Abstract
BackgroundBecause large, prospective, population-based data sets describing maternal outcomes are typically not available in low- and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality. Early identification of risk factors is essential to develop comprehensive intervention strategies preventing pregnancy-related complications. Our objective was to describe maternal mortality rates in a large, multi-country dataset and to determine maternal, pregnancy-related, delivery and postpartum characteristics that are associated with maternal mortality.MethodsWe collected data describing all pregnancies from 2010 to 2013 among women enrolled in the multi-national Global Network for Women’s and Children’s Health Research Maternal and Neonatal Health Registry (MNHR). We reported the proportion of mothers who died per pregnancy and the maternal mortality ratio (MMR). Generalized linear models were used to evaluate the relationship of potential medical and social factors and maternal mortality and to develop point and interval estimates of relative risk associated with these factors. Generalized estimating equations were used to account for the correlation of outcomes within cluster to develop appropriate confidence intervals.ResultsWe recorded 277,736 pregnancies and 402 maternal deaths for an MMR of 153/100,000 live births. We observed an improvement in the total MMR from 166 in 2010 to 126 in 2013. The MMR in Latin American sites (91) was lower than the MMR in Asian (178) and African sites (125). When adjusted for study site and the other variables, no formal education (RR 3.2 [1.5, 6.9]), primary education only (RR 3.4 [1.6, 7.5]), secondary education only (RR 2.5 [1.1, 5.7]), lack of antenatal care (RR 1.8 [1.2, 2.5]), caesarean section delivery (RR 1.9 [1.3, 2.8]), hemorrhage (RR 3.3 [2.2, 5.1]), and hypertensive disorders (RR 7.4 [5.2, 10.4]) were associated with higher risks of death.ConclusionsThe MNHR identified preventable causes of maternal mortality in diverse settings in low- and middle-income countries. The MNHR can be used to monitor public health strategies and determine their association with reducing maternal mortality.Trial Registrationclinicaltrials.gov NCT01073475
Highlights
Because large, prospective, population-based data sets describing maternal outcomes are typically not available in low- and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality
In addition to the relatively small numbers of maternal deaths, many reports are limited to women who were treated in facilities, which might underrepresent mortality due to deaths that occur at home or outside of a health care facility
Data were collected from women who resided within study clusters through a combination of methods, including abstraction of medical records and by a series of interviews conducted by trained study staff
Summary
Prospective, population-based data sets describing maternal outcomes are typically not available in low- and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality. More than 99% of the women who die from pregnancyrelated complications live in low- and middle-income countries where systematic data collection is of variable quality [1,2,3,4] In these countries, most data sets are incomplete or record small numbers of deaths. In addition to the relatively small numbers of maternal deaths, many reports are limited to women who were treated in facilities, which might underrepresent mortality due to deaths that occur at home or outside of a health care facility They misclassify maternal death as that being attributable to causes other than pregnancy-related causes [5,6,7,8]. Maternal mortality rates will not be reduced without comprehensive intervention strategies that include monitoring of risk factors shown to be associated with maternal mortality [11,12]
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