Trends In Maternal Mortality Research Articles

Impact of covid 19 pandemic on severe maternal outcomes -An observational study from a referral institute of India

IntroductionCovid 19 pandemic has taken the world by storm. As far as maternal health is concerned, it has been affected both directly and indirectly. Not only are the women getting affected by COVID disease but also the health services are suffering in terms of availability, approachability and access. The study aimed to analyze the change in the trends of maternal near and maternal mortality comprising severe maternal outcome (SMO) between 2019 and 2020 in the department of obstetrics and gynaecology of our hospital due to COVID pandemic. MethodsThis retrospective study was conducted in the Obstetrics and Gynaecology department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. The maternal death review data and maternal near miss statistics were analysed. This included assessing the change in the number of maternal deaths and obstetric near miss, their respective causes, and case fatality rate specific to COVID during pregnancy. ResultsThe total births decreased from 6056 in 2019–4140 in 2020 whereas women with severe maternal outcomes increased from 4.6% in 2019 to 6.5% in 2020(p value < 0.001). The incidence of nearmiss increased significantly from 3.5% in 2019 to 5.1% in 2020(p value < 0.0001) and maternal mortality ratio increased from 1122 per 1 lakh births to 1425 per 1 lakh births. Haemorrhage was the most common cause of maternal near miss with 45.8% in 2019 and an increase to 50.2% in 2020. The percentage of illiterate patients with near miss statistically reduced in 2020(p value - 0.004). Average hospital stay also reduced from 16.5+/-2.1 days to 12.6+/-6.3 days (p value < 0.0001). The average time taken to reach the hospital, however, increased from 27+/-3 h to 36+/-4 h (p value < 0.0001). The rate of direct maternal deaths increased from 45.6% to 52.5% between 2019 and 2020(p-value-0.434). ConclusionCovid 19 pandemic has affected both maternal mortality and morbidity. Keeping the current situation in mind, it becomes increasingly important to develop patient education via electronic media and teleconsultations. One-stop portals and helplines which involve multidisciplinary teams should be available to all such pregnancies.

Maternal mortality in South region of Brazil: an analysis from 2000 to 2018

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation. Impact Statement What is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births. What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years. What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

Temporal Trends of Maternal Mortality Due to Obstetric Hemorrhage in Chinese Mainland: Evidence from the Population-Based Surveillance Data Between 2000 and 2019

Abstract Objective: To analyze the temporal trends of maternal mortality ratio (MMR) due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019, to identify whether the rate of change has accelerated or slowed down during this period, and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future. Methods: Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019. Maternal death was defined according to the World Health Organization's criterion. The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases -10. Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable. The MMR and 95% confidence intervals (CI) for regions or causes were estimated by Poisson's distribution. Joinpoint regression was used to assess the accurate temporal patterns. Results: The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births (95% CI: 15.0–22.2) in 2000. It peaked in 2001 (22.1 per 100,000 live births, 95% CI: 18.3–26.4) and was lowest in 2019 (1.6 per 100,000 live births, 95% CI: 1.0–2.3). For specific regions, the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise, followed by a rapid decline, and then a slow decline. For specific causes, no change point was found in joinpoint analysis of the national MMR caused by placenta previa, postpartum uterine atony, and retained placenta (the annual percent change was −12.0%, −10.5%, and −21.0%, respectively). The MMR caused by postpartum hemorrhages (PPH) significantly declined by 8.0% (95% CI: 1.9–13.6) per year from 2000 to 2007. The annual percent change of MMR caused by PPH accelerated further to −25.0% between 2007 and 2011, and then decreased to −7.8% between 2011 and 2019. The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6% (8/105) in 2000 to 14.3% (4/28) in 2019. The changes in the proportion of causes were different for maternal deaths due to PPH. The proportion of postpartum uterine atony increased from 39.0% (41/105) in 2000 to 60.7% (17/28) in 2019, and the proportion of uterine rupture also increased from 12.3% (13/105) in 2000 to 14.3% (4/28) in 2019. However, the proportion of retained placenta decreased from 37.1% (39/105) in 2000 to 7.1% (2/28) in 2019. Conclusion: Over the last 20 years, the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage. However, the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture. China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage, especially for postpartum uterine atony and uterine rupture.

THE IMPACT OF THE COVID-19 PANDEMIC ON MATERNAL MORTALITY ATTRIBUTES

Background: The COVID-19 pandemic is a challenge for mothers to access health services in Indonesia. Patient management, referral processes, and maternal screening protocols are the reasons for this issue. Aims: This study aimed to analyze maternal mortality trends in East Java Province before and during the COVID-19 pandemic. Methods: This study was conducted using retrospective observation with a cross-sectional design, and samples were selected using a total sampling technique. The number of maternal deaths in East Java was 520 in 2019 and 565 in 2020. The independent variable in this study is the number of maternal deaths, and the dependent variables include age, gravida, place of death, rescue relay, time of death, and maternal complications. The variables of age, place of death, rescue relay, and gravida were assessed using the Chi-square test. Results: Statistical tests showed a ρ value of 0.195 for age; 0.916 for place of death; 0.646 for rescue relay; and 0.048 for gravida. Conclusion: Maternal mortality showed different trends before and after the pandemic in East Java. Significant differences in maternal mortality rate are influenced by gravida status.

Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study

BackgroundThe Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan.MethodsA national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated.ResultsWomen with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013–2015) to 6.4% (2016–2018) (p < 0.0001). The proportion of postpartum hemorrhage in maternal deaths decreased from 21.1% (2013–2015) to 14.1% (2016–2018) per all maternal deaths cases (p = 0.14). Cases with postpartum hemorrhage managed in large referral hospitals was increased (65.9% in 2012 to 70.4% in 2018) during the study period (p < 0.0001).ConclusionsThe efforts by the Societies to prevent maternal mortality due to obstetric hemorrhage resulted in a significant decrease in the frequency of hysterectomies and a downward trend in maternal mortality due to obstetric hemorrhage.

A Five Year Study on Maternal Mortality in The Maternity Ward of Government General Hospital, Siddhartha Medical College, Vijayawada

Introduction: Maternal health is important for the development of any country in terms of increasing equity and reducing poverty and is important in their own right and is central to solving economic, social and developmental challenges. Hence, maternal mortality is the key indicator of health and socio economic status and development of a community and the whole national system. Aim: To study the factors responsible for maternal mortality and to analyse the causes and trends in maternal mortality. Materials and Methods: A retrospective study on maternal deaths that occurred in the maternity ward of Government General Hospital, Siddhartha Medical College, Vijayawada during the period of five years from January 2017 to December 2021. Covid related deaths excluded. Results: Total 137 maternal deaths occurred during the study period. 121 maternal deaths (88.32%) were unbooked cases, 16 (11.67%) were booked cases. 58 women (42.33%) were primiparous, 76 (55.47%) were multiparous and 3 (2.18%) were grand multiparous. 76 women (55.47%) were of 20-24 years age, 38 women (27.73%)were of 25-29 years age. Maternal deaths due to direct causes were 89 (65.92%) and due to indirect causes were 47 (34.07%). Hypertensive disorders complicating pregnancy was the leading cause of death followed by hemorrhage in pregnancy. 105 (76.64%) maternal deaths occurred after delivery, 14 deaths (10.21%) during 3rd trimester of gestation. Type 1 delay (20.74%), type 2 delay (57.7%) type 3 (21.48%) delays contributed to the maternal deaths. Conclusion: Health education regarding adolescent health, pregnancy, abortion and contraception. Regular antenatal checkup, early identification of risk factors, awareness, timely intervention and referral to higher institute, proper intra natal and post natal care, multispecial team management in high risk cases are needed to reduce the maternal mortality.

Maternal mortality trends in Spain during the 2000-2018 period: the role of maternal origin

BackgroundThe available literature indicates that there are significant differences in maternal mortality according to maternal origin in high income countries. The aim of this study was to examine the trend in the maternal mortality rate and its most common causes in Spain in recent years and to analyse its relationship with maternal origin.MethodsThis was a cross-sectional study of all live births as well as those resulting in maternal death in Spain during the period between 2000 and 2018. A descriptive analysis of the maternal mortality rate by cause, region of birth, maternal age, marital status, human development index and continent of maternal origin was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analyses, with adjustment for certain variables included in the descriptive analysis.ResultsThere was a total of 293 maternal deaths and 8,439,324 live births during the study period. The most common cause of maternal death was hypertensive disorders of pregnancy. The average maternal death rate was 3.47 per 100,000 live births. The risk of suffering from this complication was higher for immigrant women from less developed countries. The adjusted effect of maternal HDI score over maternal mortality was OR = 0.976; 95% CI 0.95 – 0.99; p = 0.048; therefore, a decrease of 0.01 in the maternal human development index score significantly increased the risk of this complication by 2.4%.ConclusionsThe results of this study indicate that there are inequalities in maternal mortality according to maternal origin in Spain. The human development index of the country of maternal origin could be a useful tool when estimating the risk of this complication, taking into account the origin of the pregnant woman.

Rural-Urban Differences in Maternal Mortality Trends in the United States, 1999-2017: Accounting for the Impact of the Pregnancy Status Checkbox.

It has been difficult to measure rural-urban differences in maternal mortality ratios (MMRs) in the United States in recent years because of the incremental adoption of a pregnancy status checkbox on the standard US death certificate. Using 1999-2017 mortality and birth data, we examined the impact of the pregnancy checkbox on MMRs according to urbanicity of residence (large urban area, medium/small urban area, or rural area), using log-binomial regression models to predict trends that would have been observed if all states had adopted the checkbox as of 1999. Implementation of the checkbox resulted in an average estimated increase of 7.5 maternal deaths per 100,000 live births (95% confidence interval (CI): 6.3, 8.8) in large urban areas (a 76% increase), 11.6 (95% CI: 9.6, 13.6) in medium/small urban areas (a 113% increase), and 16.6 (95% CI: 12.9, 20.3) in rural areas (a 107% increase), compared with MMRs prior to the checkbox. Assuming that all states had the checkbox as of 1999, demographic-factor-adjusted predicted MMRs increased in rural areas, declined in large urban areas, and did not change in medium/small urban areas. However, trends and urban-rural differences were substantially attenuated when analyses were limited to direct/specific causes of maternal death, which are probably subject to less misclassification. Accurate ascertainment of maternal deaths, particularly in rural areas, is important for reducing disparities in maternal mortality.

Changing Trends of Maternal Mortality in a Rural Medical College in Eastern India: A 23-Year Retrospective Study

Introduction: Maternal mortality in a region is a measure of reproductive health of women in that area. The direct causes of maternal deaths are largely preventable. A new era of more comprehensive, international development agenda-the Sustainable Development Goals (SDG 3.1) was launched by the United Nations General Assembly 2015, New York for ending preventable maternal deaths. Aim: To determine the causes and changing trends of maternal mortality in this rural centre. Materials and Methods: A retrospective observational study was carried out in the Department of Obstetrics and Gynaecology of Bankura Sammilani Medical College in West Bengal in Eastern India. Individual hospital records of all the maternal deaths, from January 1998 to December 2020 were collected. Data regarding demographic profile and reproductive parameters like gravida, parity, antenatal care and cause of death were collected. The records were divided into two four yearly periods, to compare the changing trends (1998-2001) vs (2017-2020) and three five yearly (2002-2006), (2007-2011), (2012-2016) periods. The first term (1998-2001) was taken as the reference period. Results: Comparison between first (1998-2001) and last term (2017-2020) shows significant declining trend of Maternal Mortality Ratio (MMR) (364 vs 148)/100000 live birth (p-value &lt;0.00001). Majority of deaths occurred in primigravida (57.5% vs 60.6%). Direct obstetric causes accounted for majority of the deaths, but with a declining trend (74.7% vs 66.7%). Eclampsia remained the leading direct cause (35.5% vs 32.2%) followed by haemorrhage (20.4% vs 18.8%) and sepsis (18.8% vs 15.7%) in the first term (1998-2001) vs last term (2017-2020). Jaundice 6.45% vs 10.3%, heart disease 2.15% vs 7.1%, embolism 4.3% vs 0.8%, anaemia 6.45% vs 1.6% and other diseases 5.91% vs 13.4% in the first vs last term were the indirect causes of maternal mortality. Conclusion: There is a declining trend of maternal mortality since 1998, which can be attributed to improvement at all levels of healthcare. Eclampsia/preeclampsia and its complications remain the leading cause of maternal mortality. Majority of these maternal deaths can be prevented by regular screening of highrisk cases, integrated antenatal and postnatal care, institutional deliveries, timely referral, and proper implementation of national health programmes.

Reducing Implicit Bias in Maternity Care: A Framework for Action

Reducing Implicit Bias in Maternity Care: A Framework for Action

A New Method for Obtaining Global Estimates of Maternal Mortality

Background: Maternal mortality is widely regarded as a key indicator of population health and social and economic development. Its rates and trends are closely monitored by the United Nations and others, inspired in part by the Sustainable Development Goals (SDGs), which call for a three-quarter reduction in the maternal mortality ratio by 2015. Unfortunately, the empirical basis for such monitoring is still quite weak, requiring the use of models. statistics to get estimates for most countries.&#x0D; Objective: In this paper we describe a new method for estimating global rates and trends in maternal mortality. For countries that lack sufficient data for direct estimation of estimates, we use a parametric model that separates maternal deaths from deaths from HIV/AIDS.&#x0D; Materials and methods: For maternal deaths not associated with HIV/AIDS, the model consists of a hierarchical linear regression with three predictors and variable intercepts for country and region. Estimated uncertainty is assessed by simulating the estimation process, taking into account the variability in both the data and other model inputs. This method was used to derive the most recent set of PBB estimates, published in September 2010. Here, we provide a brief description and description of the approach, including a novel analysis of the components of variability reflected in the uncertainty interval.&#x0D; Results: Final estimates provide evidence of a more rapid decline in the global maternal mortality ratio than suggested by previous studies, including another study published in April 2010. We compared the findings of the two most recent studies and discussed topics for further research to help resolve differences.&#x0D;

Case Study in the COVID-19 Pandemic: Stunting, Low Birth Weight, Maternal Mortality and Infant Mortality in Semarang, Central Java-Indonesia

Background and Objective: Stunting, low birth weight, maternal death, and child mortality have all become public health issues in recent years, particularly in Semarang, Indonesia. Simultaneously, the COVID-19 pandemic is spreading. Between the years 2019 and 2021.&#x0D; Methods: The Semarang City Health Service's secondary data analysis strategy was combined with a quantitative descriptive research methodology in this study. To evaluate numerical patterns in stunting, low birth weight, maternal death, and infant mortality in the data, simple regression were utilized.&#x0D; Results: According to the findings, the trend of stunting (modeling results y = 35,236 x + 361.77) and maternal mortality (modeling results 0.0218x+1.2921) increased between 2019 and 2021, whereas the trend of low birth weight (modeling results y = - 0.5425x+60.008) and child mortality (modeling results y = -0.0028x+ 2.202) decreased. The number of low birth weight has the lowest trend value, while the stunting rate has the greatest.&#x0D; Conclusion: Stunting rates increased, the low birth weight dropped, maternal mortality increased, and child mortality decreased in Semarang. The conditions of the Covid-19 epidemic have at least influenced this condition.

Trends, causes and solutions of maternal mortality in Jinan, China: the epidemiology of the MMR in 1991\u20132020

BackgroundChina was one of the few countries to achieve the Millennium Development Goals 5. China had taken many effective measures to reduce maternal mortality ratio (MMR) and has achieved encouraging progress. These measures were worth sharing for other countries to reduce the MMR, but the introduction of these measures from the national perspective was too grand, and the measures implemented in a city and the results achieved were more valuable. However, there were few studies on the prevalence and trends of prolonged maternal mortality in a city. In this study, we mainly introduced the prevalence of the MMR in Jinan,China from 1991 to 2020, analyzed the causes of trends and put forward some solutions to the difficulty existing in the process of reducing the MMR,hoping to serve as a model for some developing cities to reduce MMR.MethodsWe collected maternal mortality data from paper records, electronic files and network platforms. The time trend of MMR was tested by Cochran-Armitage Test (CAT). We divided the study period into three stages with 10 years as a stage and the Chi-square test or Fisher’s exact test was used to test the difference in MMR of different periods.ResultsFrom 1991 to 2020, We counted 1,804,162 live births and 323 maternal deaths, and the MMR was 17.93 per 100,000 live births. The MMR declined from 44.06 per 100,000 live births in 1991 to 5.94 per 100,000 live births in 2020, with a total decline of 86.52% and an annual decline of 2.89%. The MMR declined by 88.54% in rural areas, with an average annual decline 2.95%, faster than that in urban areas (82.06, 2.73%). From 1991 to 2020, the top five causes of maternal deaths were obstetric haemorrhage (4.55 per 100,000 live births), amniotic fluid embolism (3.27 per 100,000 live births), pregnancy-induced hypertension (2.61 per 100,000 live births), heart disease (2.33 per 100,000 live births) and other medical complications (2.05 per 100,000 live births). Postpartum hemorrhage, amniotic fluid embolism, pregnancy-induced hypertension showed a downward trend (P < 0.05) and other medical complications showed an upward trend (P < 0.05).ConclusionsSubsidy for hospitalized delivery of rural women, free prenatal check-ups for pregnant women and rapid referral system between hospitals have contributed to reducing MMR in Jinan. However, it was still necessary to strengthen the treatment of obstetric hemorrhage by ensuring blood supply, reduce the MMR due to medical complications by improving the skills of obstetricians to deal with medical diseases, and reduce the MMR by strengthening the allocation of emergency equipment in county hospitals and the skills training of doctors.

Maternal Deaths in India: A Review of Trends and Programmes

High-quality services during childbirth in a health care facility reduce maternal morbidity and mortality. High maternal mortality in India is a critical concern. In an attempt to decrease the maternal mortality rate (MMR), the Government of India has launched many programmes. This article discusses the trends in maternal mortality in India with the inter-state disparities. As per Sample Registration System (SRS), MMR in India was estimated to be 556 in 1990, but globally it was only 385 at that time. India has achieved about a 77% reduction in maternal mortality compared to the global average of 43% between 2005 and 2017, but a huge inter-state disparity in maternal death still exists. Approximately 65%-75% of the estimated maternal deaths in India occur in a few states, including the eight Empowered Action Group (EAG) states (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, and Uttarakhand), and Assam. For instance, the MMR reported for Assam (state which has the highest MMR) was 215 in 2017-18 which is five times higher than that of Kerala (43), which has the least MMR of all states. Most of the maternal deaths are due to direct causes and are largely preventable and treatable. There was a consistent reduction in MMR as a result of a number of interventions and programmes including Janani Suraksha Yojana (JSY) which helped in surging institutional deliveries.

Trends in maternal mortality in India over two decades in nationally representative surveys.

ObjectiveTo assess national and regional trends and causes‐specific distribution of maternal mortality in India.DesignNationally representative cross‐sectional surveys.SettingAll of India from 1997 to 2020.SampleAbout 10 000 maternal deaths among 4.3 million live births over two decades.MethodsWe analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15–49 years) and live birth totals, based on the 2001–2014 Million Death Study to United Nations (UN) demographic totals for the country.Main outcome measuresMaternal mortality burden and distribution of causes.ResultsThe MMR declined in India by about 70% from 398/100 000 live births (95% CI 378–417) in 1997–98 to 99/100 000 (90–108) in 2020. About 1.30 million (95% CI 1.26–1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700–26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20–29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India’s 2016–2018 estimate of 113 (95% CI 103–123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north‐eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy‐related infection (12%) and hypertensive disorders of pregnancy (7%).ConclusionsIndia could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.Tweetable abstractWe estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Trends of maternal mortality by hemorrhage, avoidable tragedy? Maternity “Concepción Palacios” 1939-2020

A descriptive, retrospective, and analytical study was carried out, a documentary research type, under a mixed paradigm to analyze the historical evolution of maternal mortality (MM) due to obstetric hemorrhage in the “Concepción Palacios” Maternity.

MATERNAL MORTALITY AND ITS RELATIONSHIP WITH HEALTHCARE WORKERS' KNOWLEDGE - AN EVALUATION OF HOSPITALS IN TABUK PROVINCE, KINGDOM OF SAUDI ARABIA

Recently, the Kingdom of Saudi Arabia, has witnessed a progressive decrease in maternal mortality rate. A study conducted by (Najimudeen, M. et al, 2018), reveal that, the reduction of maternal mortality rates in the community is envisaged through greater patient acceptance of medical advice, family spacing and proficient obstetric services. The main objective of the current study is to examine the trends of maternal mortality rate per 10,000 live births during a 10-years period (2005 – 2014), and to assess the reporting of maternal mortality trends at Tabuk region hospitals, in Saudi Arabia. Methods: The descriptive approach was used to collect data needed, using two questionnaire methods, RAMOS questionnaire with sample size (34) cases of maternal mortality. Descriptive and inferential statistics techniques used for data analysis by using (SPSS) version 20. Findings: The study concluded that the majority of deaths among reproductive women have happened for normal reasons, the study showed that around 88.0% of maternal deaths at the age category (25-44) years, and the MMR during the period (2005-to 2014) is reaching 12.2% for (106,326) of live birth. The results reveal that, there is a statistically significant positive association between maternal death registration reports and healthcare workers' knowledge in most hospitals. Conclusion: The study concluded that there is underreporting of maternal mortality index. The study recommended that it is necessary to improve the maternal mortality registration via supporting registration systems and biostatistics and use of customized calculators creating a system for maternal mortality registration to report about maternal mortality deaths and developing a committee to monitor and follow maternal mortality registration. &#x0D; &#x0D; &lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0780/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Analysis of maternal mortality trend and age-period-cohort model in China from 1992 to 2017

Objective: To understand the trend of maternal mortality in China from 1992 to 2017, and to evaluate the effects of age, period and cohort of maternal mortality by using the age-period-cohort (APC) model. Methods: The data of maternal mortality in China from 1992 to 2017 were collected from the Global Burden of Disease project. The maternal mortality rate was adopted to describe the trend of death. The APC model and the estimable function algorithm were used to evaluate the impact of age, period and birth cohort factors on maternal mortality risk in China. Results: From1992 to 2017, the maternal mortality rate in China fluctuated slightly and then continued to decline and finally increased slightly. During this period, the net drift was -10.00% per year (95%CI:-10.92% to -9.08% per year), and all the local drifts were lower than zero in all age groups of 10-54 years old (P<0.05). The results of the APC model analysis showed that the maternal mortality risk of women in their life stage showed a trend of rapid decrease, then a slow climb and finally a rapid increase. The period relative risk and cohort relative risk of maternal mortality both showed a monotonous decreasing trend. Conclusion: From 1992 to 2017, the maternal mortality rate in China generally shows a downward trend, and the risk of maternal mortality has significant age, period and cohort effects.

Pro-poor policies and improvements in maternal health outcomes in India

BackgroundSince 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997–2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India.MethodsThis study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015–16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India.ResultsOn an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors.ConclusionsThe novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India’s impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors.

Maternal Mortality Levels and Trends in Nepal: A Brief Update.

Recently revised estimates of levels and trends of maternal mortality based on three sources are reviewed and trajectory for reaching the mortality reducing target by 2030 is assessed. According to the estimates provided by the UN Maternal Mortality Inter-agency Group (MMEIG), the maternal mortality ratio (MMR) started from a high of 901 in 1990, dropping to 258 in 2015, or a reduction of 71% over the 25 year period. Between 2000 and 2015, MMEIG estimates showed a reduction of 53%. The MMR is targeted to be reduced to at least to 70 by 2030. This implies a reduction of 73%, which is considerably higher than the reduction recorded during the earlier (2000-2015) period (which was 53%), or annualized rate of decline of 8.7% v 5.0%. Therefore, the future trajectory warrants undertaking strategic interventions more intensively than what may have been hitherto. Concurrently, more attention also needs to be given to strengthening the recording and reporting of maternal deaths. Keywords: levels and trends; maternal mortality; Nepal; projections.