Decrease In Maternal Mortality Research Articles

Changes in trends and outcomes of eclampsia: a success story from Qatar.

Background: Preeclampsia and eclampsia are two hypertensive disorders of pregnancy that significantly contribute to higher morbidity and mortality rates. Eclampsia is the occurrence of seizures in patients with preeclampsia without any previous history of seizure disorders. The incidence and prevalence of eclampsia varies, and there is scarce literature about the prevalence and trends of eclampsia in the Arabian Gulf countries. This study aimed to identify the incidence and changing trends of eclampsia in Qatar. Patients and Methods: This retrospective study was conducted at Hamad Medical Corporation, the only tertiary heathcare center in Qatar, and included all patients admitted with eclampsia from 1979 to 2017. The demographic data, maternal age, parity, gestational age, antenatal visits, timing of seizures, mode of delivery, treatment, maternal morbidity, and mortality were recorded. The study period was divided into the initial period of 1979–1988, 1991–2009, and the recent period of 2010–2017. Data analysis was performed using chi-square tests to identify trends among the three different periods. A p value of ≤ 0.05 (two-tailed) was considered statistically significant. Results: A total of 151 patients with eclampsia were admitted with an increasing incidence of eclampsia over time. There was a statistically significant improvement in antenatal follow-up and an increase in the maternal age of patients with eclampsia (p = 0.001). The incidence of eclampsia without proteinuria increased significantly over time (p = 0.03). Postpartum eclampsia was more common (p = 0.002). Labetalol was the most frequently used antihypertensive agent (p = 0.001), and magnesium sulfate has been increasingly used as an anticonvulsant agent (p = 0.001). The rate of maternal morbidity was decreasing, and in the recent period, posterior reversible encephalopathy syndrome was becoming a common comorbidity in patients with eclampsia. Maternal mortality displayed significant improvement, reaching 0% in the recent study period (p = 0.02). Perinatal mortality likewise displayed a decreasing trend and reached 3.17% in the recent period. Conclusion: The incidence of eclampsia is increasing in Qatar. The antenatal care of patients with eclampsia has improved significantly. The medical management of patients with eclampsia has also drastically improved, leading to a significant decrease in maternal mortality and improvement in perinatal outcomes.

Temporal and regional variations in use, equity and quality of antenatal care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys

BackgroundEgypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). The objective of this paper is to describe the changes over time (1991–2014) in the use of ANC in Egypt, focusing on sector of provision (public versus private), and the content and equity of this care, to inform future policies for improving maternal and newborn health.MethodsWe used Demographic and Health surveys (DHS) conducted in Egypt in 1995, 2000, 2005, 2008 and 2014 to explore national and regional trends in ANC. To assess content of care, we calculated the percentage of ANC users who reported receiving seven ANC components measured in DHS in 2014.ResultsDuring the period under consideration, the percentage of women in need of ANC who received facility-based ANC increased from 42 to 90%, the majority of which was private-sector ANC. The mean number of ANC visits among ANC users increased over time from 7.5 (95% confidence interval [CI] = 7.1–7.9) in 1991–1995 to 9.7 (95%CI 9.6–9.9) in 2010–2014. In 2010–2014, 44% of women using public ANC reported eight or more visits compared to 71% in private ANC. In the same period, 24% of ANC users received all seven care components. This percentage ranged from 10% of women reporting fewer than four ANC visits to 29% of women reporting eight or more. The poorest ANC users received all seven measured components of care less often than the wealthiest (20% versus 28%, p-value< 0.001).ConclusionsEgypt’s improvements in ANC coverage were characterized by decreasing reliance on public services and a rising number of ANC visits. However, despite rising ANC coverage, less than a third of women received the seven essential ANC components measured at least once during pregnancy, with differences between poorer and wealthier women. Policymakers need to ensure that high ANC coverage translates into equity-focused interventions targeting ANC quality. Further research needs to support this effort by assessing the determinants behind poor quality of ANC and evaluating potential interventions.

Reducing Maternal Mortality in the United States

(JAMA. 2018;320(12):1237–1238) Between 2000 and 2014, while many other countries saw decreases in maternal mortality, the rate in the United States more than doubled (9.8 to 21.5 maternal deaths per 100,000 live births). In addition, large ethnic/racial, geographic, and socioeconomic disparities exist, with African American women almost 3 times more likely than white women to die of complications related to pregnancy.

Equity and intrapartum care by skilled birth attendant globally: protocol for a systematic review

IntroductionEquity is a cross-cutting theme within the Sustainable Development Goals (SDGs) and central to the effort to improve maternal and child health globally. One key strategy to prevent maternal death...

The Strategy and Policy Development of Population Towards the Demographic Bonus 2035 in Kupang District-Indonesia

Background: Population concerns the number, structure, age, sex, religion, birth, marriage, pregnancy, death, distribution, mobility and quality in the economic, social and cultural. Residents if less managed wisely lead to security disturbances at the national and regional levels. Therefore, comprehensive management touch to the population problem is needed.Purpose: Produce document as the direction of population development strategy and policy in Kupang district to demographic bonus of 2035.Method: Combination of qualitative and quantitative research. Data were obtained through in-depth interview, FGD, Central Biro Statistic publication. 35 people were FGD participants. Implementation of research was scheduled in 60 working days.Results: The formulation strategy and development policy of Kupang District with target; population 525,706 people, growth rate 1.85% per year, TFR of 2, NRR 1.12, CBR 22.40, CPR 90%, CDR 7.03/1000 population, IMR 19.30/1000 live birth, MMR 175/100.000 live birth; Life Expectancy Rate 77.30 years, increasing labor quality, decreasing the number illegal labor abroad. Fertility field policy; availability of demographic information, delaying marriage age, increasing acceptors coverage, continuity of old and new acceptors services, increasing adolescents and couples of childbearing age, provision and distribution of contraceptives, strengthening family economy, enhancing partnerships. Field Mortality; Decrease in maternal mortality during pregnancy, Decrease infant and child mortality, reduce CDR, improve quality of life clean and healthy. Mobility; redistribution of population among subdistricts, equality of development and improvement labor skills.Conclusion: These strategies and policies are used as direction and solution the problem population development in Kupang District UC.

Acceleration in Decrease of Maternal Mortality on Developing Regions

Acceleration in Decrease of Maternal Mortality on Developing Regions

Severe maternal outcomes and quality of care at district hospitals in Rwanda\u2013 a multicentre prospective case-control study

BackgroundDespite a significant decrease in maternal mortality in the last decade, Rwanda needs further progress in order to achieve Sustainable Development Goals (SDG)3 which addresses among others maternal mortality. Analysis of severe maternal outcomes (SMO) was performed to identify their characteristics, causes and contributory factors, using standard indicators for quality of care.MethodsA prospective case-control study was conducted for which data were collected between November 2015 and April 2016 in four rural district hospitals. The occurrence of SMO with near miss incidence ratios was established, followed by an analysis of the characteristics, clinical outcomes, causes and contributory factors.ResultsThe SMO incidence ratio was 38.4 per 1000 live births (95% CI 33.4–43.4) and the maternal near-miss incidence ratio was 36 per 1000 live births (95% CI 31.1–40.9). The leading causes of SMO were postpartum haemorrhage (23.4%), uterine rupture (22.9%), abortion related complications (16.8%), malaria (13.6%) and hypertensive disorders (8.9%). The case fatality rate was high for women with hypertensive disorders (10.5%; CI 3.3–24.3) and severe postpartum haemorrhage (8%; CI 0.5–15.5). Stillbirth (OR = 181.7; CI 43.5–757.9) and length of stay at the hospital (OR = 7.9; CI 4.5–13.8) were strongly associated with severe outcomes.ConclusionsDespite the use of life saving interventions, SMO are frequent. Mortality index was found to be low at the level of district hospitals. SMO were associated with long stay at the hospital and stillbirth. There is a need for improvement of quality of care, referral practices and certain types of infrastructure, especially blood banks, which would ensure truly comprehensive emergency obstetric care and reduce the occurrence of SMO.

Trends in maternal deaths in HIV-infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015.

IntroductionAs work begins towards the Sustainable Development Goal target of reducing the global maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030, much needs to be done in ending preventable maternal deaths. After 1990, South Africa experienced a reversal of gains in decreasing maternal mortality, with an increase in HIV‐related maternal deaths. In this study, we assessed trends in maternal mortality in HIV‐infected women, on a background of an evolving HIV care programme.MethodsThis was a cross‐sectional, retrospective record review of maternal deaths in the obstetrics unit at Chris Hani Baragwanath Academic Hospital, in Johannesburg, South Africa, a referral hospital in a high HIV prevalence setting where the prevalence among pregnant women has plateaued around 29.0% for the past decade. Trends in HIV diagnosis and management in pregnancy, and causes of maternal deaths in HIV‐infected women were analysed over different time periods (1997 to 2003, 2004 to 2009, 2010 to 2012, and 2013 to 2015) reflecting major guideline changes.ResultsFrom January 1997 to December 2015, there were 692 maternal deaths in the obstetrics unit. Of the 490 (70.8%) maternal deaths with a documented HIV status, 335 (68.4%) were HIV‐infected. A Chi‐squared test for trends showed that the institutional MMR (iMMR) in women known to be HIV‐infected peaked in the period 2004 to 2009 at 380 (95% CI 319 to 446) per 100,000 live births, with a decline to 267 (95% CI 198 to 353) in 2013 to 2015, p = 0.049. This decrease coincided with changes in the South African HIV management guidelines, mainly increased availability of antiretroviral therapy (ART). Non‐pregnancy related infections were the leading cause of death throughout the review period, accounting for 61.5% (206/335) of deaths. Only 23.3% (78/335) of the women who died were on ART at the time of death, this in the context of advanced immune suppression and an overall median CD4 count of 136 cells/μl (interquartile ranges (IQR) 45 to 301).ConclusionIn this 19‐year review of maternal deaths in Johannesburg, South Africa, there was evidence of a decrease in the iMMR among HIV‐infected women, but it remains unacceptably high. Efforts to address drivers of mortality and barriers to accessing ART need to be accelerated if we are to see substantial decreases in maternal mortality.

Regional inequity in complete antenatal services and public emergency obstetric care is associated with greater burden of maternal deaths: analysis from consecutive district level facility survey of Karnataka, India

BackgroundThis equity focused evaluation analyses change in inter-district inequity of maternal health services (MHS) in Karnataka state between 2006–07 & 2012–13, alongside association of MHS inequity with distribution of maternal deaths.MethodsRepeated cross-sectional analysis of inequity and decomposition was done on nine district level MHS indicators using Theil’s T index. Data was obtained from population linked district level facility surveys and health information systems.ResultsInequity in births attended by skill birth attendants decreased the most (83.16%) among six other MHS indicators. Community provision of comprehensive emergency obstetric care strategy remained stagnant. Districts with higher complete antenatal care share and C-sections in public settings had lesser share of state’s maternal deaths (R2 = 0.29, p = 0.004). 5 districts suffered perpetual inequity of MHS with relatively greater burden of maternal deaths.ConclusionFirst 6 years of national rural health mission increased coverage of MHS and decreased regional inequity albeit non-uniformly. Distribution of system driven interventions of complete ANC and C-sections appear to determine decrease of maternal mortality in Karnataka.

Early Versus Late Blood Transfusion in Puerperal Septic Shock Patients with Anemia -a QuasiExperimental Controlled Trial

Objective: To compare the outcome of early blood transfusion i.e. within 6hrs. (hours) of admission VS late blood transfusion (after 6 hrs.) in Puerperal septic shock patients with anemia. Study design: A prospective quasi-experimental controlled trial in ICU(intensive care unit) of Lady Willingdon Hospital, a tertiary care hospital of Obstetrics and Gynecology from Aug2013 to July 2016. Population: Patients admitted with septic shock and anemia during puerperium in ICU. Methods: 74 patients were included in the study by purposive sampling technique. Exclusion criteria were an irreversible shock, chronic lung, and heart disease or those requiring surgical intervention. Surviving sepsis campaign guidelines were followed for the management of these patients. Effect of blood transfusion on the recovery of these subjects was studied. The study group consisted of 43 patients in which blood was transfused within 6hrs of admission. Control group had 31 patients in whom blood could not be transfused within this period. The demographic features and outcome of both groups were recorded and entered on spss20 statistical package. Results: The time of recovery from hypotension, tachycardia, pulmonary edema, ventilator and cardiac support was significantly shorter in the study group compared to the control. A lesser number of blood transfusions was required to treat anemia in the study group. Maternal mortality was less in the study group (23.25%) as compared to control group (48.39%) with an odds ratio of decrease in maternal mortality of 0.323(.119-.877). Conclusion: Early blood transfusion shortens the time of recovery and decreases maternal mortality and morbidity in Puerperal septic shock patients with anemia.

Update on abortion policy.

To review the status of antiabortion restrictions enacted over the last 5 years in the United States and their impact on abortion services. In recent years, there has been an alarming rise in the number of antiabortion laws enacted across the United States. In total, various states in the union enacted 334 abortion restrictions from 2011 to July 2016, accounting for 30% of all abortion restrictions since the legalization of abortion in 1973. Data confirm, however, that more liberal abortion laws do not increase the number of abortions, but instead greatly decrease the number of abortion-related deaths. Several countries including Romania, South Africa and Nepal have seen dramatic decreases in maternal mortality after liberalization of abortion laws, without an increase in the total number of abortions. In the United States, abortions are incredibly safe with very low rates of complications and a mortality rate of 0.7 per 100 000 women. With increasing abortion restrictions, maternal mortality in the United States can be expected to rise over the coming years, as has been observed in Texas recently. Liberalization of abortion laws saves women's lives. The rising number of antiabortion restrictions will ultimately harm women and their families.

Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women’s rights

ObjectiveTo evaluate changes in maternal mortality rates in Uruguay over the past 25years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. MethodsData on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated. ResultsMaternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10years also coincides with a reduction in poverty and an improvement in the HDI. ConclusionA rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.

From risk and harm reduction to decriminalizing abortion: The Uruguayan model for women’s rights

ObjectiveTo describe public policies, social actions, particularly those of obstetricians/gynecologists, and changes in abortion-related legislation in the different historical periods between 1990 and 2015, and to analyze temporal correlations with a reduction in maternal mortality. MethodsThe 1990–2015 period was divided into three different stages to permit evaluation of the legislation, health regulations, healthcare system, and professional practices related to the care provided in cases of unsafe abortion: 1990–2001, characterized by illegality and the healthcare system’s denial of abortion; 2001–2012, when the model for reducing the risk and harm of unsafe abortions was developed; and 2012–2015, when abortion was finally decriminalized. ResultsChanges in public policies and expansion of the risk reduction model coincided with changes in the social perception of abortion and a decrease in maternal mortality and abortion rates, probably due to a set of public policies that led to the decriminalization of abortion in 2012. ConclusionChanges in public policies and health actions such as the model for reducing the risk and harm of unsafe abortions coincided with a marked reduction in abortion-related maternal mortality. The challenges still to be faced include managing second trimester abortions, ensuring the creation of multidisciplinary teams, and offering postabortion contraception.

Implementation of a multidisciplinary clinical pathway for the management of postpartum hemorrhage: a retrospective study.

To compare the outcomes of postpartum hemorrhage (PPH) episodes before and after the introduction of a clinical pathway known as the Severance Protocol to save postpartum bleeding through Expeditious care Delivery (SPEED). This study was designed as a retrospective analysis. The study was conducted in a hospital implementing SPEED. The non-SPEED group included 74 patients with PPH who were treated before the introduction of SPEED, whereas the SPEED group included 155 patients. Differences in outcomes were compared between groups. Reduction in treatment duration was the primary outcome measure, whereas uterus preservation was the secondary. No significant intergroup differences were observed for hemoglobin levels, hematocrit values and vital signs upon patients' emergency room arrival. The turnaround time for hemoglobin, mean duration until treatment by obstetricians and gynecologists and duration between chest radiography ordering and performance significantly differed between the two groups (SPEED, 10.0 [1.0-30.0], 3.0 [0-25.0] and 23.0 [1.0-86.0] min, respectively; non-SPEED, 17.0 [1.0-37.0], 12.0 [0-62.0] and 46.0 [1.0-580.0] min, respectively; P < 0.001). Similarly, the mean duration until transfusion of cross-matched red blood cells (SPEED, 77.6 ± 58.6 min; non-SPEED, 103.4 ± 64.4 min; P = 0.015) and uterus preservation rate (SPEED, 90.1% [136/151]; non-SPEED, 81.7% [58/71]; P = 0.043) also differed significantly between the groups. Clinical pathways enable prompt and efficient care for patients experiencing PPH through faster evaluation and access to red blood cell transfusion, resulting in a decrease in maternal mortality.

Applying the lessons of maternal mortality reduction to global emergency health.

Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions.

TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala

Summary The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q’eqchí and/or Poqomchi’ languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas).

Who gives birth at health facility in Ethiopia? : result from Ethiopian demographic and health survey 2011

Introduction: In many developing countries, maternal mortality is still high. Although an effort has been made to achieve Millennium Development Goals, the positive results and significant decrease in maternal mortality is yet to come, especially in the sub-Saharan African countries. Ethiopia is a member of sub-Saharan countries with high maternal mortality. Since health education and promotion activities are insufficient, most births take place at home by non-health professionals and the public awareness in health facility delivery remains low. Because of these underlying factors, many Ethiopian women are dying from pregnancy and other pregnancy related causes. It is important to evaluate the women that deliver at health facilities versus the home. Objective: To identify factors associated with health facility births in Ethiopia using demographic characteristics, pregnancy-related factors, and media-related factors and to know users of health facility births. Method: This study used the data from the Ethiopian Demographic and Health Survey (EDHS) 2011, which is a national representative sample data. This study analyzed specific health facility births. The demographic characteristics, pregnancy- related factors, and media-related factors were used as independent variables. Delivery places, the outcome variables were treated as categorical variables both bivariately and multivariately. A logistic regression analysis was conducted to identify factors associated with delivery place. Result: Maternal mortality in Ethiopian still high 676/100,000 per life births. Health facility births were still low. A total of 9,429 home deliveries and 1,467 health facility deliveries were identified from the EDHS 2011. Only 13.5% of pregnant women gave birth at a health facility. Women’s residence regions, residential place, educational level, wealth index, husband/partner education level, antenatal care visit and media exposure were significantly associated with their delivery place choice. Whereas older age, high number of parity and married women were negatively associated with health facility deliveries. The outcome of birth (child alive or not) had no association with delivery place selection. Conclusion: This study verifies the factors associated with health facility births in Ethiopia. Region, place of residence, education level of pregnant women and partner and media exposure had significant association. To promote health facility utilization in birth and decrease maternal mortality special efforts will be needed taking account the significant factors. As a positive tool for breaking regional inequality and health education, media and social media may serve an important role in facilitating health facility births.

Advancing Obstetric and Neonatal Care in a Regional Hospital in Ghana via Continuous Quality Improvement

OBJECTIVE: To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. METHODS: In 2007 Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra Ghana. A model encompassing continuous assessment implementation advocacy outputs and outcomes was designed. Key areas for improvement were grouped into bundles based on personnel systems management and service quality. Primary outcomes included maternal and perinatal mortality and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. RESULTS: During the study period there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (P<0.05) and from 14.8% to 1.9% (P<0.001) respectively. Stillbirths were reduced by 36% (P<0.05). Overall the maternal mortality ratio decreased from 496 per 100000 live births in 2007 to 328 per 100000 in 2009. CONCLUSION: Maternal and newborn mortality were reduced in a low-resource setting when appropriate models for continuous quality improvement were developed and employed. Copyright (c) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement

Objective To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. Methods In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into “bundles” based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. Results During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% ( P < 0.05) and from 14.8% to 1.9% ( P < 0.001), respectively. Stillbirths were reduced by 36% ( P < 0.05). Overall, the maternal mortality ratio decreased from 496 per 100 000 live births in 2007 to 328 per 100 000 in 2009. Conclusion Maternal and newborn mortality were reduced in a low-resource setting when appropriate models for continuous quality improvement were developed and employed.