Abstract
IntroductionMaternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand.Methods and FindingsAll medical records from women who attended the Shoklo Malaria Research Unit antenatal clinics from 12th May 1986 to 31st December 2010 were reviewed, and maternal death records were analyzed for causality. There were 71 pregnancy-related deaths recorded amongst 50,981 women who attended antenatal care at least once. Three were suicide and excluded from the analysis as incidental deaths. The estimated maternal mortality ratio (MMR) overall was 184 (95%CI 150–230) per 100,000 live births. In camps for displaced persons there has been a six-fold decline in the MMR from 499 (95%CI 200–780) in 1986–90 to 79 (40–170) in 2006–10, p<0.05. In migrants from adjacent Myanmar the decline in MMR was less significant: 588 (100–3260) to 252 (150–430) from 1996–2000 to 2006–2010. Mortality from P.falciparum malaria in pregnancy dropped sharply with the introduction of systematic screening and treatment and continued to decline with the reduction in the incidence of malaria in the communities. P.vivax was not a cause of maternal death in this population. Infection (non-puerperal sepsis and P.falciparum malaria) accounted for 39.7 (27/68) % of all deaths.ConclusionsFrequent antenatal clinic screening allows early detection and treatment of falciparum malaria and substantially reduces maternal mortality from P.falciparum malaria. No significant decline has been observed in deaths from sepsis or other causes in refugee and migrant women on the Thai–Myanmar border.
Highlights
Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas
The development of an ‘‘action for survival’’ program dedicated to the care of pregnant women with malaria resulted in a dramatic reduction in maternal deaths from 341 to 54/100,000 live births from 1981 to 1986
Between the 12th May 1986 and 31st December 2010 there were 71 maternal deaths recorded amongst 50,982 women who attended antenatal care at Shoklo Malaria Research Unit (SMRU) at least once
Summary
Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand. Thailand has a population of over 60 million It has experienced significant improvements in population health and a decline in maternal and child mortality. [5,6] The relatively low maternal mortality ratio [95%CI] (per live births) in Thailand: 50 [31–78], 63 [41–89] and 48 [32–68], in 1990, 2000 and 2008, contrasts with estimates from Thailand’s western neighbor, Myanmar: 420 [23–470], 290 [170– 510] and 240 [140–410], in the same years [7]. The development of an ‘‘action for survival’’ program dedicated to the care of pregnant women with malaria resulted in a dramatic reduction in maternal deaths from 341 to 54/100,000 live births from 1981 to 1986. [8] In 2008, the malaria attributable maternal mortalities in Thailand and Myanmar were 0.4 [0.1–0.9] and 34 [17–56] per 100,000, respectively [7]
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