Temporal evolution and spatial distribution of maternal death

Contributing factors for reduction in maternal mortality ratio in India

Maternal mortality ratio (MMR) estimates have been studied over time for understanding its variation across the country. However, it is never sufficient without accounting for presence of variability across in terms of space, time, maternal and system level factors. The study endeavours to estimate and quantify the effect of exposures encompassing all maternal health indicators and system level indicators along with space-time effects influencing MMR in India. Using the most recent level of possible -factors of MMR, maternal health indicators from the National Family Health Survey (NFHS: 2019-21) and system level indicators from government reports a heatmap compared the relative performance of all 19 SRS states. Facet plots with a regression line was utilised for studying patterns of MMR for different states in one frame. Using Bayesian Spatio-temporal random effects, evidence for different MMR patterns and quantification of spatial risks among individual states was produced using estimates of MMR from SRS reports (2014-2020). India has witnessed a decline in MMR, and for the majority of the states, this drop is linear. Few states exhibit cyclical trend such as increasing trends for Haryana and West Bengal which was evident from the two analytical models i.e., facet plots and Bayesian spatio- temporal model. Period of major transition in MMR levels which was common to all states is identified as 2009-2013. Bihar and Assam have estimated posterior probabilities for spatial risk that are relatively greater than other SRS states and are classified as hot spots. More than the individual level factors, health system factors account for a greater reduction in MMR. For more robust findings district level reliable estimates are required. As evident from our study the two most strong health system influencers for reducing MMR in India are Institutional delivery and Skilled birth attendance.

Will Brazil comply with the SDG 3.1 of the 2030 Agenda? An analysis of maternal mortality, from 1996 to 2018

This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.

Polycystic Ovary Syndrome and Endometriosis as Reasons for Women's Admission to Outpatient Specialist Care in Poland-A Retrospective Analysis

This study aimed at presenting selected aspects of outpatient specialist care for women diagnosed with polycystic ovary syndrome (PCOS) or endometriosis. The study was carried out using a retrospective analysis of the services provided under Outpatient Specialist Care (AOS) for women, based on data from the National Health Fund (NFZ). The study included data on women with PCOS or endometriosis based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in Poland from 2016 to 2018. The average age of women in the study group with PCOS was 25.31 (±7.02) years and, for those with endometriosis, 38.21 (±10.79). AOS patients with diagnosed PCOS most often made 2–3 visits (34.60%) to a specialist doctor, and those with diagnosed endometriosis most often made one visit (39.95%). Significant differences between patients with PCOS and endometriosis using AOS were found concerning the women’s age, the year, season, place of treatment, type of clinic, mode of admission, number of visits, and their place of residence or macroregion. With increasing age, women with PCOS made more visits to AOS, and women with endometriosis made fewer visits to the AOS specialist.

Severe Acute Respiratory Syndrome by COVID-19 in pregnant and postpartum women

Abstract Objectives: to evaluate the morbidity and mortality profile and factors associated with death due to severe acute respiratory syndrome (SARS) by COVID-19 in pregnant and postpartum women. Methods: this is a quantitative and retrospective research that analyzed the SIVEP-gripe Database (Influenza Epidemiological Surveillance Information System), from 01/01/2020 to 04/01/2021. All pregnant women and postpartum women diagnosed with SARS caused by COVID-19 in the State of Minas Gerais were included. After the descriptive analysis of the hospitalizations profile, the association between different exposure variables and the occurrence of death was evaluated. Results: of the 227 records obtained, 94.3% required hospitalization. Among hospitalizations in the Intensive Care Unit, 29.8% used invasive ventilatory support. Fifteen deaths were recorded. The most frequent clinical manifestations were: cough and fever; the predominant comorbidities were cardiovascular disease and diabetes mellitus. The variables “ICU stay”, “use of ventilatory support” and “heart disease” were associated with the occurrence of deaths. Conclusions: hospitalization was necessary for most pregnant women with SARS and the presence of previous heart disease increased the risk of death. Knowing the SARS morbidity and mortality profile is important in the definition of public health strategies aimed at reducing the impacts of COVID-19 during pregnancy and the puerperium.

Maternal mortality according to race/skin color in Mato Grosso do Sul, Brazil, from 2010 to 2015

Abstract Objectives: to investigate the epidemiological profile, by race/skin color, of maternal deaths in the state of Mato Grosso do Sul, Brazil. Methods: the present epidemiological study of maternal death distribution by race/skin color was based on data extracted from Brazilian mortality and livebirth information systems from 2010 to 2015. The maternal mortality ratio and the specific maternal mortality ratio were calculated and analyzed according to obstetric variables. Results: the death risk for black (RR = 4.3, CI95%= 2.088.71) and indigenous women (RR = 3.7, CI95% 2.26.23) was approximately fourfold in comparison to the risk for white women. For direct causes of death, the state of Mato Grosso do Sul showed higher levels, 74.1%, as well as for most races/skin colors in the first triennium. The specific maternal mortality ratio was higher among black and indigenous women aged30 to 39 years old (416.7 and 651.8, respectively) per 100,000 live births (p<0.05). Conclusions: higher maternal mortality ratio for indigenous and black women and the predominance of deaths related to direct obstetric causes among race/skin color categories reflect inadequate health care during pregnancy and puerperium.

Vigilância do óbito como indicador da qualidade da atenção à saúde da mulher e da criança

Resumo Objetivamos avaliar a implementação de uma rede regional de vigilância do óbito, refletindo sobre desafios e potencialidades de atuação enquanto observatório da violência contra a mulher. A pesquisa envolveu nove municípios de uma região de saúde da Zona da Mata de Minas Gerais. Acompanhamos reuniões do comitê regional de vigilância do óbito e realizamos entrevistas semiestruturadas com seus profissionais e com gestores municipais de saúde. Também analisamos informações sobre investigações realizadas e, para um município, analisamos de forma integrada notificações de óbito e de casos de violência contra a mulher. Os resultados apontam dificuldades como: falta de reconhecimento da atividade de vigilância do óbito; sobrecarga de trabalho; comunicação falha entre instituições e precariedade de recursos, infraestrutura e capacitação profissional. Também foram relatados avanços: maior interação entre municípios, crescimento das investigações e conscientização da importância da vigilância do óbito entre os/as trabalhadores/as. Identificamos, com as investigações dos óbitos, casos de violência doméstica, obstétrica e institucional. A vivência enquanto comitê regional amplia o fortalecimento da vigilância dos óbitos e da rede de atenção às mulheres em situação de violência.

Factors associated with maternal death in an intensive care unit

Objective

To identify factors associated with maternal death in patients admitted to an intensive care unit.

Methods

A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis.

Results

A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65).

Conclusion

The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death.

Space-time patterns in maternal and mother mortality in a rural South African population with high HIV prevalence (2000-2014): results from a population-based cohort

Background

International organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA) significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective.

Methods

Population-based mortality data from 2000 to 2014 for women aged 15–49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and ‘Mother death’; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time.

Results

The overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a significant spatial cluster of mother deaths in childhood (p = 0.022) in a peri-urban community near the national road. Based on our multivariable logistic regression model, HIV positive status (Adjusted odds ratio [aOR] = 2.5, CI 95%: [1.5–4.2]; primary education or less (aOR = 1.97, CI 95%: [1.04–3.74]) and parity (aOR = 1.42, CI 95%: [1.24–1.63]) were significant predictors of maternal mortality.

Conclusions

There has been an overall decrease in maternal and mother death between 2000 and 2014. The identification of a clear cluster of mother deaths shows the possibility of targeting intervention programs in vulnerable communities, as population-wide interventions may be ineffective and too costly to implement.

Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012

OBJECTIVE

Maternal and neonatal mortality are important public health issues in low-income countries. This study evaluated spatial and temporal maternal and neonatal mortality trends in Brazil between 1997 and 2012.

METHODS

This study employed spatial analysis techniques using death records from the mortality information system. Maternal mortality rates per 100,000 and neonatal mortality rates (early and late) per 1000 live births were calculated by state, region, and period (1997-2000, 2001-2004, 2005-2008, and 2009-2012). Multivariate negative binomial models were used to explain the risk of death.

RESULTS

The mean Brazilian maternal mortality rate was 55.63/100,000 for the entire 1997-2012 period. The rate fell 10% from 1997-2000 (58.92/100,000) to 2001-2004 (52.77/100,000), but later increased 11% during 2009-2012 (58.69/100,000). Early and late neonatal mortality rates fell 33% (to 7.36/1000) and 21% (to 2.29/1000), respectively, during the 1997-2012 period. Every Brazilian region witnessed a drop in neonatal mortality rates. However, maternal mortality increased in the Northeast, North, and Southeast regions.

CONCLUSION

Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals. Public policies and intersectoral efforts may contribute to improvements in these health indicators.

Fertility rates among very young adolescent women: temporal and spatial trends in Brazil

BACKGROUND

We assessed whether the reported decrease in fertility rates among 15 to 19 years old Brazilian adolescents has met with a parallel decrease in very young adolescent (10 to 14 years old) fertility rates. So we explored temporal trends for fertility rates among very young adolescents between 2000 and 2012 for Brazil as a whole, its regions and states; and also analyzed the spatial distribution of fertility rates among Brazilian municipalities in the years 2000 and 2012.

METHODS

We used data from the Information System on Live Births to calculate the rates. To examine the temporal trends, we used linear regression for time series with Prais-Winsten estimation, including the annual percentage change, for the country, regions, and states. To analyze the spatial distribution among Brazilian municipalities, we calculated the Global Moran Index and created a local Moran significance and cluster map through Local Indicators of Spatial Association (LISA). We also elaborated a thematic map with the rates using empirical Bayesian estimation.

RESULTS

Brazilian very young adolescent fertility rates remained high and stable throughout the 2000 to 2012 period, and significantly decreased in three out of 26 states, and in the federal district. On the other hand, an increase was observed in two Northern and Northeastern states. The rates were spatially dependent in Brazilian municipalities (Moran Index = 0.22 in 2012; p = 0.05). The maps indicated a heterogeneous distribution of the rates, with high-rate clusters predominant in the North and low-rate clusters predominant in the South, Southeast, and Midwest.

CONCLUSIONS

Our findings indicate that Brazilian very young adolescent fertility rates have not decreased in parallel with adolescent fertility rates as they remain high and did not decrease from 2000 and 2012, even though a few states presented a decrease. Thus, these phenomena probably have distinct underlying causes that warrant further elucidation. Progress in this field is crucial for the development of specific policies and programs focused on very young adolescents.