Abstract
BackgroundWhile progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala.MethodsWe conducted a prospective study in the Western Highlands of Guatemala from 2010 through 2013, enrolling women during pregnancy with follow-up through 42-days postpartum. All pregnant women were identified and enrolled by study staff in the clusters in the Chimaltenango region for which we had 4 years of data. Enrolment usually occurred during the antenatal period; women were also visited following delivery and 42-days postpartum to collect outcomes. Measures of antenatal and delivery care were also obtained.ResultsApproximately four thousand women were enrolled annually (3,869 in 2010 to 4,570 in 2013). The stillbirth rate decreased significantly, from 22.0 per 1000 births (95% CI 16.6, 29.0) in 2010 to 16.7 (95% CI 13.5, 20.6) in 2013 (p-value 0.0223). The perinatal mortality rate decreased from 43.9 per 1,000 births (95% CI 36.0, 53.6) to 31.6 (95% CI 27.2, 36.7) (p-value 0.0003). The 28-day neonatal mortality rate decreased from 28.9 per 1000 live births (95% CI 25.2, 33.2) to 21.7 (95% CI 17.5, 26.9), p-value 0.0004. The maternal mortality rate was 134 per 100,000 in 2010 vs. 113 per 100,000 in 2013. Over the same period, hospital birth rates increased from 30.0 to 50.3%.ConclusionsIn a relatively short time period, significant improvements in neonatal, fetal and perinatal mortality were noted in an area of Guatemala with a history of poor pregnancy outcomes. These changes were temporally related to major increases in hospital-based delivery with skilled birth attendants, as well as improvements in the quality of delivery care, neonatal care, and prenatal care.
Highlights
While progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala
Each year, families in low and middle income (LMIC) countries face the death of approximately 4 million newborns, 3 million fetuses and 300,000 pregnant women (99% of those that occur worldwide) [1,2,3,4]
Millennium Development Goal 4 (MDG4), which called for a twothirds reduction in child mortality by 2015, depended in large part on the reduction of neonatal deaths, which made up 37% of child mortality in 1990 and 42% in 2014 [1,5]
Summary
While progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala. The main causes of stillbirths are asphyxia due to obstructed labor, placental abruption, preclampsia or eclampsia and umbilical cord complications [7]. Despite their high frequency, stillbirths were not included in the MDGs or in the Countdown to 2015 and are often not considered when pregnancy outcomes are reported from LMIC [12,13]. Stillbirths were not included in the MDGs or in the Countdown to 2015 and are often not considered when pregnancy outcomes are reported from LMIC [12,13] Because of their common causality, interventions that reduce stillbirths frequently reduce maternal and neonatal mortality [12]
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