Decline In Maternal Mortality Ratio Research Articles

Antenatal care services in Yobe state Nigeria: The determinants and interventions to increase utilization

Introduction: Maternal and perinatal mortality are global public health issues and Nigeria in particular carries a high burden as 33,000 women dies every year though significant decline in maternal mortality ratio has been observed; neonatal mortality rate is 37 per 100,000 livebirths against the 2015 MDGs target of 12 per 100, 000 and stillbirth is unbearably high. Yobe State remains one of the regions with high maternal and perinatal death in Nigeria most of which are preventable with quality Antenatal care (ANC) services yet the ANC coverage is only 49% against the Nigerian national figure of 68.9% (which is moderate) and more than 67% of the pregnant women did not receive atleast 4 ANC visits in Yobe as recommended by World Health Organization. The aimed of this study was to analyse and recommend interventions in ANC services in order to increase utilization to improve maternal and perinatal health in Yobe State, Nigeria. Methods: This is an in-depth study on ANC service utilization from local and international literatures; databases used are PubMed, Medline and Global health. The conceptual framework is based on socio ecological model. The analytical tools used to analyse the proposed intervention strategies are based on the criteria of technical effectiveness, organisational feasibility, sociocultural feasibility, financial feasibility and equity consideration. Results: Multilevel determinants are responsible for low Utilization of ANC services in Yobe State which include intrapersonal (women education and literacy), interpersonal (families, peers, relatives influence), community (culture and beliefs), health system (health services, human resources, and health policy) and structural determinants (conflicts and poverty). Effective and feasible strategies to increase ANC services Utilization identified and appraised include outreach and health and education; men involvement in ANC; community based health insurance scheme; improving the skills and supportive supervision of ANC providers; employment of CHW and task shifting to lower cadres. Conclusion: ANC services requires multi-dimensional approach to increase Utilization, each intervention augment one another for the desired effects and better outcome of improving maternal and perinatal health. Further research is recommended on interventions of determinants like conflicts, poverty and women education which are beyond the scope of this dissertation and men involvement in ANC, community based health insurance scheme, improving the skills and supportive supervision of health ANC providers; task shifting to lower cadres and further research.

Antenatal Care - How to ensure quality!

Antenatal Care - How to ensure quality!

Challenges in Obstetric Morbidity and Mortality, With Special Reference to India: A Literature Review

The purpose of this article was to conduct a review on the determinants of maternal morbidity and mortality, obstetric health scenario, especially after the implementation of the Janani Surksha Yojana (JSY) and recognise the existing gaps in research in obstetric health and healthcare utilisation in India. The articles were retrieved using search engines like Google Scholar and PubMed, using specific combination of terms along with the grey literature available in national and regional health databases. Although the current medical knowledge and interventions are capable to tackle most physical preconditions responsible for maternal deaths, yet the utilisation of healthcare facilities depends on the available health infrastructure, human resources and quality of services that are accessible and acceptable to the beneficiaries. Acceptability especially is impacted by the health-seeking behaviour of a community. The implementation of JSY is believed to contribute to the decline of maternal mortality ratio, yet maternal health outcome reports gross inequity in terms of utilisation of antenatal care and postnatal care at many sub-national levels. Thus, micro-level studies are required to understand critically the level of utilisation of formal healthcare facilities, in order to ensure an unscathed maternal health profile throughout India.

The trends of maternal mortality ratios and cause pattern in 34 Chinese provinces, 1990–2017

BackgroundUnderstanding the trends and causes to the burden of maternal deaths is a key requirement to further reduce the maternal mortality ratio (MMR), and devise targeted intervention policy. We aimed to evaluate the spatiotemporal trends of MMRs and cause patterns across the 34 provinces of China during 1990–2017.MethodsUsing data from the Global Burden of Disease Study 2017, we calculated the levels and trends of total maternal deaths and MMR due to ten different causes through Bayesian multivariable regression model for pregnancies aged 10–54 years, and assessed the age and regional distribution over time.ResultsChina has experienced fast decline in MMR, dropped from 95.2 (87.8–102.3) in 1990 to 13.6 (12.5–15.0) in 2017, with an annualised rate of decline of 7.0%. In 1990, the range of MMRs in mainland China was 31.1 in Shanghai, to 323.4 in Tibet. Almost all provinces showed remarkable decline in the last two decades. However, spatial heterogeneity in levels and trends still existed. The annualised rate of decline across provinces from 1990 to 2017 ranged from 0.54% to 10.14%. Decline accelerated between 2005 and 2017 compared with between 1990 and 2005. In 2017, the lowest MMR was 4.2 in Zhejiang; the highest was still in Tibet, but had fallen to 82.7, dropped by 74.4%. MMR was highest in the 40–49 years age group in both 1990 and 2017. In 2017, haemorrhage and hypertensive disorders were the leading two specific causes for maternal deaths.ConclusionsMMRs have declined rapidly and universally across the provinces of China. Setting of associated interventions in the future will need careful consideration of provinces that still have MMR significantly higher than the national mean level.

Risk management of pregnant women and the associated low maternal mortality from 2008\u20132017 in China: a national longitude study

BackgroundReducing maternal mortality is one of the key targets of the Sustainable Development Goals (SDGs). In response to the impact of increased birth rate on maternal and child safety following the implementation of the two-child policy in 2013, the Chinese government implemented the risk management strategy (namely Five Strategies for Maternal and Newborn Safety, FSMNS) to reduce maternal mortality ratio (MMR). We aimed to analyze the changes in the proportion of pregnant women at high risk screened before and after the implementation of the risk management strategy and the association with maternal mortality during the two-child policy era in China.MethodsWe conducted a nationwide longitudinal study using data obtained from the National Statistical Yearbook and the National Health Statistics Yearbook for all 31 provinces from 2008–2017 to assess and analyze the changes in the proportion of pregnant women at high risk screened before (2008–2013) and after (2014–2017) the implementation of the risk management strategy during the two-child policy era. We used generalized estimating equation (GEE) models to analyze the relationship between the proportion of pregnant women at high risk and MMR after controlling for sociodemographic factors, health resources, and other maternal healthcare factors.ResultsIn the past decade, the number of livebirths in China increased by 32.3%, from 13.3 million in 2008 to 17.6 million in 2017. The median proportion of pregnant women at high risk in 31 provinces increased by 64.8%, from 14.87% in 2008 to 24.50% in 2017. The annual rate of increase in the median proportion of pregnant women at high risk after the implementation of risk management (1.33%) was higher than that before the implementation (0.74%). The median MMR in China decreased by 39.6%, from 21.7 per 100,000 livebirths in 2008 to 13.1 per 100,000 livebirths in 2017. The univariate GEE models showed that MMR decreased by 7.9% per year from 2008–2017 (cRR 0.92, 95% CI 0.91–0.93), and the proportion of pregnant women at high risk was negatively correlated with MMR (cRR 0.97, 95%CI 0.94–0.99; p = 0.001). In the multivariate GEE models, after adjusting for confounders, the proportion of pregnant women at high risk remained negatively correlated with MMR. In the subgroup analysis, the association of MMR with GDP per capita and government health expenditure per capita existed only prior to the implementation of risk management; while high MMR was associated with a low proportion of pregnant women at high risk after the implementation of risk management.ConclusionThe national risk management strategy contributed to the stable decline of MMR in China during the two-child policy era. Further attention should be focused on pregnant women in China’s central and western regions to ensure reaching SDGs targets and the ‘Healthy China Plan’ by 2030.

ASHA - World’s Largest All-female Frontline Community Health Worker: Features and Challenges

India accounts for the second-highest number of maternal deaths all over the world. India has shown a remarkable decline in MMR (Maternal Mortality Ratio) during the last two decades. According to the SRS (Sample Registration System), MMR dropped from more than 556 per 100,000 in 1990 to 113 in 2018 and the proportion of deliveries attended by skilled health personnel has increased from 58% in the 1990s to 81% in 2019. In the year 2005, the Government of India launched the National Rural Health Mission (NRHM) with the purpose of improving the existing health facilities provided to the community with a special focus on the poor and vulnerable states and societies. NRHM identified ASHA (Accredited Social Health Activist), a voluntary community health worker, to provide services to the community on incentives. ASHA workers are the female health workers who have hailed from the same community where they serve. An ASHA worker acts as a link person between the health system and the community. At present, ASHA services are utilised in a number of programmes including maternal and child health, Various studies have extensively documented about ASHAs dissatisfaction with their pay and workload. ASHA services are widely accepted by societies, especially the poor, but issues like sexual harassment, violence, unsafe working conditions, and cast discrimination were also reported.ASHA programme plays a critical role in implementing Government health programmes, especially on MCH. Therefore keeping the ASHA updated and motivated is very important for performing her duties efficiently and effectively.

Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016

BackgroundDriven by the government’s firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements.MethodsPanel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level.ResultsThe MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = − 0.112, 95% CI: − 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123–2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009.ConclusionsThis study provided empirical evidences on China’s impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.

Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4

India has achieved noticeable decline in maternal mortality ratio through the implementation of National Health Mission programme across the country. However, India lags behind to achieve the target of millennium development goal (MDG5) to reduced maternal mortality ratio and improve universal reproductive health by 2015.The significant improvement in maternal health care utilisation is expected to reduce geographical, regional, socio-economic inequality across the subgroups of population, but little is known about the degree of inequality in maternal health in urban subgroups. Using data from National Family Health Survey conducted in 2015–16, this study quantifies the extent of inequality in utilisation of maternal health care in urban India. The study found substantial disparities in utilisation of maternal health care among poor and non-poor. The findings show significant gap in maternal health care utilisation among poor and non-poor with pronounced inequality in full antenatal care followed by post-natal care and skilled attendants at birth. Further, concentration index (CI) estimates reveal that maternal health services were concentrated among more affluent women and the CI for SBA was 0.042, and, for PNC, CI was 0.063, while CI was 0.169 for Full ANC at national level. The decomposition analysis reveals that higher education, Scheduled Caste and exposure to mass media positively contributed to the inequality and observed a huge poor and non-poor disparities. It is suggested that maternal health programme especially Janani Suraksha Yojana should be continued and effectively implement to increase the uptake of full ANC component and reduce maternal mortality ratio in India.

Provincial-level outcomes of China\u2019s \u2018Reducing maternal mortality and eliminating neonatal tetanus\u2019 program

To determine whether the nationwide program ‘Reducing maternal mortality and eliminating neonatal tetanus’ contributed to the rapid decline in China’s maternal mortality ratio (MMR) and neonatal tetanus elimination by enhancing hospital delivery, we compared MMR and neonatal tetanus incidence rate (NTR) reductions by province from 2000 to 2013. The difference-in-difference method was used to analyze the program effect. Long-term effects were analyzed relative to MMR and NTR in 2000 and 2002, respectively, while short-term effects in a given year were analyzed relative to MMR and NTR in the preceding year. The national program was associated with a faster decline in MMR in the long term. The rate of decline showed an inverse ‘U’ shape from 2000 to 2013, peaking in 2009. The program had a short-term effect in MMR reduction in 2005, 2007, and 2009. The program was also associated with faster decline in NTR in the short term at some time points, but this association was not consistent and was not found in the long term. In conclusion, the program accelerated decline of MMR from 2000 to 2013 but did not clearly reduce NTR at the province level. Therefore, this targeted program worked efficiently in resource-poor areas.

Anatomy of provincial level inequality in maternal mortality in China during 2004\u20132016: a new decomposition analysis

BackgroundThe maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016.MethodsWe collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values.ResultsDuring our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality.ConclusionAccess to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.

Maternal death review and surveillance: The case of Central Hospital, Benin City, Nigeria.

BackgroundDespite the adoption of Maternal and Perinatal Death Surveillance and Response (MPDSR) by Nigeria’s Federal Ministry of Health to track and rectify the causes of maternal mortality, very limited documentation exists on experiences with the method and its outcomes at institutional and policy levels.ObjectiveThe objective of this study was to identify through the MPDSR process, the medical causes and contributory factors of maternal mortality, and to elucidate the policy response that took place after the dissemination of the results.MethodsThe study was conducted at the Central Hospital, Benin between October 1, 2017, and May 31, 2019. We first developed a strategic plan with the objective to reduce maternal mortality by 50% in the hospital in two years. An MPDSR committee was established and the members and all staff of the Maternity Department of the hospital were trained to use the nationally approved protocol. All consecutive cases of maternal deaths in the hospital were then reviewed using the MPDSR protocol. The results were submitted to the hospital Management and its supporting agencies for administrative action to correct the identified deficiencies.ResultsThere were 18 maternal deaths in the hospital during the period, and 4,557 deliveries giving a maternal mortality ratio (MMR) of 395/100,000 deliveries. This amounted to a seven-fold reduction in MMR in the hospital at the onset of the project. The main medical causes identified were obstetric hemorrhage (n = 10), pulmonary embolism (n = 2), ruptured uterus (n = 2), eclampsia (n = 1), anemic heart failure (n = 1) and post-partum sepsis (n = 2). Several facility-based and patient contributory factors were identified such as lack of blood in the hospital and late reporting with severe obstetric complication among others. Response to the recommendations from the committee include increased commitment of hospital managers to immediately rectify the attributable causes of deaths, the establishment of a couples health education program, mobilization and sensitization of staff to handle pregnant women with great sensitivity, promptness and care, the refurbishing of an intensive care unit, and the increased availability of blood for transfusion through the intensification of blood donation drive in the hospital.ConclusionWe conclude that the results of MPDSR, when acted upon by hospital managers and policymakers can lead to an improvement in quality of care and a consequent decline in maternal mortality ratio in referral hospitals.

Maternal mortality ratios in 2852 Chinese counties, 1996–2015, and achievement of Millennium Development Goal 5 in China: a subnational analysis of the Global Burden of Disease Study 2016

SummaryBackgroundAs one of only a handful of countries that have achieved both Millennium Development Goals (MDGs) 4 and 5, China has substantially lowered maternal mortality in the past two decades. Little is known, however, about the levels and trends of maternal mortality at the county level in China.MethodsUsing a national registration system of maternal mortality at the county level, we estimated the maternal mortality ratios for 2852 counties in China between 1996 and 2015. We used a state-of-the-art Bayesian small-area estimation hierarchical model with latent Gaussian layers to account for space and time correlations among neighbouring counties. Estimates at the county level were then scaled to be consistent with country-level estimates of maternal mortality for China, which were separately estimated from multiple data sources. We also assessed maternal mortality ratios among ethnic minorities in China and computed Gini coefficients of inequality of maternal mortality ratios at the country and provincial levels.FindingsChina as a country has experienced fast decline in maternal mortality ratios, from 108·7 per 100 000 livebirths in 1996 to 21·8 per 100 000 livebirths in 2015, with an annualised rate of decline of 8·5% per year, which is much faster than the target pace in MDG 5. However, we found substantial heterogeneity in levels and trends at the county level. In 1996, the range of maternal mortality ratios by county was 16·8 per 100 000 livebirths in Shantou, Guangdong, to 3510·3 per 100 000 livebirths in Zanda County, Tibet. Almost all counties showed remarkable decline in maternal mortality ratios in the two decades regardless of those in 1996. The annualised rate of decline across counties from 1996 to 2015 ranges from 4·4% to 12·9%, and 2838 (99·5%) of the 2852 counties had achieved the MDG 5 pace of decline. Decline accelerated between 2005 and 2015 compared with between 1996 and 2005. In 2015, the lowest county-level maternal mortality ratio was 3·4 per 100 000 livebirths in Nanhu District, Zhejiang Province. The highest was still in Zanda County, Tibet, but the fall to 830·5 per 100 000 livebirths was only 76·3%. 26 ethnic groups had population majorities in at least one county in China, and all had achieved declines in maternal mortality ratios in line with the pace of MDG 5. Intercounty Gini coefficients for maternal mortality ratio have declined at the national level in China, indicating improved equality, whereas trends in inequality at the provincial level varied.InterpretationIn the past two decades, maternal mortality ratios have reduced rapidly and universally across China at the county level. Fast improvement in maternal mortality ratios is possible even in less economically developed places with resource constraints. This finding has important implications for improving maternal mortality ratios in developing countries in the Sustainable Development Goal era.FundingNational Health and Family Planning Commission of the People's Republic of China, China Medical Board, WHO, University of Washington Center for Demography and Economics of Aging, Bill & Melinda Gates Foundation.

Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria.

BACKGROUND:Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM:This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY:A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial” was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS:There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION:Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

A retrospective analysis of trends in maternal mortality in a Gambian tertiary health centre

BackgroundMaternal mortality ratio (MMR) has been on the decline in the Gambia since 1990. However, there has been no steady decline in maternal mortality ratio in the Edward Francis Small Teaching Hospital, the only tertiary health facility in the Gambia. The aim of the study is to determine the trend in maternal mortality over the last 8 years.A retrospective review of all maternal deaths occurring at the Edward Francis Small Teaching Hospital from 1st January 2007 to 31st December 2014 was done. Case abstraction was done with a pre-structured questionnaire using the WHO definition of maternal mortality.ResultsThere were 663 maternal deaths recorded during the study period. During the same period the total number of live births were 38,896. The annual MMR in each year varied with a range between 1461 and 2105 per 100,000 live births. The MMR in the hospital in on the rise compared to earlier studies. The causes of maternal mortality have not changed much in the hospital. However, the seasonal variation in maternal mortality in earlier studies attributed to the influence of malaria and anaemia was not seen in this study. We attribute this change to the widespread use of intermittent prophylactic treatment for malaria in the antenatal period.ConclusionWhile MMR was decreasing in the country, it was increasing in the only tertiary health facility in the country. This was attributed to increasing referrals from other health facilities. The influence of malaria and anemia as a cause of maternal mortality seems to be declining.

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia.

BackgroundIn a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work.ResultsIn this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24–0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2–4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P<0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61–4.61)).ConclusionsOur results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is implemented.

Incidence of Maternal "Near-Miss" Events in a Tertiary Care Hospital of Central Gujarat, India.

Constant decline in maternal mortality ratio has given rise to the need of a new indicator. This search has motivated investigation of severe maternal morbidity-"maternal near-miss" (MNM) event. World Health Organization (WHO) defines MNM as "a woman who, being close to death, survives a complication that occurred during pregnancy, delivery or up to 42days after the end of her pregnancy". A hospital-based cross-sectional study was carried out at Sir Sayajirao General Hospital (SSGH), a tertiary care referral hospital in Vadodara, Central Gujarat, from May to September 2012. MNM events were identified according to either WHO or Mantel et al. criteria or both. During study period, 1929 live births, 18 maternal deaths and 46 "near-miss" cases were recorded. Among these 46 near-miss cases, 57 near-miss events were identified. Calculated MNM ratio was 23.85/1000 live births, MNM rate was 20.6/1000 obstetric admissions, the ratio of maternal death to MNM event was 1:2.6, and overall Mortality index was 28.1%. Among near-miss cases, percentage of preterm delivery was 42% and stillbirth rate was 35% (16/46). Out of 46 MNM, pregnancies were continued in 3 while 43 pregnancies were terminated. (25 live births, 16 stillbirths, 2 abortions). Identification of preventable factors and special preventive actions should be taken for management of complications in such near-miss cases.

Factors associated with adverse pregnancy outcomes and perceptions of risk factors among reproductive age women in Soba LGA, Kaduna State 2013.

IntroductionMaternal mortality defined as deaths due to complications of pregnancy or childbirth remains a public health concern. Although statistics show a decline in maternal mortality ratio from 380 deaths to 210 deaths per 100,000 live births from1990 to 2013, in Sub-Saharan Africa, maternal mortality rates remain unacceptably high. Maternal mortality In Nigeria is currently 560/100,000 live births. This study was conducted to identify the associated risk factors and perceptions of adverse pregnancy outcomes among reproductive age women in Soba local government area (LGA).MethodsA 1:1 unmatched case control study with 138 respondents was used. Cases were women aged 15-49 years with a history of adverse pregnancy outcome. Controls: 15-49 years without a history of adverse outcomes. Adverse outcomes were: pregnancy induced hypertension and spontaneous abortions. Anthropometric measurements and blood pressure were taken. Six focus group discussions (FGDs) with grandmothers, mothers and teenagers were used to explore perceptions. Quantitative data was analyzed using Epi-info version 3.5.3. Qualitative data analyzed by thematic approach.ResultsThe median age of cases was: 25 years (Range: 16-44years), Median age of controls: 27 years (Range: 16-43years). Commencement of Antenatal care (ANC) attendance <4months (adjusted odds ratio (AOR): 0.32; 95% CI: 0.12-0.81) and Number of pregnancies ≥4 (AOR: 5.02; 95% CI: 1.97-12.82) were found to be associated with adverse outcomes.ConclusionRisk factors associated with outcomes are multiple pregnancies and delayed commencement of antenatal care. There was poor perception of adverse pregnancy outcomes. We recommended frequent community health talks, early commencement of antenatal and Utilization of Family planning services.

Status of Maternal Mortality in Zambia: Use of Routine Data

Maternal mortality constitutes a major public health problem in developing countries. Although Zambia has been experiencing a decline in maternal mortality ratio (MMR) at a minimal rate, MMR still remains high, at 483 maternal deaths per 100 000 live births. Data from HMIS between 2011 and 2013 was used to analyze levels and trends of maternal mortality at national and subnational level. By yearly variation, MMR records 257/100,000 live births in 2011, (146/100,000) in 2012 and (171/100,000) in 2013. The major delivery complication was abortion which accounted for 57.4%, 55.6% and 52.6% in 2011, 2012 and 2013 respectively. Obtaining data on the magnitude of the health problem and its causes at the subnational level is vital for effective policy and program implementation and sustainability. However, improvement in skilled birth attendant and prompt efficient and enhancement routine data reporting will assist in the fight to reduce maternal mortality in Zambia

Impact of implementation of NRHM program on NMR in Tamil Nadu (TN): a case study.

The Government of India had set up the National Rural Health Mission (NRHM) in 2005 in an effort towards providing quality healthcare to the underserved rural areas and also to achieve the Millennium Development Goals (MDGs) by 2015. While the trends in child and maternal mortality show great progress by India since 1990 with steady decline in Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR), a comparison of the predicted trend and target of MDGs show that India would fall short by a few points. In contrast, Tamil Nadu has reached its MDGs and is ensuring sustained progress in reducing child and maternal mortality with an effective implementation of the various schemes of NRHM. Tamil Nadu leads the way in ensuring universal health coverage leveraging the expertise and funds of NRHM by providing round the clock services, introducing new and innovative programs to improve outcomes and regular monitoring of the functional operation and outcomes to ensure effective implementation. Adopting the features of the Tamil Nadu model of healthcare system that caters to their particular state and effectively implementing the initiatives of NRHM would help the other states in considerably reducing the child and maternal mortality and also ensure early achievement of MDGs by the nation.

Declining maternal mortality in the face of persistently high HIV prevalence in a middle‐income country

To estimate maternal mortality ratio (MMR) and determine maternal death causes and trends in Greater Soweto, Johannesburg, South Africa. Cross-sectional study. Chris Hani Baragwanath Maternity Hospital (CHBMH) in Greater Soweto. Maternal deaths at CHBMH. Record review of maternal deaths from 1997 to 2012, using hospital death records, with denominator data from the district health information system and the hospital. Maternal mortality ratio per 100,000 live births, and causes of death classified as in the South African confidential enquiries. There were 479 deaths, with a peak MMR of 139 in 2004 and a decline to 86 in 2012. Of 332 women tested, 245 (74%) were HIV-infected. Nonpregnancy-related infection (40%) was the most frequent cause of death, followed by hypertension (16%) and obstetric haemorrhage (13%). HIV infection rates in these groups were 92%, 30% and 61%, respectively. Previous caesarean section was associated with obstetric haemorrhage death (odds ratio [OR] 3.2, 95% confidence interval [95% CI] 1.7-6.0), maternal age ≥35 years with hypertension death (OR 2.2, 95% CI 1.2-3.7) and antenatal anaemia with nonpregnancy-related infection death (OR 4.0, 95% CI 2.3-6.9), compared with other causes of death. There is evidence of a decline in MMR since HIV treatment for pregnant women was introduced in 2004. Previous caesarean section, advanced maternal age, and anaemia were associated with death from obstetric haemorrhage, hypertensive disorders of pregnancy and nonpregnancy-related infections, respectively. MMR may be further reduced with accelerated initiation of HIV treatment during pregnancy.