Reduction Of Maternal Mortality Research Articles

Predictors of Delays in Emergency Obstetric Care among Reproductive Age Women at Tubah Health District, Cameroon

Background: Delay to timely healthcare contributes to high maternal mortality and morbidity in developing countries. The “three delay model” has been used extensively to investigate factors relating to maternal mortality. In developing countries, 1 in 16 dies, compared to one in 2800 in the developed countries due to pregnancy-related complications. This study aimed to determine the predictors of delays in Emergency Obstetric Care to contribute to a reduction in maternal and infant mortality. Methods: This was a community-based cross-sectional study. The participants were women of reproductive age selected from four villages of the Tubah Health District. Sampling was done using a multistage sampling technique in which reproductive-age women at Tubah Health District were administered a structured questionnaire. Delay was considered at three levels which included: delay in deciding to seek care (first delay), delay in reaching the health facility (second delay) and delay in receiving care at the level of the Health facility (third delay). Univariate and multivariate regressions were used to determine the predictors of delay at each level of delay. Results: Out of 420 participants, 226(53.8%) delayed in deciding to go to the Health facility and had: Maternal age (p= 0.002), Household income (p= 0.003), decision maker for obstetric care (p= 0.042) and antenatal care (p= 0.022) as significant predictors. For the second delay, 124 (29.5%) were delayed, maternal age (p=0.022) being the main predictor. 246 participants (58.6%) were delayed in receiving care at the level of the health facility and the significant predictor was low maternal age (p=0.018). Conclusion: Predictors of the first delay were: maternal age, household income, decision maker for obstetric care, and antenatal care. The main predictor of the second delay was young maternal age; for the third delay, the significant predictor was still maternal age. Young maternal was found to be a major predictor at all levels of delay.

Analysis of Transparency and Accountability of the Health Operational Assistance (BOK) Budget at Sirombu Inpatient Health Center

Health Operational Assistance (HOA) is a fund that is used to ease the public burden on financing the health sector, especially service in community health centers, reduction in maternal mortality, infant mortality and malnutrition. Puskesmas Sirombu as a health service unit is used as a medical center for the welfare of the community, but in reality the Puskesmas Sirombu has not been optimal in realizing the budgeted funds. This study aims to determine the transparency and accountability of budget execution Bantuan Operasional Kesehatan (BOK) at Puskesmas Rawat Inap Sirombu in 2021. The research sample was taken using the method purposive sampling (specific goals or criteria). The data analysis technique used is triangulation method which combines in-depth interviews and document searches and triangulation of sources using different information to do cross check information from several sources, to improve the results of the data obtained when getting different data. Based on the research results, it can be concluded that the Puskesmas Sirombu has implemented its transparency and accountability well but has not been optimal in managing the budget for transportation assistance for Health Operational Officers (BOK), this can be seen from the fact that some of the budget was not realized.

Perception of Traditional Medicine During Pregnancy, Childbirth, and Postpartum in the Tacueyo Indigenous Reservation, Cauca, Colombia

Objective: The objective of this study is to investigate the perception of traditional medicine use during gestation processes in the Tacueyo Indigenous Reservation. The aim is to understand how indigenous women in the reservation perceive and utilize this resource during pregnancy, childbirth, and postpartum in the period 2021-2022. Theoretical Framework: This study is relevant in a context of high maternal and perinatal morbidity rates, focusing on ancestral practices to improve adherence to prenatal and postpartum care, contributing to the reduction of maternal mortality. Method: The study was guided by qualitative methodology and an ethnographic approach, using semi-structured interviews with 10 women. Results and Discussion: The results revealed the use of medicinal plants, interculturality as a protective factor, and barriers to accessing effective medical care. Research Implications: The implications of this research highlight the need to strengthen collaboration between traditional health practices and local health institutions within the framework of the Indigenous Own and Intercultural Health System (SISPI). Originality/Value: This study contributes to the literature by highlighting its intercultural approach and the integration of ancestral knowledge with modern public health to improve maternal health outcomes in indigenous communities.

Knowledge and Attitude Towards Utilisation of Partograph among Midwives in Selected Hospitals in Gombe State, Nigeria

Maternal mortality (MM) has remained high in developing countries including Nigeria. Various interventions for labour care like partograph are known to contribute to the reduction of MM, but reports show that they are not well utilized. Also, there is dearth of information on knowledge and attitudes of midwives towards the use of partograph. Therefore, the study assessed knowledge and attitude of midwives in Gombe state, towards the use of partograph. A cross-sectional descriptive design was adopted and 63 participants from three selected hospitals were recruited using purposive sampling technique. A self-administered questionnaire was used for data collection. Descriptive data were presented using frequency tables. Hypotheses were tested using Chi-square statistic at p≤ 0.05. The mean age of respondents was 37.2±7.6 years, and 77.8% were married. Majority, 96.8% had good knowledge, 70.6% had a positive attitude towards the use of partographs while only 44.4% utilised it regularly. Also, (57.1%) never attended any workshop on partograph post-graduation. There was no significant association between knowledge of partograph and its utilization (x2=0.026, p=0.103). Factors such as shortage of manpower, poor management support and time constraints were found to negatively influence the partograph utilisation. Despite their good knowledge, partograph utilization was not consistent. It is recommended that hands-on training on the use of partograph be organized periodically and an audit system put in place to ensure its effective use.

Men’s perception and participation in maternal and child health care in the field practice area of a teaching hospital: A cross-sectional study from rural Bengal

ABSTRACT Introduction: Participation of men in maternal and child health (MCH) is crucial for the reduction of infant and maternal mortality. MCH care services have been focused on providing information and services to women, but males’ behaviour and decisions affect the health of the child and mother. Objectives: The objectives of the study were to assess the perception and participation of males in MCH care as well as, to identify the association of their perception and participation with socio-demographic characteristics and to find out the correlation between perception and participation regarding MCH care. Materials and Methods: A descriptive type of observational study with a cross-sectional design was conducted among 125 male residents from selected subcentres in Budge Budge II block of South 24 Parganas. Data were collected by face-to-face interviews using a predesigned, pretested, structured schedule. Multivariable binary logistic regression was done to identify the association between dependent and independent variables (P < 0.05). The correlation between perception and participation was assessed by Spearman’s rho. Results: The mean age of the participants was 34.3 (±5.6) years with most (59.2%) between the ages of 31–40 years of age. About 24% were unaware of pregnancy registration time, and 30.4% did not know the number of minimum antenatal check-ups. In total, 20% of study participants did not accompany their partner to the Antenatal Care (ANC) clinic, 6.4% did not accompany them during delivery, and almost 33.6% did not accompany their child to the immunization session. No variables were found to be significantly associated with the dependent variables. A statistically significant positive correlation was found between perception and participation (ρ = 0.3). Conclusion: Men’s perception and participation in MCH care services were found to be reasonably good though they can be improved. Awareness raises about the importance of men’s role in supporting their partner’s health during pregnancy and postpartum, as well as the overall well-being of their children through public health campaigns, community events, and targeted educational programs.

Examining the Cultural Appropriateness and Acceptability of a Traditional Birth Attendants' Training Program in Rural Guatemala.

While there has been notable global advancement in reducing maternal mortality rates (MMRs) in Latin America, the rates among indigenous women remain alarmingly high. This disparity persists in Guatemala, where indigenous women face a two-fold higher MMR compared to their non-indigenous counterparts. Most of the obstetrical care is performed by traditional Mayan birth attendants (TBAs), also known as comadronas, who have minimal formalized clinical training in obstetrical care. Considering there was no national comprehensive training program for TBAs, a unique training program was established in 2014. This program, the School of PowHER (Providing Outreach in Women's Health and Educational Resources), aims to ensure sustainable education led by TBAs for TBAs in rural Guatemala with the ultimate goal of helping TBAs provide basic antenatal care and learn how to identify and refer high-risk pregnancies.The aim of this proposed study is to examine the cultural appropriateness and sensitivity of the training program through a mixed-methods approach. We utilized a mixed-methods strategy, combining quantitative and qualitative methodologies. The quantitative aspect involved a 14-item written survey using a three-point Likert scale for responses, while the qualitative part utilized a semi-structured interview guide to conduct a focus group discussion. The survey (n=33) showed that 32 comadronasfound the curriculum applicable (97%) and comprehensible (97%). However,only 26 comadronas (79%) were comfortable with anatomy terminology. Opinions on teaching tools varied: 13 comadronas (39%) felt they were always representative, 13 comadronas (39%)sometimes, and seven comadronas (21%) never. Group discussions echoed this lack of representation. In the learning environment, 32 comadronas felt welcomed (97%) and 31 felt understood (94%), but five comadronas (15%) were not comfortable asking questions. Thirty-one comadronas (94%) believed training made pregnant women trust comadronas more. Group interviews highlighted increased confidence, better care, and perceived lower maternal mortality. This study found the program to be culturally sensitive and effective. Group interviews highlighted increased confidence, improved patient care, and perceived reductions in maternal mortality. Feedback emphasized the need for more culturally relevant materials, resources, and collaboration with the Ministry of Health. This program's community-centered approach could serve as a model for similar initiatives in low- and middle-income countries addressing high maternal mortality rates, despite language and access challenges.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Effect of Educational Program on Maternity Nursing Students’ Perception toward Sustainability Development: Challenges for Women Empowerment and Reducing Maternal Mortality

Effect of Educational Program on Maternity Nursing Students’ Perception toward Sustainability Development: Challenges for Women Empowerment and Reducing Maternal Mortality

Maternal Risk Factors and Birth Outcomes of Pregnancies Complicated by Preeclampsia: A Case–control Study in a Tertiary Care Hospital of Central India

Background: Preeclampsia contributes substantially to maternal and perinatal mortality. Reduction of maternal and perinatal mortality is a global priority, particularly in low- and middle-income countries like India. Preeclampsia is often overlooked during pregnancy and emerges as a significant contributor to mortality if not addressed proactively. Hence, the present study planned to explore maternal risk factors and birth outcomes in women with preeclampsia admitted for delivery in a tertiary care hospital. Materials and Methods: The present case–control study, including 100 matched cases and a similar number of controls, was carried out. For cases, pregnant women admitted for delivery, diagnosed with preeclampsia, while controls included all pregnant women admitted for delivery without preeclampsia were interviewed. A structured interview questionnaire, patient documents, and maternal and child protection (MCP) cards were used for data collection. Results: Family history of hypertension (odds ratio [OR] = 2.90, 95% confidence interval [CI] = 1.65–5.31), history of chronic hypertension (OR = 6.00, 95% CI = 1.97–18.27), and primiparity (OR = 1.28, 95% CI = 0.72–2.26) were significantly associated with preeclampsia. Preterm birth occurred in 58.1% of cases and 41.8% of controls. No associations were found between preeclampsia and the mode of delivery, gender, and birth weight of the baby. Conclusion: Women with a family history of hypertension, primiparous women, and those with a chronic history of hypertension have more tendency to adverse consequences of pregnancy and its outcomes like preterm births. Recognizing high-risk cases promptly and implementing effective management strategies are essential for planning and executing women’s health programs ultimately enhancing nationwide maternal and child health-care delivery.

Facilitators and barriers of midwife-led model of care at public health institutions of dire Dawa city, Eastern Ethiopia, 2022: a qualitative study

BackgroundThe midwife-led model of care is woman-centered and based on the premise that pregnancy and childbirth are normal life events, and the midwife plays a fundamental role in coordinating care for women and linking with other health care professionals as required. Worldwide, this model of care has made a great contribution to the reduction of maternal and child mortality. For example, the global under-5 mortality rate fell from 42 deaths per 1,000 live births in 2015 to 39 in 2018. The neonatal mortality rate fell from 31 deaths per 1,000 live births in 2000 to 18 deaths per 1,000 in 2018. Even if this model of care has a pivotal role in the reduction of maternal and newborn mortality, in recent years it has faced many challenges.ObjectiveTo explore facilitators and barriers to a midwife-led model of care at a public health institution in Dire Dawa, Eastern Ethiopia, in 2021.Methodology: A qualitative approach was conducted at Dire Dawa public health institution from March 1–April 30, 2022. Data was collected using a semi-structured, in-depth interview tool guide, focused group discussions, and key informant interviews. A convenience sampling method was implemented to select study participants, and the data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach goes through six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing up.ResultTwo major themes were driven from facilitators of the midwife-led model of care (professional pride and good team spirit), and seven major themes were driven from barriers to the midwife-led model of care (lack of professional development, shortage of resources, unfair risk or hazard payment, limited organizational power of midwives, feeling of demoralization absence of recognition from superiors, lack of work-related security).ConclusionThe midwifery-led model of care is facing considerable challenges, both pertaining to the management of the healthcare service locally and nationally. A multidisciplinary and collaborative effort is needed to solve those challenges.

Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries

BackgroundMost countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries’ (LMICs’) midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration.MethodsUsing the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality.ResultsIn LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country.ConclusionsA complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes.

EPH164 Results and Impact of the Acceleration Plan Implementation for Maternal Mortality Reduction in the Department of Bolívar, Colombia

EPH164 Results and Impact of the Acceleration Plan Implementation for Maternal Mortality Reduction in the Department of Bolívar, Colombia

Factors associated with maternal mortality in Kazakhstan: a pre- and during-pandemic comparison.

The maternal mortality indicator serves as a crucial reflection of a nation's overall healthcare, economic, and social standing. It is necessary to identify the variations in its impacts across diverse populations, especially those at higher risk, to effectively reduce maternal mortality and enhance maternal health. The global healthcare landscape has been significantly reshaped by the COVID-19 pandemic, pressing disparities and stalling progress toward achieving Sustainable Development Goals, particularly in maternal mortality reduction. This study investigates the determinants of maternal mortality in Kazakhstan from 2019 to 2020 and maternal mortality trends in 17 regions from 2000 to 2020, employing data extracted from national statistical reports. Stepwise linear regression analysis is utilized to explore trends in maternal mortality ratios in relation to socioeconomic factors and healthcare service indicators. The national maternal mortality ratio in Kazakhstan nearly tripled from 13.7 in 2019 to 36.5 per 100,000 live births in 2020. A remarkable decrease was observed from 2000 until around 2015 with rates spiked by 2020. Significant factors associated with maternal mortality include antenatal care coverage and the number of primary healthcare units. Additionally, socioeconomic factors such as secondary education enrollment and cases of domestic violence against women emerged as predictors of MMR. Moreover, the impact of the pandemic was evident in the shift of coefficients for certain predictors, such as antenatal care coverage in our case. In 2020, predictors of MMR continued to include secondary education enrollment and reported cases of domestic violence. Despite Kazakhstan's efforts and commitment toward achieving Sustainable Development Goals, particularly in maternal mortality reduction, the impact of the COVID-19 pandemic poses alarming challenges. Addressing these challenges and strengthening efforts to mitigate maternal mortality remains imperative for advancing maternal health outcomes in Kazakhstan.

Education in Obstetric Anesthesiology: An International Approach

(Int J Obstet Anesth. 2023;55:103896/https://doi.org/10.1016/j.ijoa.2023.103896 0208-5216/) Obstetric anesthesiology has transformed from administering inhaled anesthetics to handling complex cases in pregnant or postpartum patients, driven by enhanced education in the field. Different countries employ diverse approaches to prepare anesthesiology trainees for obstetric anesthesia, but common threads include competency-based education and the challenge of assessing clinical judgment and skills. In the United States, anesthesiologists undergo basic obstetric anesthesia training with optional advanced programs. Maternal mortality reduction in the 20th century reflects improved education. However, racial disparities persist in pregnancy-related morbidity and mortality, emphasizing the ongoing need for evolving obstetric anesthesiology education to help address this issue and maternal safety in general. The process involves residency and optional fellowship, ensuring competence through clinical experience. Board certification and ongoing education further contribute to advancing obstetric anesthesiology.

Strategy to Accelerate Sustainable Development in the Health Field in Bengkulu Province

This research aims to determine a strategy to accelerate the reduction of maternal mortality, infant mortality and stunting and to describe the acceleration of sustainable health development in Bengkulu Province. This research was designed as descriptive research with a correlational investigation and intervention study; namely, the research wanted to find significant variables related to the problem with minimum intervention. The sample in this study used a clustering technique (Cluster Random Sampling), using primary and secondary data. Primary data in this research uses a questionnaire. Meanwhile, the collected data will be tested using validity and reliability tests on research instruments. Meanwhile, to achieve the objectives of this research, data analysis will be carried out using the SWOT test. The research results found that strategies to accelerate the reduction of maternal mortality can be carried out by providing training or education to health cadres, adding skilled health workers, providing supporting facilities related to accelerated access to health services, providing education about the benefits of nutritious and balanced food to improve health. Meanwhile, the strategy to accelerate the reduction in child mortality is to assist in processing drinking water suitable for consumption, provide fast access to services with a community pick-up program, and create a health service program with early detection of diseases in pregnant women. Meanwhile, strategies to accelerate the reduction in stunting rates include providing assistance to treat stunting, providing education about nutritious and balanced food, and health service programs with early disease detection in expectant mothers. There are still many shortcomings; it is recommended that further researchers add research indicators to the variables studied and use the AHP and FGD analysis methods.

Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990–2019

BackgroundDespite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10–54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services.MethodsUsing 1990–2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country.FindingsIn the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%.ConclusionsWithin the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.

Drivers of success in global health outcomes: A content analysis of Exemplar studies.

Applying a positive outlier lens is one effective approach for generating evidence to inform global health policy, program, and funding decisions. Exemplars in Global Health (EGH) is a program that studies positive outlier countries that have made extraordinary progress in health outcomes (despite limited resources) and disseminates their successes through multiple types of outputs. To date, EGH has studied, or is studying, 14 global health topics in 28 countries. This paper aims to identify findings, summarized as themes and sub-themes, that appear among all completed EGH studies. We developed a conceptual framework and used a content analysis approach to identify the top thematic areas that appear as drivers for programmatic success across EGH studies that were completed between June 2020-May 2023. The EGH studies (N = 31) spanned six topics including under-five child mortality (n = 6), childhood stunting (n = 5), community health workers (CHW) (n = 4), vaccine delivery (n = 3), COVID-19 response (n = 6), and newborn and maternal mortality reduction (n = 7) across 19 countries in sub-Saharan Africa, Latin America, South and Central Asia, and the Caribbean regions. Top drivers of success were defined as those critical or catalytic in achieving the intended outcome. Eight key drivers were identified: (1) efficient data collection and use for decision-making, (2) strong political commitment and health leadership, (3) effective stakeholder coordination, (4) a local, connected, and capacitated workforce, (5) intentional women's empowerment and engagement, (6) effective adoption and implementation of national policies, (7) effective and sustainable financing, and (8) equitable, efficient outreach and targeting. These cross-cutting drivers span a broad range of development outcomes, sectors, and populations, and indicate a need to effectively integrate people, systems, and sectors to improve global health outcomes. Findings from this study aim to support peer learning among countries and support evidence-based decision-making for funders, policymakers, and other key stakeholders.

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

Background Recent estimates have shown a stagnation in maternal mortality reduction globally. Levels and trends in maternal mortality in urban settings in Africa are of interest due to health system challenges posed by rapid urbanisation. Given the high percentage of births occurring in city health facilities, tracking the institutional maternal mortality ratio (IMMR) can reveal key performance issues. We described the trends in IMMR between 2016 and 2021, and the causes and characteristics of maternal deaths in Kampala, Uganda. Methods This retrospective study utilised routine data from all facilities in Kampala that provided childbirth services from 2016 to 2021. Three key variables were used: number of deliveries, live births, and maternal deaths. Additionally, from medical records in three purposively selected hospitals, we extracted information on characteristics of women recorded as maternal deaths and their causes for the period 2016-2021 from death notification and review forms. We conducted descriptive analysis and assessed time trends in IMMR. Results For the six-year period, the Kampala-level IMMR was 189/100,000 deliveries (194/100,000 livebirths). The IMMR declined from 213 (2016) to 109/100,000 deliveries in 2019 (p=0.04) and then increased to 258 in 2021 (p=0.12). A review of 358 maternal death records showed that 65% of deaths were women referred from other health facilities, and 47% lived in the surrounding district (Wakiso). Obstetric haemorrhage (44%) and hypertensive disorders in pregnancy (28%) were the most commonly recorded causes of death. Health system factors such as lack of blood and other supplies contributed to 65% of the deaths reviewed. Conclusions IMMR in Kampala increased from 2019-2021. Health infrastructure changes and maternal health initiatives potentially accounted for the observed trend by affecting data quality. Referral and facility readiness were underlying reasons for maternal deaths. Addressing bottlenecks in emergency referral processes may contribute to mortality reduction. Further research should determine the relative contribution of key influences on mortality levels and examine the dynamics between women’s care-seeking pathways and service delivery arrangements for emergency obstetric care in urban settings.

Effective multi-sectoral approach for rapid reduction in maternal and neonatal mortality: the exceptional case of Bangladesh

BackgroundBangladesh experienced impressive reductions in maternal and neonatal mortality over the past several decades with annual rates of decline surpassing 4% since 2000. We comprehensively assessed health system and non-health...

Leveraging Community Health Workers as a Novel Approach to Reduce Maternal Mortality: A Discourse Analysis

Maternal mortality remains unacceptably high, particularly in low and middle-income countries (LMICs), representing a critical challenge requiring novel approaches to reach underserved populations. Community health worker (CHW) programs have demonstrated potential to promote maternal health by enhancing health literacy, service utilization, and access to care. This study aimed to critically synthesize evidence on leveraging CHWs as an innovative strategy for reducing maternal deaths across LMICs. A review of empirical literature from 2000-2023 was conducted across major databases (PubMed, CINAHL, Embase). Quantitative, qualitative, mixed-methods and review studies reporting primary data on CHW program impacts related to maternal health in LMICs were included. Thematic synthesis was used to explore CHW roles, implementation factors affecting effectiveness, and impacts on drivers of maternal mortality. CHWs increased antenatal care attendance, facility-based deliveries, obstetric complication recognition/referrals, and postnatal follow-up—contributing to reductions in maternal mortality across contexts like Nepal, Ethiopia, and Malawi. However, optimizing impact required comprehensive training, logistical support, functional integration of CHWs into health systems, community participation mechanisms, and tailored incentive packages fostering motivation. Persistent implementation challenges included poor supervision, lack of supplies/transportation, fragmented referral coordination, and inadequate sustainable financing. On implications, there is the need for context-adapted program models underpinned by health system readiness and multistakeholder commitment to overcoming long-standing implementation barriers.