Abstract
BackgroundNo systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization.MethodsA systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables.ResultsAmongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran.ConclusionsThis study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities.
Highlights
No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran
The results of this review study highlighted the importance of attention toward the causes of maternal deaths in Iran with higher proportions
This study summarized the results of analyses examined the association between maternal mortality and characteristics of the mothers in Iran, and indicated that gravidity, type of delivery, period of death, socioeconomic status of mothers, place of birth and death, and utilization of maternity care are associated with death
Summary
The Maternal Mortality Ratio (MMR; number of maternal deaths per 100,000 livebirths), is an important public health indicator that reflects both the quality of health care services and the women’s status and importance in their society [3, 4]. MDG5 focused on improving maternal health with two clear sub-goals, first, a 75% reduction in the maternal mortality ratio between 1990 and 2015 and second, to obtain universal access to reproductive health for women. Despite a global trend of declining maternal mortality, most of the countries have been behind to achieve their MDG targets by 2015 [3]. There is evidence that, despite the considerable decline in MMR in the world, it has arisen from the risks attributable to pregnancy and childbirth as well as from the poor quality care of health services, which needs serious attention [9]
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