Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial's Baseline Study Results.

Mrutynjaya B Bellad,Peter Von Dadelszen,Clip Working Group ,Laura Magee,Laura Magee,Beth Payne,Ashalata Mallapur,Umesh Ramadurg,Narayan V Honnungar,Laura Magee,Marianne Vidler,Sumedha Sharma,Chandrashekhar Karadiguddi,Tang Lee,Peter Von Dadelszen,Geetanjali Katageri,Laura Magee,Shashidhar Bannale,Jing Li,Richard Derman,Shivaprasad S Goudar,Umesh Charanthimath,Avinash Kavi

doi:10.1371/journal.pone.0166623

Abstract

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)–Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013–2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women’s and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013–2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013–14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.

Highlights

Maternal and newborn mortality place significant burden on fragile health systems with 303,000 global maternal deaths annually [1]
Maternal mortality has decreased significantly across India with an estimated maternal mortality ratio (MMR) of 174 per 100,000 livebirths [139–217] in 2015, and an annual rate of reduction of 4.6% between 2000 and 2015[1]; progress has varied by region
Chronic hypertension is strongly associated with pre-eclampsia and eclampsia, which in turn, may be responsible for maternal deaths related to other conditions: renal and hepatic disease, anaemia and systemic infections or sepsis [3, 4]

Summary

Introduction

Maternal and newborn mortality place significant burden on fragile health systems with 303,000 global maternal deaths annually [1]. The major causes of maternal death and morbidity globally are haemorrhage, the hypertensive disorders of pregnancy, and sepsis [3]. Chronic hypertension is strongly associated with pre-eclampsia and eclampsia, which in turn, may be responsible for maternal deaths related to other conditions: renal and hepatic disease, anaemia and systemic infections or sepsis [3, 4]. Comprehensive epidemiological data on maternal and perinatal mortality and morbidity are often missing from low- and middle-income countries (LMIC), from rural areas. Existing health registration systems in India have been unable to reliably capture all pregnancies and outcomes, in rural areas where most Indians live [5]. The inequities between health outcomes in urban and rural areas may be responsible for a difference in maternal mortality of 132%, as suggested by the Government of India National Family Health Survey (NFHS II, 1998–1999) [6]

Results

Discussion

Conclusion