Lifetime Risk Of Maternal Death Research Articles

Reduction in maternal mortality ratio varies by district in Sidama National Regional State, southern Ethiopia: Estimates by cross-sectional studies using the sisterhood method and a household survey of pregnancy and birth outcomes.

Few studies assess the magnitude, variations, and reduction of maternal mortality at a lower administrative level. This study was conducted to estimate the life time risk (LTR) of maternal death and the maternal mortality ratio (MMR) and assess the reduction in MMR. This is a population-based cross-sectional study conducted in six districts of Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. The study was conducted with men and women aged 15-49 years. By creating a retrospective cohort of women of reproductive age, we calculated the LTR of maternal mortality and approximated the MMR using the total fertility of the rural Ethiopian population. Variations in maternal mortality was assessed based on characteristics of the respondents, like age, sex, and the districts where they lived. Reduction in MMR was examined using the estimates of the sisterhood method and the 5-year recall of pregnancy and birth outcome household survey. We analysed 17374 (99.6%) respondents: 8884 (51.1%) men and 8490 (48.9%) women. The 17,374 respondents reported 64,387 maternal sisters. 2,402 (3.7%) sisters had died; 776 (32.3%) were pregnancy-related deaths. The LTR of maternal death was 3.2%, and the MMR was 623 (95% CI: 573-658) per 100,000 live births (LB). The remote district (Aroresa) had a MMR of 1210 (95% CI: 1027-1318) per 100,000 LB. The estimates from male and female respondents were not different. A significant reduction in MMR was observed in districts located near the regional centre. However, no reduction was observed in districts located far from the regional centre. The high MMR with district-level variations and the lack of mortality reduction in districts located far from the centre highlight the need for instituting interventions tailored to the local context to save mothers and accelerate reductions in MMR.

Financial inclusion and healthcare in Africa: Examining the moderating role of education

AbstractThe 2023 Sustainable Development Goal Report reveals that Africa is still struggling in its pursuit to achieve universal healthcare coverage. However, financial risk protection and human capital development could come to the rescue by facilitating the attainment of quality healthcare services. This study examines the effect of financial inclusion on healthcare in Africa, spanning from 2000 to 2021. Healthcare is proxied by life expectancy at birth, the immunisation rate, and the lifetime risk of maternal death. Financial inclusion is approached through access and usage of financial services. After controlling for the problem of potential endogeneity through the system generalised method of moment (GMM), the findings reveal that financial inclusion enhances healthcare in Africa, signifying that financially included individuals have a higher conditional probability of spending more on improving their health relative to the financially excluded individuals. Moreover, the findings indicate that education and technology diffusion are imperative in the quest for enhancing healthcare in Africa. In addition, after testing for sensitivity analysis by adopting different indicators of healthcare, the results remain consistent throughout the study, confirming the role of financial inclusion in enhancing healthcare in Africa. After computing the marginal effects, the findings depict that education and financial inclusion interact to produce positive synergy effects, signifying that the positive role of financial inclusion and education in enhancing healthcare outweighs the negative conditional effect. The results recommend policymakers establish a framework that promotes financial literacy for the enhancement of healthcare in Africa.

Assessing the effects of terrorism on female health outcomes: Evidence from sub-Saharan African countries

This paper aims at assessing the effects of terrorism on a range of female health outcomes in 20 sub‐Saharan African countries between 2002 and 2018. A causality test is implemented to find out if terrorism causes a deterioration in female health outcomes. Additionally, regression analysis is used to assess the impact of terrorism on female health outcomes after con‐ trolling for female education, seats held by women in parliament, average income, military expenditure, political stability, and the incidence of malaria. The causality analysis shows that terrorism is directly altering female health through its impact on mortality outcomes while its impact on the other dimensions of female health is indirect or uncertain. The regression analysis reveals that terrorism has a positive, significant, and robust impact on the lifetime risk of maternal death and the maternal mortality ratio meanwhile its effects on the fertility rate, the proportion of women living with HIV, and life expectancy are not significant. The findings suggest that African governments could improve female health outcomes by altering the root causes of terrorism with policies promoting the rule of law, ethnic and religious diversity, inclusive political dialogue, checks and balances, and strong political institutions.

Innovations to reduce maternal mortality and improve health and wellbeing of adolescent girls and their babies in Sierra Leone

Sierra Leone has one of the highest maternal mortality rates globally (717 deaths per 100 000 livebirths in 2019),1,2 with the greatest burden in adolescent girls. More than a third of women aged 20–24 years in Sierra Leone have given birth before age 18 years (more than 10% of girls before age 16 years). The lifetime risk of maternal death is one in 17, with some evidence suggesting that the risk is higher for pregnant adolescents.3 Additionally, infants born to adolescent mothers are at increased risk of sickness and death.

Causes of Maternal Mortality Rate: Postpartum Haemorrhage - A Major Cause in Madhya Pradesh

Maternal mortality is an indicator of the state of maternal health services, status of women, women’s health, and above all development of the nation. 15% of global maternal deaths can be attributed to India alone. The lifetime risk of maternal death in India is 1 in 220 as compared to 1 in 5800 in the UK. The major burden of maternal mortality is in the Empowered Action Group (EAG) states. As per recent SRS data, 2014–2016, the Maternal mortality rate (MMR) observed in Madhya Pradesh (MP) was 173.Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide with a prevalence rate of approximately 6%; 50% of these are due to atonic PPH. According to WHO 2014- in India.

Primary healthcare services and maternal mortality in Ugep

This paper focusses on pregnancy related deaths which is a contemporary issue in modern day Nigeria. Maternal Mortality is more pronounced in Ugep, Cross River State with the maternal mortality ratio of l200/100,000 which is higher than the national figure of 1100/100,000 (Nigerian Partnership for Safe Motherhood, 2018). In Nigeria, about 75 % of women die as a result of these complications either during the course of giving birth or the week preceding delivery (Choudhry, 2012). Recent statistics shows that Maternal deaths account for 32% of all deaths among women age 15–49 in Nigeria. The maternal mortality rate for the seven-year period preceding NDHS 2013 survey was 1.05 maternal deaths per 1000 women. The maternal mortality ratio was 576 maternal deaths per 100,000 live births. The lifetime risk of maternal death indicates that out of every 30 women in Nigeria, one will have a death related to pregnancy or childbearing (NDHS, 2013). Statistics further revealed that pregnancy complications in 2012 led to the death of over 52,000 women in Nigeria (Dada, 2016). Maternal Mortality in the seven years preceding the National Demographic Health Survey in 2013 records the figure of live births to be 575 per 100,000, which implies that for one single pregnancy complications resulting to death, more than 20 others are confronted with disabilities which may last a life time, (NDHS, 2013). The theoretical application combines aspects of the Environmental Precedence Theory, Rational Choice Theory and the Health Belief Model (HBM) to explain core variables of the relationship between maternal health practices and pregnancy outcomes. Several conclusions were inferred from the application of sociological theories to the chosen contemporary issue.

Skilled birth attendance in Sierra Leone, Niger, and Mali: analysis of demographic and health surveys

BackgroundSkilled birth attendance (SBA) is a key strategy for averting maternal mortality ratio (MMR). The lifetime risk of maternal death is high in countries with low SBA. With the presence of a skilled birth attendant, the possibility of death owing to intrapartum-related complications or stillbirth can be reduced by 20%.MethodsUsing data from the most recent Demographic and Health Surveys, we investigated the prevalence of skilled birth attendance, variations, and associated factors. The sample was drawn from women aged 15–49 who were surveyed in these countries as part of the Demographic and Health Survey (DHS) program. With multivariate logistic regression, we explored the socio-demographic factors that predict women’s likelihood of seeking skilled birth attendance or otherwise.ResultsLess than half of the women in Niger, Sierra Leone, and Mali obtained skilled birth attendance, with the worst case occurring in Niger (32.6%). Women in rural areas have less likelihood of obtaining skilled birth attendance (OR 0.21; 95% CI 0.16–0.28), as compared to women in urban locations. Highly educated women (OR 2.50; 95% CI 0.72–8.69), those who had subscribed to health insurance (OR 1.39; 95% CI 0.88–2.20), those who obtain four or more antenatal care visits (OR 1.63; 95% CI 1.43–1.86), and women who watch television at least once a week (OR 2.33; 95% CI 1.88–2.88) are more probable to seek SBA.ConclusionInterventions to increase SBA rates in these countries need to be reassessed to focus on the rural-urban disparity in healthcare, female education, and ANC attendance.

Maternal mortality and health in the Arab World: A 25-year epidemiological study.

In this work, we aim to assess the maternal health in terms of maternal mortality ratios and lifetime risk of maternal death in of women in the Arab World. Data on maternal mortality rates (MMR) and lifetime risk of maternal death (LTR) were extracted from the official databases of the United Nations Children's Fund. Annual Percentage Change was calculated using Joinpoint regression model. Statistical significance among countries was determined using one-way analysis of variance (anova) on spss version 25.0 (IBM SPSS, 2017). The MMR and LTR significantly decreased in almost all Arab countries. Somalia was found to be the country with the highest burden of MMR, while Gulf countries had the lowest burden. Our study shows a decrease in the MMR and LTR of maternal death in the Arab world. Although there is a decrease in these rates, but continuous research and efforts must be undergone to better develop the health care system in a great number of Arab countries to decrease the burden of maternal deaths.

Estimating Maternal Mortality in Remote Rural Regions: an Application of the Sisterhood Method in Tajikistan.

IntroductionThe sisterhood method of maternal mortality data collection and analysis provides a validated framework for estimating maternal mortality ratios in situations of limited infrastructure. The aim of this study is to assess sub-national maternal mortality in the Badakhshan region of Tajikistan using the sisterhood method as part of a larger ethnographic study on maternal risk.MethodsIn 2006–2007, 1004 married women of reproductive age in Gorno-Badakhshan Autonomous Oblast, Tajikistan were surveyed using the sisterhood method. Respondents were asked eleven questions about the sex, age and survivorship of all children born to the respondent’s mother.ResultsUsing a national total fertility rate (TFR) estimate of 4.88, the maternal mortality ratio (MMR) in Tajik Badakhshan was 141 maternal deaths per 100,000 live births (95% CI 49–235). The lifetime risk of maternal death was 1 in 141 (95% CI 34–103).ConclusionGiven the inherent time-lag of the sisterhood method, precise estimates of maternal mortality are dependent on accurate TFRs, which may vary based upon regional experiences of demographic transitions. Socio-political instability and the dismantling of Soviet welfare programs and civil war following Tajikistan’s independence from the Soviet Union in 1991 likely impacted TFR in Tajik Badakhshan. Socio-political trends influencing TFR in rural regions compared to urban, and the investigation of factors associated with maternal mortality, require additional investigation.

Estimation of maternal mortality by sisterhood method in two rural communities in Kaduna State, Nigeria

Background: One of the sustainable development goals is reducing the global maternal mortality burden with maternal mortality ratio (MMR) being one of the indicators to track the progress. Unfortunately, there is paucity of MMR data, especially at subnational levels. Standard household survey methods used in maternal mortality estimation are very resource intensive. The indirect sisterhood method offers a cheaper alternative. Although the results may be retrospective and not very useful in tracking progress, it provides useful information for advocacy. Objective: This article determines the proportion of deaths that was due to maternal causes, lifetime risk of maternal death, and MMR in two rural communities in northwestern Nigeria. Methodology: The indirect sisterhood method for estimation of maternal mortality was used to collect information from a sample of 1905 women within the reproductive age group in two rural communities, in Kaduna state, northwestern Nigeria. Results: There were a total of 416 deaths among ever married sisters of the respondents, of which 50% were due to maternal causes. The lifetime risk of maternal death is one in 11, whereas the MMR was 1400 per 100,000 live births. Conclusion: The maternal mortality indicators in these two communities are higher than the national rates and this underscores the need for the generation of subnational data and the scaling up of maternal mortality indicators. It also underpins the need to focus on social determinants like maternal education and early marriage in the course of reducing maternal mortality.

Food-beverage-tobacco consumption, smoking prevalence, and high-technology exports influenced healthcare sustainability agenda across the globe.

The objective of the study is to analyze the long-run, causal, and inter-temporal relationships between food-beverage-tobacco consumption, smoking prevalence in male and females, and high-technology exports and their resulting impact on global healthcare sustainability agenda in a panel of 19 European, North American, and Asian countries during a period of 1990-2016. The results show that the sample countries are largely affected by high mass consumption of food, beverages, and tobacco, due to which the health spending is very high in their economies that increase healthcare costs and mortality rates accordingly. The relationship between death rate and per capita income is found negative in a panel of selected countries, where high death rates substantially decrease country's per capita income. The Granger causality estimates confirm the unidirectional causality running from (i) high-technology exports to CO2 emissions, (ii) smoking prevalence of male and female to health expenditures, (iii) industrial value added to mortality, (iv) health expenditures to per capita income, (v) per capita income to death rates, and (vi) food, beverages, and tobacco consumption to mortality indicators, whereas, the inter-temporal causation confirmed that lifetime risk of maternal death will largely influence health expenditures in a panel of selected countries for the next 10-year time period.

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story.

IntroductionNigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos.Materials and methodsThe study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected.ResultsData was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894–1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility.DiscussionThe maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations—as in the urban slums of Lagos.

Maternal and newborn care practices in Sierra Leone: a mixed methods study of four underserved districts.

Despite recent progress, Sierra Leone’s lifetime risk of maternal death remains high (1 in 21), as does neonatal mortality (35 per 1000 live births). We present findings on maternal and neonatal care practices from a mixed methods study conducted in four districts during July–August 2012. We conducted a household cluster survey with data on maternal and newborn care practices collected from women ages 15–49 years who had ever given birth. We also conducted focus group discussions and in-depth interviews in two communities in each of the four districts. Participants included pregnant women, mothers of young children, older caregivers, fathers, community health volunteers, traditional birth attendants (TBAs) and health workers. We explored personal experiences and understandings of pregnancy, childbirth, the newborn period and social norms. Data analysis was conducted using STATA (quantitative) and thematic analysis using Dedoose software (qualitative). Antenatal care was high (84.2%, 95% CI: 82.0–86.3%), but not timely due to distance, transport, and social norms to delay care-seeking until a pregnancy is visible, particularly in the poorer districts of Kambia and Pujehun. Skilled delivery rates were lower (68.9%, 95% CI: 64.8–72.9%), particularly in Kambia and Tonkolili where TBAs are considered effective. Clean cord care, delaying first baths and immediate breastfeeding were inadequate across all districts. Timely postnatal checks were common among women with facility deliveries (94.1%, 95% CI: 91.9–96.6%) and their newborns (94.5%, 95% CI: 92.5–96.5%). Fewer women with home births received postnatal checks (53.6%, 95% CI: 46.2–61.3%) as did their newborns (75.8%, 95% CI: 68.9–82.8%). TBAs and practitioners are well-respected providers, and traditional beliefs impact many behaviours. Challenges remain with respect to maternal and neonatal health in Sierra Leone; these were likely exacerbated by service interruptions during the 2014–2016 Ebola Virus Disease epidemic. The reasons behind existing practices must be examined to identify appropriate strategies to improve maternal and newborn survival.

Towards ending preventable maternal deaths by 2035.

Maternal mortality has been reduced by half from 1990 to 2010, yet a woman in sub-Saharan Africa has a lifetime risk of maternal death of 1 in 39 compared with around 1 in 10,000 in industrialized countries. Annual rates of reduction of maternal mortality of over 10% have been achieved in several countries. Highly cost-effective interventions exist and are being scaled up, such as family planning, emergency obstetric and newborn care, quality service delivery, midwifery, maternal death surveillance and response, and girls' education; however, coverage still remains low. Maternal mortality reduction is now high on the global agenda. We examined scenarios of reduction of maternal mortality by 2035. Ending preventable maternal deaths could be achieved in nearly all countries by 2035 with challenging yet realistic efforts: (1) massive scaling-up and skilling up of human resources for family planning and maternal health; (2) reaching every village in every district and every urban slum toward universal health coverage; (3) enhanced financing; (4) knowledge for action: enhanced monitoring, accountability, evaluation, and R&D.

Lessons from an elective in Sierra Leone.

Lessons from an elective in Sierra Leone.

Estimating Maternal Mortality Level in Rural Northern Nigeria by the Sisterhood Method

Maternal mortality is one of the major challenges to health systems in sub Saharan Africa. This paper estimates the lifetime risk of maternal death and maternal mortality ratio (MMR) in four states of Northern Nigeria. Data from a household survey conducted in 2011 were utilized by applying the “sisterhood method” for estimating maternal mortality. Female respondents (15–49 years) were interviewed thereby creating a retrospective cohort of their sisters who reached the reproductive age of 15 years. A total of 3,080 respondents reported 7,731 maternal sisters of which 593 were reported dead and 298 of those dead were maternal-related deaths. This corresponded to a lifetime risk of maternal death of 9% (referring to a period about 10.5 years prior to the survey) and an MMR of 1,271 maternal deaths per 100,000 live births; 95% CI was 1,152–1,445 maternal deaths per 100,000 live births. The study calls for improvement of the health system focusing on strategies that will accelerate reduction in MMR such as availability of skilled birth attendants, access to emergency obstetrics care, promotion of facility delivery, availability of antenatal care, and family planning. An accelerated reduction in MMR in the region will contribute towards the attainment of the Millennium Development Goal of maternal mortality reduction in Nigeria.

Editors’ Choice

Editors’ Choice

Maternal mortality in northern Nigeria: findings of a health and demographic surveillance system in Zamfara State, Nigeria

The aim of this study was to estimate: (1) the lifetime risk (LTR) of maternal death; and (2) the maternal mortality ratio (MMR) in the Zamfara State of northern Nigeria. Data from the Nahuche Health and Demographic Surveillance System were utilized using the 'sisterhood method' for estimating maternal mortality. Female respondents (15-49 years) from six districts in the surveillance area were interviewed, creating a retrospective cohort of their sisters who had reached the reproductive age of 15 years. Based on population and fertility estimates, we calculated the LTR of maternal death and the MMR. A total of 17,087 respondents reported 38,761 maternal sisters of whom 3592 had died and of whom 1261 were maternal-related deaths. This corresponded to an LTR of maternal death of 8% (referring to a period of about 10.5 years prior to the survey) and an MMR of 1049 deaths per 100,000 live births (95% confidence interval, 1021-1136). The study provides documented evidence of high maternal mortality in the study area and the state as a whole. Thus, there is a need to improve the health system with an emphasis on interventions that will accelerate reduction in MMR such as the availability of skilled birth attendants and emergency obstetric care, promotion of facility delivery and antenatal care attendance. This can be achieved through a holistic approach and is critical in order to accelerate progress in meeting the Millennium Development Goal of maternal mortality reduction.

Addressing Maternal Healthcare Needs in the Counterinsurgency Environment

All pregnant women are at risk of obstetric complications, most of which occur during labor and delivery among women with no previously identified risk factors. More than 95 percent of these deaths occur in developing countries. In sub-Saharan Africa, a region of the world currently experiencing significant humanitarian crises, the lifetime risk of maternal death is one in 30 whereas the lifetime risk in developed countries is one in 2,800.1 The majority of maternal deaths from obstetric complications are due to hemorrhage, eclampsia, sepsis, or obstructed labor, each of which is treatable. Emergency obstetric care is critical to reducing maternal death and disability. SOF medical personnel supporting counterinsurgency (COIN) operations may find themselves in situations where no legitimate agencies are available to provide maternal healthcare. Similarly, SOF medical personnel should be prepared to assist in rebuilding infrastructure and basic services to include the provision for maternal health. This article provides an overview of maternal health in underdeveloped countries; the importance of addressing the unique healthcare needs of women during COIN operations; and how the employment of Female Treatment Teams (FTT) can assist in meeting these needs. A subsequent article will review the basics of prenatal care and life-saving emergency obstetric care, and discusses the essential information and skills that should be taught in a MEDSEM covering maternal healthcare.

High maternal mortality estimated by the sisterhood method in a rural area of Mali

BackgroundMaternal mortality is high in Mali. Nevertheless, there are few studies on this topic from rural areas, and current estimates are mostly based on studies from urban settings. Our objective was to estimate the maternal mortality ratio in Kita, rural Mali.MethodsUsing the "sisterhood method", we interviewed participants aged 15-50 years from 20 villages in Kita, Mali, and thereby created a retrospective cohort of their sisters in reproductive age. Based on population and fertility estimates, we calculated the lifetime risk of maternal death, and from that the estimated approximate maternal mortality ratio.ResultsThe 2,039 respondents reported 4,628 sisters who had reached reproductive age. Of these 4,628 sisters, almost a third (1,233; 27%) had died, and 429 (9%) had died during pregnancy or childbirth. This corresponded to a lifetime risk of maternal death of 20% and a maternal mortality ratio of 3,131 per 100,000 live births (95% confidence interval 2,967-3,296), with a time reference around 1999.ConclusionsWe found a very high maternal mortality in rural Mali and this highlights the urgent need for obstetric services in the remote rural areas.