Self-reported maternal morbidity: Results from the community level interventions for pre-eclampsia (CLIP) baseline survey in Sindh, Pakistan.

Sana Sheikh,Imran Ahmed,Laura Magee,Peter Von Dadelszen,Zulfiqar Bhutta,Diane Sawchuck,Tang Lee,Rahat Najam Qureshi,Beth A Payne,Marianne Vidler,Javed Memon,Farrukh Raza

doi:10.1016/j.preghy.2019.05.016

Abstract

Community-based data regarding maternal and perinatal morbidity and mortality are scarce in less-developed countries. The aim of the study was to collect representative community-level demographic health information to provide socio-demographic and health outcome data. A retrospective household survey of women of reproductive age (15-49 years) living in two districts of Sindh Province, Pakistan was conducted. Pregnancy incidence over the past 12 months and during each woman's lifetime; maternal, fetal, infant and child deaths in the past 12 months; and rates of hypertension and seizures in pregnancy were calculated. From June to September 2013, 88,410 households were surveyed with 1.2 (±0.6) women of reproductive age per household. 19,584 women (11.9%) reported pregnancies in the preceding 12 months; 83.0% had live births, 3.5% resulting in stillbirths and 13.6% in miscarriages. 34.2% of deliveries occurred at home. Out of all women who reported a pregnancy in past 12 months, 62.1% reported high blood pressure and 11.9% reported seizures complicating her most recent pregnancy. Blood pressure was not measured during survey to confirm hypertension. The perinatal, neonatal and maternal mortality ratios were 64.7/1000, 39/1000 and 166/100,000 livebirths, respectively. This study estimated population-level mortality ratios that can be used for the planning of health interventions in these regions. Self-reported pregnancy hypertension and seizures was inaccurate, reflecting limited community understanding of these disorders. Mortality estimates are comparable to those reported by the World Health Organization for maternal mortality ratio and neonatal mortality rate of 170/100,000 and 36/1000 live births, respectively.

Highlights

Reliable data regarding maternal, newborn and child health are scarce in low- and middle-income countries (LMIC)
In the absence of robust health information and vital registration systems, these findings provide first hand community-derived population demographics, morbidity and mortality estimates in married women of reproductive age (MWRA) and children in Sindh, Pakistan
Despite an established health information system there is a lack of quality vital statistics available in Sindh [5,6]

Summary

Introduction

Newborn and child health are scarce in low- and middle-income countries (LMIC). Many countries with a high burden of maternal morbidity and mortality do not have reliable vital statistics systems [1]. Pakistan has an inefficient civil registration system and a high estimated maternal mortality ratio (MMR) (170/100,000 live births) [2]. In the early 90s the Ministry of Health (MoH) established a Health Management Information System (HMIS) to inform planning, management and monitoring of health facilities to improve service delivery [3]. In 2007 this system was modified as the District Health Information System (DHIS) with wider scope and a revision of data collection indicators, tools and software. The aim of DHIS was to collect precise and timely data from health facilities to district health offices to set health priorities and allocate resource [4]. Exploration of use of HMIS/DHIS revealed that data quality was poor and was not efficiently used for decision-making or dissemination [3,5,6]

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Conclusion