Assessing Maternal Morbidity in India, Pakistan, Kenya and Malawi.

Abstract

Title Assessing Maternal Morbidity in India, Pakistan, Kenya and Malawi. Background For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low- and middle-income countries. The PhD study sought to assess the extent and type of maternal morbidity in these settings. Methods A descriptive observational cross-sectional study was conducted to assess physical (infectious and medical/obstetric), psychological and social morbidity. Socio-demographic factors, education, socioeconomic status, reported symptoms, clinical examination and laboratory investigations, quality of life, and satisfaction with health were assessed. Relationships between morbidity and maternal characteristics were investigated using logistic regression analysis. Findings 11454 women were assessed in India (2099), Malawi (2923), Kenya (3145), and Pakistan (3287). Almost 3 out of 4 women had ≥1 symptom (73.5%), abnormalities on clinical examination (71.3%) or laboratory investigation (73.5%). In total, 9.0% of women had an identified infectious disease (HIV, malaria, syphilis or chest infection) and 23.1% had signs of early sepsis with an identifiable source of infection in 43%. HIV positive status was highest in Malawi (14.5%) as was malaria (10.4%). Overall, 47.9% of women were anaemic, 11.5% had other medical or obstetric conditions, 25.1% psychological and 36.6% social morbidity. Infectious morbidity was highest in Malawi (40.5%) and Kenya (38.5%), psychological and social morbidity was highest in Pakistan (47.3%, 60.2%). Morbidity was not limited to a core at risk group; only 1.2% had a combination of all four morbidities. Age, socioeconomic status, educational, previous pregnancies, and adverse maternal or neonatal outcomes were associated with different types of morbidity per country, but there was no consistent direction of strength of association. For each country, women with medical/obstetric morbidity was more likely to report psychological and infectious morbidity, apart from Malawi. Women with an infectious morbidity were more likely to report medical/obstetric, psychological and social morbidity in Pakistan and Malawi. Women with psychological morbidity were more likely to report social morbidity in Pakistan and Kenya. Conclusion Despite women reporting that they have a good quality of life and are satisfied with their health, there is evidence of a significant burden of infectious, medical/obstetric, psychological, and social morbidity in women during and after pregnancy. At present available antenatal and postnatal care packages do not include comprehensive screening for all forms of ill-health. This study demonstrates that women have health needs, beyond simply the physical aspects of health and includes psychological and social well-being. To ensure all women have the right to the highest attainable standard of health and well-being, current antenatal and postnatal care packages need to be adapted and improved to provide comprehensive, holistic care in a way that meets a woman’s health needs.