Science, University of North Sumatra.
| | - Sandeep Poddar
- Research and Innovation, Lincoln University College,Wisma Lincoln, Jalan, Petaling Jaya, Selangor.
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13
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Cahyanti RD, Widyawati W, Hakimi M. "Sharp downward, blunt upward": district maternal death audits' challenges to formulate evidence-based recommendations in Indonesia - a qualitative study. BMC Pregnancy Childbirth 2021; 21:730. [PMID: 34706687 PMCID: PMC8554828 DOI: 10.1186/s12884-021-04212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Indonesia, the largest archipelago globally with a decentralized health system, faces a stagnant high maternal mortality ratio (MMR). The disparity factors among regions and inequities in access have deterred the local assessments in preventing similar maternal deaths. This study explored the challenges of district maternal death audit (MDA) committees to provide evidence-based recommendations for local adaptive practices in reducing maternal mortality. Methods A qualitative study was conducted with four focus-group discussions in Central Java, Indonesia, between July and October 2019. Purposive sampling was used to select 7–8 members of each district audit committee. Data were analyzed using the thematic analysis approach. Triangulation was done by member checking, peer debriefing, and reviewing audit documentation. Results The district audit committees had significant challenges to develop appropriate recommendations and action plans, involving: 1) non-informative audit tool provides unreliable data for review; 2) unstandardized clinical indicators and the practice of “sharp downward, blunt upward”; 3) unaccountable hospital support and lack of leadership commitment, and 4) blaming culture, minimal training, and insufficient MDA committee’ skills. The district audit committees tended to associated maternal death in lower and higher-level health facilities (hospitals) with mismanagement and unavoidable cause, respectively. These unfavorable cultures discourage transparency and prevent continuing improvement, leading to failure in addressing maternal death’s local avoidable factors. Conclusion A productive MDA is required to provide an evidence-based recommendation. A strong partnership between the key hospital decision-makers and district health officers is needed for quality evidence-based policymaking and adaptive practice to prevent maternal death.
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Affiliation(s)
- Ratnasari D Cahyanti
- Obstetrics and Gynecology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia. .,Doctoral Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Widyawati Widyawati
- Pediatric and Maternity Nursing Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Obstetrics and Gynecology Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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14
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Chen L, Feng P, Shaver L, Wang Z. Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations. BMC Public Health 2021; 21:1536. [PMID: 34380436 PMCID: PMC8359022 DOI: 10.1186/s12889-021-11557-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. Methods Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991–2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. Results The yearly trends of the national, rural and urban maternal mortality ratio were − 2.290 (p < 0.01), − 3.167 (p < 0.01), and − 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = − 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). Conclusion China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.
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Affiliation(s)
- Lu Chen
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China
| | - Penghui Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lance Shaver
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Zengwu Wang
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China.
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15
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Musarandega R, Machekano R, Pattinson R, Munjanja SP. Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study. PLoS One 2021; 16:e0252106. [PMID: 34081727 PMCID: PMC8174727 DOI: 10.1371/journal.pone.0252106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe-an SSA country. METHODS In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007-2008 and 2018-2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. DISCUSSION This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007-2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Rhoderick Machekano
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robert Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, SAMRC Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa
| | - Stephen Peter Munjanja
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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16
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Koukoubanis K, Prodromidou A, Stamatakis E, Valsamidis D, Thomakos N. Role of Critical Care Units in the management of obstetric patients (Review). Biomed Rep 2021; 15:58. [PMID: 34007451 DOI: 10.3892/br.2021.1434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/19/2021] [Indexed: 11/06/2022] Open
Abstract
Pregnancy is considered a natural process for the majority of women. However, a limited proportion of pregnancies and deliveries can present with a broad variety of complications that may require admission to a Critical Care Unit (CCU). In the present review, the indications of admission of obstetrical and postpartum patients to CCUs were critically evaluated with a particular focus on the management of their complications. The management of critically ill obstetric patients remains challenging due to the physiological changes that occur during pregnancy, pregnancy-related diseases and the need to carefully consider the well-being of the fetus before any intervention can be recommended/performed. Indications for admission to CCUs include both obstetric and non-obstetric conditions that may require continuous monitoring and further interventions. Hypertensive disorders of pregnancy and mass hemorrhage are amongst the most common causes of admission to CCUs in pregnant and postpartum women. The establishment of a diagnostic and care algorithm based on the contribution of a multidisciplinary team is of critical importance to aid in the determination of which patients will require intensive care, and to assist in deciding what type of critical care each critically ill patients receives.
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Affiliation(s)
- Konstantinos Koukoubanis
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 'Alexandra' Hospital, 11528 Athens, Greece
| | - Anastasia Prodromidou
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 'Alexandra' Hospital, 11528 Athens, Greece
| | - Emmanouil Stamatakis
- Department of Anesthesiology and Pain Management, 'Alexandra' General Hospital of Athens, 11528 Athens, Greece
| | - Dimitrios Valsamidis
- Department of Anesthesiology and Pain Management, 'Alexandra' General Hospital of Athens, 11528 Athens, Greece
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 'Alexandra' Hospital, 11528 Athens, Greece
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17
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Musarandega R, Machekano R, Munjanja SP, Pattinson R. Methods used to measure maternal mortality in Sub-Saharan Africa from 1980 to 2020: A systematic literature review. Int J Gynaecol Obstet 2021; 156:206-215. [PMID: 33811639 DOI: 10.1002/ijgo.13695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gobally, Sub-Saharan Africa (SSA) has the largest maternal mortality burden, but the region lacks accurate data. OBJECTIVE To review methods historically used to measure maternal mortality in SSA to inform future study methods. SEARCH STRATEGY We searched databases: PubMed, Medline, WorldCat and CINHAL, using keywords "maternal mortality," "pregnancy-related death," "reproductive age mortality," "ratio," "rate," and "risk," using Boolean operators "OR" and "AND" to combine the search terms. SELECTION CRITERIA We searched for empirical and analytical studies that: (1) measured maternal mortality levels, (2) were in SSA, (3) reported original results, and (4) were not duplicate studies. We included studies published in English since 1980. DATA COLLECTION AND ANALYSIS We screened the studies using titles and abstracts, reading the full text of selected studies. We analyzed the estimates and strengths, and limitations of the methods. MAIN RESULTS We identified 96 studies that used nine methods: demographic surveillance (n = 4), health record reviews (n = 18), confidential enquiries and maternal death surveillance and response (n = 7), prospective cohort (n = 9), reproductive age mortality survey (RAMOS) (n = 6), sisterhood method (n = 35), mixed methods (n = 4), and mathematical modeling (n = 13). CONCLUSION Sisterhood method studies and RAMOS studies that combined institutional records and community data produced maternal mortality ratios more comparable with WHO estimates.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rhoderick Machekano
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen Peter Munjanja
- Obstetrics and Gynaecology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Robert Pattinson
- Maternal, Fetal, Newborn & Child Health Care Strategies Research Centre, University of Pretoria, Pretoria, South Africa
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18
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Bauserman M, Thorsten VR, Nolen TL, Patterson J, Lokangaka A, Tshefu A, Patel AB, Hibberd PL, Garces AL, Figueroa L, Krebs NF, Esamai F, Nyongesa P, Liechty EA, Carlo WA, Chomba E, Goudar SS, Kavi A, Derman RJ, Saleem S, Jessani S, Billah SM, Koso-Thomas M, McClure EM, Goldenberg RL, Bose C. Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends. Reprod Health 2020; 17:173. [PMID: 33334343 PMCID: PMC7745363 DOI: 10.1186/s12978-020-00990-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. METHODS We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. RESULTS We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. CONCLUSIONS The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. TRIAL REGISTRATION The MNHR is registered at NCT01073475 .
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Affiliation(s)
- Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA.
| | | | | | - Jackie Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, India
- Adjunct Faculty Medical Research, Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | | | | | | | - Sk Masum Billah
- Maternal and Child Health Division (icddr, b), Dhaka, Bangladesh
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
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19
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Kabuya JBB, Mataka A, Chongo G, Kamavu LK, Chola PN, Manyando C, De Brouwere V, Ippolito MM. Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study. Int J Equity Health 2020; 19:119. [PMID: 32646431 PMCID: PMC7350714 DOI: 10.1186/s12939-020-01185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Maternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed the impact of an [MDR program] at a district-level hospital in rural Zambia. Methods We conducted a mixed methods convergent study using hospital data on maternal mortality and audit reports of 106 maternal deaths from 2007 to 2011. To evaluate the overall impact of MDR on maternal mortality, we compared baseline (2007) to late (2010–11) post-intervention inpatient maternal mortality indicators. MDR committee reports were coded and dominant themes were extracted in a qualitative analysis. We assessed potential risk factors for maternal mortality in a before-and-after design comparing the periods 2008–09 and 2010–11. Results In-hospital maternal mortality declined from 23 per thousand live births in 2007 to 8 per thousand in 2010–11 (P < 0.01). Maternal case fatality for puerperal sepsis and uterine rupture decreased significantly from 63 and 32% in 2007 to 10 and 9% in 2010–11 (P < 0.01). No significant reduction was seen in case fatality due to postpartum hemorrhage. Qualitative analysis of risk factors for maternal mortality revealed four core themes: standards of practice, health systems, accessibility, and patient factors. Specific risk factors included delayed referral, missed diagnoses, intra-hospital delays in care, low medication inventory, and medical error. We found no statistically significant differences in the prevalence of risk factors between the before-and-after periods. Conclusions Implementation of MDR was accompanied by a significant decrease in maternal mortality with reductions in maternal death from puerperal sepsis and uterine rupture, but not postpartum hemorrhage. Qualitative analysis of audit reports identified several modifiable risk factors within four core areas. Comparisons of potential explanatory factors did not show any differences over time. These results imply that MDR offers a means for hospitals to curtail maternal deaths, except deaths due to postpartum hemorrhage, suggesting additional interventions are needed. Documentation of MDR meetings provides an instrument to guide further quality improvements.
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Affiliation(s)
| | | | | | | | | | - Christine Manyando
- Department of Public Health, Tropical Diseases Research Centre, Ndola, Zambia
| | - Vincent De Brouwere
- Unit of Health Services Organization, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Matthew M Ippolito
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Alba S, Sondorp E, Kleipool E, Yadav RS, Rahim AS, Juszkiewicz KT, Burnham G. Estimating maternal mortality: what have we learned from 16 years of surveys in Afghanistan? BMJ Glob Health 2020; 5:e002126. [PMID: 32371572 PMCID: PMC7228470 DOI: 10.1136/bmjgh-2019-002126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sandra Alba
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Egbert Sondorp
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | | | | | - Arab S Rahim
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | | | - Gilbert Burnham
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Berdzuli N, Lomia N, Staff AC, Kereselidze M, Lazdane G, Jacobsen AF. Maternal Mortality in Georgia: Incidence, Causes and Level of Underreporting: A National Reproductive Age Mortality Study 2014. Int J Womens Health 2020; 12:277-286. [PMID: 32308502 PMCID: PMC7154943 DOI: 10.2147/ijwh.s227349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Accurate data on maternal mortality are essential for assessing progress towards Sustainable Development Goals (SDG).The aim of the study was to determine the incidence and causes of maternal deaths in Georgia, then explore the potential for improvement of quality of maternal health care. The study’s secondary aims were to identify the level of underreporting of maternal deaths in Georgian vital statistics over 1 year (2012) and to compare these results with previous data from 2006. The study findings allow to support the country in developing evidence-based policies and tracking progress towards meeting SDG targets. Methods A national Reproductive Age Mortality Survey (RAMOS) was conducted in Georgia in 2014–15. Multiple data sources were used to identify deaths of women aged 15–49 years between January and December 2012. All deaths in women of reproductive age were investigated through verbal autopsy (VA) diagnoses. Deaths in women during pregnancy or one-year postpartum were further investigated by conducting interviews and medical record reviews at the last medical facility which provided health care for the woman during her fatal condition. A specialist panel reviewed these cases and assigned underlining causes of deaths. Results We found that 98% of deaths among women of reproductive age were registered by Georgia's civil registration and vital statistics system (CRVS). A total of 918 deaths met the study inclusion criteria. Thirty-six (4.1%) women died during pregnancy or within one-year postpartum. Among these 36 deaths, 23 (63.8%) were maternal deaths, 15 early (either during pregnancy or 42 days postpartum) and eight late (43–365 days postpartum) deaths (65.2% vs 34.8%). The remaining 13 of 36 deaths were coincidental deaths. Fourteen maternal deaths were reported by official statistics and nine deaths were not included in these statistics. Thus, the underreporting rate was 39%. Direct obstetric causes accounted for 73.9% (n=17) of maternal deaths, whereas 26.1% (n=6) were indirect. The leading causes of direct maternal deaths were infection (21.7%), hemorrhage (17.4%), pulmonary embolism (13.0%), and pregnancy-induced hypertension (8.7%). The RAMOS study calculated a maternal mortality ratio (early maternal deaths) of 26.3 per 100,000 live births compared with the official figure of 22.8 per 100,000 live births. Discussions Registration of early maternal deaths significantly improved since last survey in 2008, while indirect and late maternal deaths continue to be unrecognized, as reflected in official Georgian statistics. The difference between RAMOS study findings and officially reported maternal mortality rates is minimal, showing improvements in detection of maternal deaths by the national maternal mortality surveillance system. The greatest number of direct obstetric deaths occur in the first week postpartum, which likely reflects deficiencies in quality of care.
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Affiliation(s)
- Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Diseases Control and Public Health, Tbilisi, Georgia
| | | | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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22
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van den Broek N. Happy Mother's Day? Maternal and neonatal mortality and morbidity in low- and middle-income countries. Int Health 2019; 11:353-357. [PMID: 31529113 PMCID: PMC6748767 DOI: 10.1093/inthealth/ihz058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
At least 800 women die each day during pregnancy or birth and more than 15 000 babies each day are stillborn or die in the first month of life. Almost all of these deaths occur in low- and middle-income countries. Many more women and babies are known to suffer morbidity as a result of pregnancy and childbirth. However, reliable estimates of the burden of physical, psychological and social morbidity and comorbidity during and after pregnancy are not available. Although there is no single intervention or ‘magic bullet’ that would reduce mortality and improve health, there are evidence-based care packages which are defined and agreed internationally. A functioning health system with care available and accessible for everyone at all times is required to ensure women and babies survive and thrive.
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Affiliation(s)
- Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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