Determinants Of Maternal Death Research Articles

Determinants of Maternal Deaths in the Eastern Region of Ghana, 2011 – 2016

Introduction: An estimated 99% of largely preventable maternal deaths occur across developing regions characterized by a cascade of well-established delays at all levels. Data on community deaths remains scanty hence a wide reliance on institutional data. Target 3.1 ofthe SDG aims to attain a global reduction of less than 70/100000 live births by 2030. Ghana’s MMR of 350/100000 live births is accounted for by commensurately high MMR across its 10 administrative regions. The MMR of the Eastern region, ranked amongthe top 5 by MMR, has exceeded the national average since 2011. Studies are largely cross sectional, not computing individual risk. This study aimed to (1) identify trends of institutional maternal deaths, (2) estimate magnitudes of individual risk with exposure to specific factors and (3) recommend preventive strategies.Methodology: Records on 479 maternal deaths were compared with 616 records on obstetric clients over the same period that did not die from 2011 - 2016 using an unmatched case control study design. Data were analyzed with epi info 3.5.4.Results: Maternal deaths were mainly direct. Controls were largely urban residents, with traceable addresses, engaged in formal occupations, of higher educational backgrounds and ANC attendants. Leading cause of death was obstetric hemorrhage. Most abortions, mainly cases, were unsafe. Mean maternal age was higher for cases. Maternal age of 11 - 20 and ≥ 35, rural residence,underlying medical conditions, informal occupations, multi- and grand multiparity increased risk of maternal deaths, while, ≥ SHS education and ANC ≥ 4 reduced risk of death.Recommendations: Health policies to address concerns of fertility control for adolescents and clients ≥ 35, inequitable access to CEmONC services, quality ANC, low literacy and awareness on the abortion law should be prioritized.

Determinants of Maternal Morbidity and Mortality Related to Anesthesia in Course of Cesarean Section in a Low-Income Country: Experience from the Centre Hospitalier Mère-Enfant Monkole

Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.

Maternal Mortality and its Determinants among Women Utilized Obstetrics and Gynecologic Services in Asella Teaching and Referral Hospital. Oromia Region, Ethiopia. 2018

Background: Although maternal deaths worldwide have decreased by 45% since 1990, 800 women still die each day from largely preventable causes. Every year about 412 women out of 100,000 live births die due to pregnancy related complications in Ethiopia. Thus, the aim of this study was to identify determinants of maternal death among mothers who utilized obstetrics and gynecological services in Asella Teaching and Referral Hospital. 2018.

Determinants of Maternal Death in a Pastoralist Area of Borena Zone, Oromia Region, Ethiopia: Unmatched Case-Control Study.

Background Globally, more than 830 maternal deaths happen daily, and nearly, all of these occur in developing countries. Similarly, in Ethiopia, maternal mortality is still very high. Studies done in pastoralist women are almost few. Therefore, the objective of this study was to assess the determinant factors of maternal death in the pastoralist area of Borena zone, Oromia region, Ethiopia. Methods Community-based unmatched case-control study was conducted on 236 mothers (59 maternal deaths (cases) and 177 controls). The sample included pregnant women aged 15–49 years from September 2014 to March 2017. Data were collected using a structured questionnaire adapted from Maternal Death Surveillance and Response Technical Guideline, entered into the EpiData, exported into SPSS for analyses. Odds ratios (ORs) and 95% confidence interval (CI) were computed to determine contributing factors of maternal death and control potential confounding variables. Results About 51 (86%) of all maternal deaths were due to direct obstetric causes. Of this, hemorrhage (45%), hypertensive disorders of pregnancy (23%), and obstructed labor (18%) were the leading direct causes of maternal deaths. Husbands who had no formal education were 5 times higher compared with their counterparts (AOR = 5.1, 95% CI: 1.6–16). Mothers who were not attending ANC were 5 times more at risk for death than those who attend (AOR 5.3, 95% CI 2.3–12.1). Mothers who gave birth at home/on transit were twice to die compared to health facility delivery (AOR 2.6, 95% CI 2.4–6) that were contributing factors of maternal deaths. Conclusions Husband's level of education, lack of antenatal care, and home delivery were the factors contributing to maternal deaths in the zone. Frequent and tailored antenatal care, skilled delivery, and access to education also need due attention.

Pattern and determinants of mortality among eclamptic women that presented in the Federal Teaching Hospital Abakaliki, Southeast, Nigeria

Background: Eclampsia is a life-threatening obstetric emergency and one of the major causes of preventable maternal and perinatal mortality worldwide. Some women suffered eclampsia and died, while some live to tell their stories; what determines who dies? Aims: To determine the pattern and determinants of mortality among eclamptic women in our institution. Materials and Methods: This was a 5-year retrospective study of eclampsia managed between 1st January 2012 and 31st December 2016. Results: From this study, the incidence of eclampsia was 13.3 per 1000 deliveries and it contributes 21.1% of the maternal death and fetal case fatality rate of 30.2%. Women between the age range of 20–24 years accounted for majority (33.3%) of cases of eclampsia. The modal parity was Para 0 (50%) and most (89.6%) were unbooked. Antepartum eclampsia (53.1%) was the commonest form of eclampsia. Vaginal delivery was the commonest route of delivery. The determinants of maternal death were late presentation (>24 hours) (x2 = 15.37, P 24 hours) (x2 = 16.76, P Conclusion: Eclampsia is still a huge burden in our environment affecting maternal and perinatal morbidity and mortality profile. Early presentation and adequate treatment can help to reduce the incidence of this preventable obstetric disaster in our environment.

Bio-Social Characteristics as Determinants of Maternal Death: A Community based Case-Control Study

Bio-Social Characteristics as Determinants of Maternal Death: A Community based Case-Control Study

Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study

Background: The WHO estimates that, of the 529 000 maternal deaths occurring every year 136 000 take place in India amongst which postpartum haemorrhage (PPH) being the most (29.6%) commonly reported complication. However deaths from PPH can be prevented. The purpose of this study was to identify the risk factors contributing to maternal deaths amongst women who develop PPH.Methods: This was a community based paired case-control study done in rural areas of Lucknow, UP (India) done in a period of one year. Thirty-one maternal deaths due to PPH (cases) were matched and compared with two mothers who survived from PPH (controls). Data was analysed using SPSS version 17.0 and Open Epi version 2.3. The appropriate significance test was applied using MacNemar test for paired data. Risk factors obtained significant in bivariate analysis were subjected to conditional multiple logistic regressions for adjustment and controlling the effect of confounding variables. Results have been given in form of unadjusted Odds ratio (UOR) and adjusted Odds ratio (AOR).Results: It was seen that the mothers who had taken ≥4 antenatal visits during the index pregnancy had a protective effect against deaths due to PPH. Home delivery raised the odds of death by seven times.Conclusions: Deaths due to PPH can be reduced by ensuring institutional delivery, good antenatal care and better referral facilities, especially for mothers from weaker sections of society.

Social autopsy: a potential health-promotion tool for preventing maternal mortality in low-income countries.

Despite significant global improvements, maternal mortality in low-income countries remains unacceptably high. Increasing attention in recent years has focused on how social factors, such as family and peer influences, the community context, health services, legal and policy environments, and cultural and social values, can shape and influence maternal outcomes. Whereas verbal autopsy is used to attribute a clinical cause to a maternal death, the aim of social autopsy is to determine the non-clinical contributing factors. A social autopsy of a maternal death is a group interaction with the family of the deceased woman and her wider local community, where facilitators explore the social causes of the death and identify improvements needed. Although still relatively new, the process has proved useful to capture data for policy-makers on the social determinants of maternal deaths. This article highlights a second aspect of social autopsy - its potential role in health promotion. A social autopsy facilitates "community self-diagnosis" and identification of modifiable social and cultural factors that are attributable to the death. Social autopsy therefore has the potential not only for increasing awareness among community members, but also for promoting behavioural change at the individual and community level. There has been little formal assessment of social autopsy as a tool for health promotion. Rigorous research is now needed to assess the effectiveness and cost effectiveness of social autopsy as a preventive community-based intervention, especially with respect to effects on social determinants. There is also a need to document how communities can take ownership of such activities and achieve a sustainable impact on preventable maternal deaths.

Maternal Mortality in Argentina: A Closer Look at Women Who Die Outside of the Health System

To assess maternal mortality among women who died outside health institutions. To use the technique of verbal autopsy to identify maternal deaths and to obtain qualitative information about the determinants of maternal death using the "three delays" model. Subjects were women aged 10-49 who died outside of a health institution during 2002 in five Argentine provinces with maternal mortality ratios above the national average. Cases were identified through the national and provincial registries, and data were collected using verbal autopsies, where the relatives of the deceased are interviewed. Of 252 completed verbal autopsies, 15 maternal deaths and five late maternal deaths were found. Hemorrhage was the most common cause of maternal death. Seventy-nine percentage of women who died of maternal causes experienced at least one delay in accessing care, with delays in seeking assistance as the most common, followed by delays in accessing and receiving quality care. Maternal causes of death are equally prevalent among women who die outside the health system as among those who die within it, but avoidable deaths are still a problem. Interventions to improve understanding of "alarm signals" (serious symptoms) and improved access and quality of care are necessary to reduce maternal mortality.

Non-medical Determinants of Maternal Death in India

A study was carried out to explore non-medical factors responsible for the persistently high maternal mortality in India showed that most deaths occurred at home and during the postnatal period. Most 'death cases' belonged to high-risk age groups, had high parity (3+), were socially disadvantaged, had not received prenatal care and advice to go to hospital as compared to women with complications. Consequently, they either had not gone to hospital or had gone too late. Delay in care was also because of lack of transport facilities, inappropriate referrals or poor emergency preparedness of referral facilities. Data suggested that about balf the deaths could have been avoided if the health system had been alert and accessible. The critical determinants of avoidable death were families' awareness about complications, emergency transport and preparedness of referral facilities. The study highlighted the need for health workers to stress on health education, care during the third trimester and postnatal period, and referral to appropriate and accessible facilities, even bypassing the hierarchical referral system if necessary.