Maternal Causes Research Articles

Algunas consideraciones sobre aspectos obstétricos en la mortalidad perinatal

La mortalidad perinatal en la madre y el niño del Hospital "San Bartolomé", ubicada en Lima, Perú, durante el año mayo 1967 a abril 1968 se informó. La tasa de mortalidad fue de 29,8% PN. Mayor mortalidad PN se produjo entre los bebés prematuros: 59,2%. Toxemia fue el más importante (40%) de las causas de mortalidad materna PN. Prevención de la prematuridad y la toxemia entonces debería ayudar a reducir aún más la mortalidad PN.

Impacts of maternal mortality on living children and families: A qualitative study from Butajira, Ethiopia

BackgroundThe consequences of maternal mortality on orphaned children and the family members who support them are dramatic, especially in countries that have high maternal mortality like Ethiopia. As part of a four country, mixed-methods study (Ethiopia, Malawi, South Africa, and Tanzania) qualitative data were collected in Butajira, Ethiopia with the aim of exploring the far reaching consequences of maternal deaths on families and children.MethodsWe conducted interviews with 28 adult family members of women who died from maternal causes, as well as 13 stakeholders (government officials, civil society, and a UN agency); and held 10 focus group discussions with 87 community members. Data were analyzed using NVivo10 software for qualitative analysis.ResultsWe found that newborns and children whose mothers died from maternal causes face nutrition deficits, and are less likely to access needed health care than children with living mothers. Older children drop out of school to care for younger siblings and contribute to household and farm labor which may be beyond their capacity and age, and often choose migration in search of better opportunities. Family fragmentation is common following maternal death, leading to tenuous relationships within a household with the births and prioritization of additional children further stretching limited financial resources. Currently, there is no formal standardized support system for families caring for vulnerable children in Ethiopia.ConclusionsImpacts of maternal mortality on children are far-reaching and have the potential to last into adulthood. Coordinated, multi-sectorial efforts towards mitigating the impacts on children and families following a maternal death are lacking. In order to prevent impacts on children and families, efforts targeting maternal mortality must address inequalities in access to care at the community, facility, and policy levels.

Continuing with “…a heavy heart” - consequences of maternal death in rural Kenya

BackgroundThis study analyzes the consequences of maternal death to households in Western Kenya, specifically, neonatal and infant survival, childcare and schooling, disruption of daily household activities, the emotional burden on household members, and coping mechanisms.MethodsThe study is a combination of qualitative analysis with matched and unmatched quantitative analysis using surveillance and survey data. Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy that led to the death; schooling experiences of surviving school-age children; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions. Quantitative data on neonatal and infant survival from a demographic surveillance system in the study area were also used. Descriptive and bivariate analyses were conducted with the quantitative data, and qualitative data were analyzed through text analysis using NVivo.ResultsMore than three-quarters of deceased women performed most household tasks when healthy. After the maternal death, the responsibility for these tasks fell primarily on the deceased’s husbands, mothers, and mothers-in-law. Two-thirds of the individuals from households that suffered a maternal death had to shift into another household. Most children had to move away, mostly to their grandmother’s home. About 37% of live births to women who died of maternal causes survived till age 1 year, compared to 65% of live births to a matched sample of women who died of non-maternal causes and 93% of live births to surviving women. Older, surviving children missed school or did not have enough time for schoolwork, because of increased housework or because the loss of household income due to the maternal death meant school fees could not be paid. Respondents expressed grief, frustration, anger and a sense of loss. Generous family and community support during the funeral and mourning periods was followed by little support thereafter.ConclusionThe detrimental consequences of a maternal death ripple out from the woman’s spouse and children to the entire household, and across generations.

“Without a mother”: caregivers and community members’ views about the impacts of maternal mortality on families in KwaZulu-Natal, South Africa

BackgroundMaternal mortality in South Africa is high and a cause for concern especially because the bulk of deaths from maternal causes are preventable. One of the proposed reasons for persistently high maternal mortality is HIV which causes death both indirectly and directly. While there is some evidence for the impact of maternal death on children and families in South Africa, few studies have explored the impacts of maternal mortality on the well-being of the surviving infants, older children and family. This study provides qualitative insight into the consequences of maternal mortality for child and family well-being throughout the life-course.MethodsThis qualitative study was conducted in rural and peri-urban communities in Vulindlela, KwaZulu-Natal. The sample included 22 families directly affected by maternal mortality, 15 community stakeholders and 7 community focus group discussions. These provided unique and diverse perspectives about the causes, experiences and impacts of maternal mortality.Results and discussionChildren left behind were primarily cared for by female family members, even where a father was alive and involved. The financial burden for care and children’s basic needs were largely met through government grants (direct and indirectly targeted at children) and/or through an obligation for the father or his family to assist. The repercussions of losing a mother were felt more by older children for whom it was harder for caregivers to provide educational supervision and emotional or psychological support. Respondents expressed concerns about adolescent’s educational attainment, general behaviour and particularly girl’s sexual risk.ConclusionThese results illuminate the high costs to surviving children and their families of failing to reduce maternal mortality in South Africa. Ensuring social protection and community support is important for remaining children and families. Additional qualitative evidence is needed to explore differential effects for children by gender and to guide future research and inform policies and programs aimed at supporting maternal orphans and other vulnerable children throughout their development.

The impacts of maternal mortality and cause of death on children's risk of dying in rural South Africa: evidence from a population based surveillance study (1992-2013).

BackgroundMaternal mortality, the HIV/AIDS pandemic, and child survival are closely linked. This study contributes evidence on the impact of maternal death on children’s risk of dying in an HIV-endemic population in rural South Africa.MethodsWe used data for children younger than 10 years from the Agincourt health and socio-demographic surveillance system (1992 – 2013). We used discrete time event history analysis to estimate children’s risk of dying when they experienced a maternal death compared to children whose mother survived (N=3,740,992 child months). We also examined variation in risk due to cause of maternal death. We defined mother’s survival status as early maternal death (during pregnancy, childbirth, or within 42 days of most recent childbirth or identified cause of death), late maternal death (within 43-365 days of most recent childbirth), any other death, and mothers who survived.ResultsChildren who experienced an early maternal death were at 15 times the risk of dying (RRR 15.2; 95% CI 8.3–27.9) compared to children whose mother survived. Children under 1 month whose mother died an early (p=0.002) maternal death were at increased risk of dying compared to older children. Children whose mothers died of an HIV/AIDS or TB-related early maternal death were at 29 times the risk of dying compared to children with surviving mothers (RRR 29.2; 95% CI 11.7–73.1). The risk of these children dying was significantly higher than those children whose mother died of a HIV/AIDS or TB-related non-maternal death (p=0.017).ConclusionsThis study contributes further evidence on the impact of a mother’s death on child survival in a poor, rural setting with high HIV prevalence. The intersecting epidemics of maternal mortality and HIV/AIDS – especially in sub-Saharan Africa – have profound implications for maternal and child health and well-being. Such evidence can help guide public and primary health care practice and interventions.

The Quality and Completeness of 2008 Perinatal and Under-five Mortality Data from Vital Registration, Jamaica.

To evaluate the completeness and timeliness of registration of stillbirths and under-five deaths and the validity of the certification and coding process. Registered stillbirths and under-five deaths occurring in 2008 were compared to hospital, police, forensic pathologist and coroner's records. Missed cases and new information such as birthweight, gestation and date of birth were added to the database. A 10% random sample was evaluated to measure the quality of certification and coding. Of 646 stillbirths [≥ 1000 g] and 933 under-five deaths, 69% and 79%, respectively were registered by December 31, 2009, for inclusion in the 2008 final demographic returns. Non-reporting of stillbirths was associated with infant gender, region and place of death (seven of 21 public hospitals accounted for 96% of unregistered stillbirths). Among under-five deaths, age at death, region, place and cause of death were important. Injury and community deaths increased with age. Registration delays including non-registration were associated with coroner's inquests. Most [80%] stillbirth certificates lacked usable cause of death data. Neonatal deaths due to prematurity and perinatal asphyxia were often misclassified by coders. The stillbirth [≥ 1000 g], infant and under-five mortality rates were 15, 20 and 22/1000 births/live births, respectively. While registration of stillbirths and under-five deaths improved between 1998 and 2008, persistent under-reporting reduced official rates by 20-31%. A new perinatal death certificate documenting maternal and fetal causes of death and risk factors such as birthweight, gestation and age at death would improve stillbirth and neonatal death (0-28 days) data quality.

Right Ventricular Enlargement In Utero: Is It Coarctation?

Antenatal diagnosis of right heart enlargement has a wide spectrum of differential diagnosis from maternal, placental and fetal causes, and outcomes of all are not known. Coarctation of the aorta is in the differential diagnosis of right heart enlargement. In our study, we focused to measure multiple cardiac dimensions in fetuses with right heart enlargement to identify the fetus with coarctation of the aorta utilizing echocardiographic measurements. Ten cardiovascular dimensions were measured from fetal studies between 20- and 34-week gestation, and six were measured on postnatal echocardiograms. Z-scores for the cardiac dimensions were calculated, and each variable for fetuses and infants was tested using a two-sample t test between patients with and without coarctation. We excluded fetuses with TAPVR, Shone complex, interrupted aortic arch, Ebstein anomaly or HLHS. Of the 31 fetuses with in utero right heart enlargement, 11 had coarctation postnatally and 20 did not have coarctation. We compared the fetal and newborn cardiac dimensions between the groups. The mean fetal carotid-subclavian index (CS Index) was 0.7 mm with coarctation compared with 1.1 mm without coarctation (p < 0.0001). The mean difference in diameter z-scores for fetal aortic isthmus (p < 0.0001), mitral valve (<0.001) and aortic valve (p < 0.009) was also significantly different. Similar significant differences were noted postnatally in the diameters of the cardiac dimensions between the coarctation and no-coarctation group: CS index (p < 0.0001), aortic isthmus (p < 0.0002) and aortic valve annulus (p < 0.007). A spectrum of diagnoses was found postnatally in fetuses with right heart enlargement, including a normal heart. The likelihood of identifying fetuses with coarctation of the aorta and planning for postnatal management can be refined by noninvasive screening measurements. A smaller CS index and smaller diameters of the aortic isthmus, mitral valve and aortic valve were significantly associated prenatally (p < 0.05) with coarctation of the aorta versus without coarctation and might be useful in prenatally diagnosing coarctation of the aorta. Postnatally, these measurements are reproducible. This is the first study utilizing these specific measurements to diagnose coarctation prenatally.

A cross-sectional analysis of the geographic distribution and causes of maternal mortality in South Africa: 2002-2006.

BackgroundMajor changes in health policy, health service delivery, specific protocols, guidelines and recommendations for the management of common causes of maternal death have been developed in South Africa since the advent of the current democratic government. However, maternal mortality ratio remains high. The scientific community has conducted numerous studies on maternal mortality in South Africa; save for an analysis of the causes of maternal deaths, stratified by province. This study examines the geographic distribution of maternal causes of death in South Africa.MethodsA pooled cross-sectional dataset for the years 2002–2006 retrieved from the vital registration database of Statistics South Africa was used to analyse maternal causes of death. About 8773 maternal deaths between 10–55 years were analysed using frequency tables, cross-tabulations and logistic regression. Maternal mortality ratios (MMR), odds ratios (OR) and 95% confidence intervals (CI) were used to analyse provincial disparities.ResultsMMR was highest in the Free State (286/100 000) and lowest in the Western Cape (87/100 000). Tuberculosis (10.4%) was the leading single indirect cause of maternal deaths while hypertensive disorders (9.1%) were the leading direct cause of death. KwaZulu-Natal women had a significantly higher risk of dying from sepsis (aOR=3.1,95% CI=1.2-7.9). North West women had the lowest risk of dying from hypertensive disorders (aOR=0.4,95% CI=0.2-0.7). The risk of dying from complications of labour was lowest for Gauteng women (aOR=0.4,95% CI=0.1-0.9). The 30–34 years age group had a significantly high risk (aOR=2.5,95% CI=1.6-4.0) of dying from abortion while the 25–29 years age group had a significantly higher risk of dying from maternal infectious diseases (aOR=2.3,95% CI=1.3-3.9). The 40–44 years age group had a significantly higher risk of dying from haemorrhage (aOR=2.3,95% CI=1.3-3.9 and the 45+ age group from other maternal diseases (aOR=3.3,95% CI=1.2-8.5) and miscellaneous direct causes (aOR=4.1,95% CI=1.7-9.9) respectively.ConclusionsThe study shows great variations in the distribution and causes of maternal deaths by age and provincial level. Poorer provinces had lower MMR than the better off provinces. The provincial variations in the leading causes of death indicate the importance of targeted interventions at sub-national level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1597-5) contains supplementary material, which is available to authorized users.

A retrospective study on incidence of dystocia in cattle and buffaloes at referral center

A retrospective study on the incidence of bovine dystocia between October, 2012 to September, 2013 was screened. A high incidence of maternal cause of dystocia was found in both cows (78.89%) and buffaloes (80.33%). Maldisposition of fetus was the commonest cause of fetal dystocia in both cows (16.67%) and buffaloes (18.03%). Imperfect dilatation of cervix (50%) was the major cause of maternal dystocia in cattle while uterine torsion (55.74%) in buffaloes. Other causes of dystocia with low incidence include narrow pelvis, fetal emphysema and fetal monster.

A morphological and morphometric study of placenta with its clinical implications

Objective: In the idiopathic intrauterine growth restriction where there are no clear maternal or fetal causes, the placenta may hold the key to its etiology. So, this study was undertaken to look for any placental and umbilical cord abnormality and to establish the relationship of fetal birth weight with placental measurements. Materials and Methods: In this study, 100 freshly delivered placentae were collected. The placenta and the umbilical cord were examined to look for any abnormalities in the shape, cord insertion, and vessels in the cord; placenta weight, its circumference, diameter, volume, and thickness at the level of cord insertion were also noted. Baby's weight at birth and age in weeks, maternal history about diabetes and hypertension were also noted down. IBM SPSS Statistics for Windows version 20.0, USA was used to do statistical analysis of the measurements. Results: In the present study, placenta weight, volume, diameter, and circumference show a strong correlation with fetal weight. We found placenta of round and abnormal shapes in 89% and 11% of cases, respectively. In 76% of cases, we got normal cord insertion and in 24% of cases, abnormal cord insertion. Statistical analysis of all the parameters of the placenta was done. Conclusion: In our study, placenta weight, volume, diameter, and circumference showed a strong correlation with fetal weight. The knowledge of these measurements on the placenta and umbilical cord will be helpful to the pediatrician and obstetrician in clinical practice.

Polyhydramnios and Adverse Perinatal Outcome

Polyhydramnios complicates 1% to 3% of all pregnancies, and approximately 50% to 60% of cases are idiopathic. Although many fetal and maternal causes of polyhydramnios are known, idiopathic polyhydramnios is defined as that with no identifiable etiology. Amniotic fluid is commonly assessed using the amniotic fluid index (AFI), with polyhydramnios defined as an AFI of 24 cm or greater or 25 cm or greater, which is in the 95th or 97.5th percentile in normal singleton pregnancies. Polyhydramnios is subdivided into mild (24–30), moderate (30.1–35), and severe (AFI > 35). This retrospective cohort study was performed to reevaluate the cutoff point for polyhydramnios and identify a specific value associated with an increased risk for adverse outcomes. All patients enrolled had a sonographic assessment during pregnancy, and all had a singleton fetus at 20 weeks’ gestation or later with an AFI of greater than 10 cm. The patients were stratified into 5 groups according to the AFI: 10 to 19, 20 to 23, 24 to 27, 28 to 31, and 32 or greater. The group with AFI of less than 20 cm was the comparison group. Pregnancy characteristics, complications, and perinatal outcomes were compared among the groups. A total of 14,813 deliveries were enrolled: 9974 (67.3%) had 10 to 19, 2771 (18.7%) had 20 to 23, 1315 (8.8%) had 24 to 27, 494 (3.3%) had 28 to 31, and 260 (1.7%) had AFI of 32 or greater. Preterm labor, placental abruption, cesarean delivery, and malpresentation were more prevalent in a linear fashion as the AFI increased, with the highest prevalence in the group with AFI of 32 or greater. A nonlinear but significant difference between the groups was observed for prior cesarean delivery, gestational diabetes mellitus, postterm pregnancies, and macrosomia. With these complications, the prevalence increased as AFI increased up to an AFI of 31, with a relative decrease in the group with AFI of 32 or greater. A significantly increased rate of perinatal mortality was noted as AFI increased. The rate of low Apgar scores at 1 and 5 minutes was significantly higher and fetal pH tended to be lower in the groups with increased AFI. An Apgar score of less than 7 at 1 and 5 minutes showed a linear association with increased AFI. Three multiple logistic regression models using preterm labor, Apgar of less than 5 at 7 minutes, and perinatal mortality were constructed. All models exhibited a linear increase in the risk for adverse perinatal outcome with increasing AFI. The main finding of the study is the increased adverse perinatal outcome as AFI rises in a dose-response manner from AFI of greater than 20. The widely accepted cutoff for polyhydramnios is AFI of greater than 24, with established associations between polyhydramnios and adverse perinatal outcomes. A diagnosis of polyhydramnios requires additional evaluation to detect fetal anatomic or chromosomal anomalies or maternal conditions such as diabetes. The accepted definition of polyhydramnios as AFI of greater than 24 should be further reevaluated.

Deaths ascribed to non-communicable diseases among rural Kenyan adults are proportionately increasing: evidence from a health and demographic surveillance system, 2003-2010.

BackgroundNon-communicable diseases (NCDs) result in more deaths globally than other causes. Monitoring systems require strengthening to attribute the NCD burden and deaths in low and middle-income countries (LMICs). Data from health and demographic surveillance systems (HDSS) can contribute towards this goal.Methods and FindingsBetween 2003 and 2010, 15,228 deaths in adults aged 15 years (y) and older were identified retrospectively using the HDSS census and verbal autopsy in rural western Kenya, attributed into broad categories using InterVA-4 computer algorithms; 37% were ascribed to NCDs, 60% to communicable diseases (CDs), 3% to injuries, and <1% maternal causes. Median age at death for NCDs was 66y and 71y for females and males, respectively, with 43% (39% male, 48% female) of NCD deaths occurring prematurely among adults aged below 65y. NCD deaths were mainly attributed to cancers (35%) and cardio-vascular diseases (CVDs; 29%). The proportionate mortality from NCDs rose from 35% in 2003 to 45% in 2010 (χ2 linear trend 93.4; p<0.001). While overall annual mortality rates (MRs) for NCDs fell, cancer-specific MRs rose from 200 to 262 per 100,000 population, mainly due to increasing deaths in adults aged 65y and older, and to respiratory neoplasms in all age groups. The substantial fall in CD MRs resulted in similar MRs for CDs and NCDs among all adult females by 2010. NCD MRs for adults aged 15y to <65y fell from 409 to 183 per 100,000 among females and from 517 to 283 per 100,000 population among males. NCD MRs were higher among males than females aged both below, and at or above, 65y.ConclusionsNCDs constitute a significant proportion of deaths in rural western Kenya. Evidence of the increasing contribution of NCDs to overall mortality supports international recommendations to introduce or enhance prevention, screening, diagnosis and treatment programmes in LMICs.

PO-0600 Assessment Of Unsuccessfull Maternal Breastfeeding Factors In First Day After Delivery

<h3>Background and aims</h3> In this research we study the preventive factors in successful breastfeeding in first day after delivery. <h3>Methods and materials</h3> This research type was observational descriptive case series. It takes from august 2013 to February 2014. Our target populations were 387 and contain every delivered mother with breastfeeding problems in first day after delivery. For every mother unsuccessful breastfeeding factors as table-1 determined and data analysed with SPSS type 20 software and assessed with pearson’s correlation and linear regression. <h3>Results</h3> Table 2 shows the influence of unsuccessful breastfeeding factors in first day after delivery. <h3>Conclusion</h3> Maternal causes have the most strength, and educational, hospital, and newborn causes have intermediate preventive relation as unsuccessful maternal breastfeeding factors. Cultural causes have the most strength indirect preventive influence on unsuccessful maternal breastfeeding, but epidemiologic causes have not significant relation with unsuccessful maternal breastfeeding.

Avoiding 40% of the premature deaths in each country, 2010–30: review of national mortality trends to help quantify the UN Sustainable Development Goal for health

The UN will formulate ambitious Sustainable Development Goals for 2030, including one for health. Feasible goals with some quantifiable, measurable targets can influence governments. We propose, as a quatitative health target, "Avoid in each country 40% of premature deaths (under-70 deaths that would be seen in the 2030 population at 2010 death rates), and improve health care at all ages". Targeting overall mortality and improved health care ignores no modifiable cause of death, nor any cause of disability that is treatable (or also causes many deaths). 40% fewer premature deaths would be important in all countries, but implies very different priorities in different populations. Reinforcing this target for overall mortality in each country are four global subtargets for 2030: avoid two-thirds of child and maternal deaths; two-thirds of tuberculosis, HIV, and malaria deaths; a third of premature deaths from non-communicable diseases (NCDs); and a third of those from other causes (other communicable diseases, undernutrition, and injuries). These challenging subtargets would halve under-50 deaths, avoid a third of the (mainly NCD) deaths at ages 50-69 years, and so avoid 40% of under-70 deaths. To help assess feasibility, we review mortality rates and trends in the 25 most populous countries, in four country income groupings, and worldwide. UN sources yielded overall 1970-2010 mortality trends. WHO sources yielded cause-specific 2000-10 trends, standardised to country-specific 2030 populations; decreases per decade of 42% or 18% would yield 20-year reductions of two-thirds or a third. Throughout the world, except in countries where the effects of HIV or political disturbances predominated, mortality decreased substantially from 1970-2010, particularly in childhood. From 2000-10, under-70 age-standardised mortality rates decreased 19% (with the low-income and lower-middle-income countries having the greatest absolute gains). The proportional decreases per decade (2000-10) were: 34% at ages 0-4 years; 17% at ages 5-49 years; 15% at ages 50-69 years; 30% for communicable, perinatal, maternal, or nutritional causes; 14% for NCDs; and 13% for injuries (accident, suicide, or homicide). Moderate acceleration of the 2000-10 proportional decreases in mortality could be feasible, achieving the targeted 2030 disease-specific reductions of two-thirds or a third. If achieved, these reductions avoid about 10 million of the 20 million deaths at ages 0-49 years that would be seen in 2030 at 2010 death rates, and about 17 million of the 41 million such deaths at ages 0-69 years. Such changes could be achievable by 2030, or soon afterwards, at least in areas free of war, other major effects of political disruption, or a major new epidemic. UK Medical Research Council, Norwegian Agency for Development Cooperation, Centre for Global Health Research, and Bill & Melinda Gates Foundation.

Causes of death among females-investigating beyond maternal causes: a community-based longitudinal study.

BackgroundIn developing countries, investigating mortality levels and causes of death among all age female population despite the childhood and maternal related deaths is important to design appropriate and tailored interventions and to improve survival of female residents.MethodsUnder Kilite-Awlealo Health and Demographic Surveillance System, we investigated mortality rates and causes of death in a cohort of female population from 1st of January 2010 to 31st of December 2012. At the baseline, 33,688 females were involved for the prospective follow-up study. Households under the study were updated every six months by fulltime surveillance data collectors to identify vital events, including deaths. Verbal Autopsy (VA) data were collected by separate trained data collectors for all identified deaths in the surveillance site. Trained physicians assigned underlining causes of death using the 10th edition of International Classification of Diseases (ICD). We assessed overall, age- and cause-specific mortality rates per 1000 person-years. Causes of death among all deceased females and by age groups were ranked based on cause specific mortality rates. Analysis was performed using Stata Version 11.1.ResultsDuring the follow-up period, 105,793.9 person-years of observation were generated, and 398 female deaths were recorded. This gave an overall mortality rate of 3.76 (95% confidence interval (CI): 3.41, 4.15) per 1,000 person-years. The top three broad causes of death were infectious and parasitic diseases (1.40 deaths per 1000 person-years), non-communicable diseases (0.98 deaths per 1000 person-years) and external causes (0.36 per 1000 person-years). Most deaths among reproductive age female were caused by Human Deficiency Virus/Acquired Immune Deficiency Virus (HIV/AIDS) and tuberculosis (0.14 per 1000 person-years for each cause). Pregnancy and childbirth related causes were responsible for few deaths among women of reproductive age—3 out of 73 deaths (4.1%) or 5.34 deaths per 1,000 person-years.ConclusionsCommunicable diseases are continued to be the leading causes of death among all age females. HIV/AIDS and tuberculosis were major causes of death among women of reproductive age. Together with existing efforts to prevent pregnancy and childbirth related deaths, public health and curative interventions on other causes, particularly on HIV/AIDS and tuberculosis, should be strengthened.

Approaches to improve the quality of maternal and newborn health care: an overview of the evidence.

Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for these women and newborns is one of the major contributing factors for their elevated rates of morbidity and mortality. In addition, women who perceive the quality of facilty-based care to be poor,may choose to avoid facility-based deliveries, where life-saving interventions could be availble. In this context, understanding the underlying factors that impact the quality of facility-based services and assessing the effectiveness of interventions to improve the quality of care represent critical inputs for the improvement of maternal and newborn health. This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns. The first paper outlines the conceptual framework that guided this study and the methodology used for selecting the reviews and for the analysis. The results are described in the following three papers, which highlight the evidence of interventions to improve the quality of maternal and newborn care at the community, district, and facility level. In the fifth and final paper of the series, the overall findings of the review are discussed, research gaps are identified, and recommendations proposed to impove the quality of maternal and newborn health care in resource-poor settings.

Ill-defined causes of death in Brazil: a redistribution method based on the investigation of such causes.

OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes.METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes.RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights.CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.

Deaths in young people aged 0–24 years in the UK compared with the EU15+ countries, 1970–2008: analysis of the WHO Mortality Database

Concern is growing that mortality and health in children and young people in the UK lags behind that of similar countries. We analysed death registry data provided to the WHO Mortality Database to compare UK mortality for children and young people aged 0-24 years with that of European Union member states (before May, 2004, excluding the UK, plus Australia, Canada, and Norway [the EU15+ countries]) from 1970 to 2008 using the WHO World Mortality Database. We grouped causes of death by Global Burden of Disease classification: communicable, nutritional, or maternal causes; non-communicable disorders; and injury. UK mortality trends were compared with quartiles of mortality in EU15+ countries. We used quasi-likelihood Poisson models to explore differences between intercepts and slopes between the UK and the EU15+ countries. In 1970, UK total mortality was in the best EU15+ quartile (<25th centile) for children and young people aged 1-24 years, with UK infant mortality similar to the EU15+ median. Subsequent mortality reductions in the UK were smaller than were those in the EU15+ countries in all age groups. By 2008, total mortality for neonates, infants, and children aged 1-4 years in the UK was in the worst EU15+ quartile (>75th centile). In 2008, UK annual excess mortality compared with the EU15+ median was 1035 deaths for infants and 134 for children aged 1-9 years. Mortality from non-communicable diseases in the UK fell from being roughly equivalent to the EU15+ median in 1970 to the worst quartile in all age groups by 2008, with 446 annual excess deaths from non-communicable diseases in the UK (280 for young people aged 10-24 years) in 2008. UK mortality from injury remained in the best EU15+ quartile for the study period in all age groups. The UK has not matched the gains made in child, adolescent, and young adult mortality by other comparable countries in the 40 years since 1970, particularly for infant deaths and mortality from non-communicable diseases, including neuropsychiatric disorders. The UK needs to identify and address amenable social determinants and health system factors that lead to poor health outcomes for infants and for children and young people with chronic disorders. None.

English

Abortion is considered not only a major reproductive health matter, but also as a health risk factor for mothers&rsquo; well-being which also threaten mother&rsquo;s lives and comfort. This study seeks to assess the incidence of abortion with particular reference to factors responsible for spontaneous abortion among women admitted into gynaecology wards of three selected hospitals in Maiduguri, Borno State, from January to June, 2012. This study involved 126 women admitted into gynaecology wards of University of Maiduguri Teaching Hospital (UMTH), State Specialist Hospital and Nursing Home in Maiduguri, Borno State from January to June, 2012, respectively. Data were collected using questionnaire items that comprised open and close-ended questions items. Women who were illiterate were interviewed during their hospitalization period and their records were also used for more data. The data were analyzed using frequency distribution count. The study shows that of 126 women, 65 (51.6%) were between the ages of 31 to 40 years, the Gravida status of women that presented more were Gravida 3 to 4 (40.5%) with 51 women. On the causes of present abortion, maternal causes presented more with about 26 (20.6%) of the women. On the management of spontaneous abortion, it is managed expectantly, medically (use of prostaglandin and uterotonic drugs) and surgically by the use of manual vacuum aspiration and dilation and curettage were found to be in us. Based on the information obtained from the study, it was recommended that efforts should be concentrated on providing quality services for the management of post abortion complications. Key words: Abortion, spontaneous abortion, recurrent spontaneous abortion.

The trend of national and subnational burden of maternal conditions in Iran from 1990 to 2013: the study protocol.

It is widely accepted that maternal mortality is a proxy for maternal health status. Maternal deaths only represent the top of the iceberg; morbidity due to maternal causes apart from maternal mortality, poses a huge burden on women's families. There is an excessive need to widen the research on maternal morbidity. Here, we explain the framework of our study on maternal conditions and their burden in Iran as a part of the National and Sub-national Burden of Diseases (NASBOD) study. A systematic search will be carried out for both published and unpublished data on maternal mortality and morbidity reported between 1985 and 2013. Data collected through systematic review and those obtained from national and sub-national surveys will be extracted in a data set. Two statistical models will be applied: Bayesian Autoregressive Multi-level models and Spatio-Temporal Regression models. Models will be used to overcome the problem of data gaps across provinces, years and age groups. In order to control and manage maternal conditions and to make more efficient and cost-effective policies, there is an excessive need for data on the burden of such diseases. There are a few sub-national analyses of the burden of disease. In the current study, burden of maternal conditions will be assessed at national and sub-national levels in Iran between 1990 and 2013. The results of this study are undoubtedly required to provide comprehensive information at the national and provincial levels to administer interventions more effectively, since the priority based policies need regional assessments and comparisons.