WorldWideScience

Sample records for preventable maternal mortality

  1. Postpartum haemorrhage: a preventable cause of maternal mortality

    International Nuclear Information System (INIS)

    Shaheen, B.; Hassan, L.

    2007-01-01

    To assess the preventable predictors of severe postpartum haemorrhage and the adverse outcome associated with it. All the admitted patients who developed severe postpartum haemorrhage (>1500 ml) were included in the study. Clinical and sociodemographic data was obtained along with results of investigations to categorize the complications encountered. Odds ratio (OR) and 95% confidence intervals were determined. During the study period, 75 out of 4683 obstetrical admissions, developed severe postpartum haemorrhage (1.6 %). About 65% of the patients were admitted with some other complications including obstructed labour, antepartum haemorrhage and eclampsia. The risk factors were grand multiparity (OR=3.4), pre-eclampsia (OR=2.75), antepartum haemorrhage (OR=13.35), active labour of more than 10 hours (OR=46.92), twin delivery (OR=3.25), instrumental delivery (OR=8.62) and caesarean section (OR=9.74). Maternal mortality in these cases was 2.66% and residual morbidity being 40%. Birth attendant other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Maternal outcome associated with postpartum haemorrhage is a function of care given during labour and postnatal period with early diagnosis and management of the complication and its risk factors, being the key of good maternal outcome. (author)

  2. Maternal early warning systems-Towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness.

    Science.gov (United States)

    Zuckerwise, Lisa C; Lipkind, Heather S

    2017-04-01

    Despite increasing awareness of obstetric safety initiatives, maternal mortality and severe maternal morbidity in the United States have continued to increase over the past 20 years. Since results from large-scale surveillance programs suggest that up to 50% of maternal deaths may be preventable, new efforts are focused on developing and testing early warning systems for the obstetric population. Early warning systems are a set of specific clinical signs or symptoms that trigger the awareness of risk and an urgent patient evaluation, with the goal of reducing severe morbidity and mortality through timely diagnosis and treatment. Early warning systems have proven effective at predicting and reducing mortality and severe morbidity in medical, surgical, and critical care patient populations; however, there has been limited research on how to adapt these tools for use in the obstetric population, where physiologic changes of pregnancy render them inadequate. In this article, we review the available obstetric early warning systems and present evidence for their use in reducing maternal mortality and severe maternal morbidity. We also discuss considerations and strategies for implementation and acceptance of these early warning systems for clinical use in obstetrics. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Autopsy as a tool in the prevention of maternal mortality | Daramola ...

    African Journals Online (AJOL)

    Maternal mortality rates are an index of the state of a nation's health system. Maternal autopsies help to determine these rates, provide information on avoidable/unavoidable causes of mortality, consequently leading to the development of strategies for treatment and prevention ofmaternalmortality andmorbidity. The lesson ...

  4. Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

    Science.gov (United States)

    2014-01-01

    Background Bangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh. Methods Using data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions. Results Using project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births. Conclusion This theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further

  5. Maternal Mortality in Texas.

    Science.gov (United States)

    Baeva, Sonia; Archer, Natalie P; Ruggiero, Karen; Hall, Manda; Stagg, Julie; Interis, Evelyn Coronado; Vega, Rachelle; Delgado, Evelyn; Hellerstedt, John; Hankins, Gary; Hollier, Lisa M

    2017-05-01

    A commentary on maternal mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that maternal mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the maternal mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying maternal death are also discussed, as well as risk factors and causes of maternal death in Texas. Finally, several state efforts currently underway to address maternal mortality in Texas are described. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Classification differences and maternal mortality

    DEFF Research Database (Denmark)

    Salanave, B; Bouvier-Colle, M H; Varnoux, N

    1999-01-01

    of experts into obstetric or non-obstetric causes. An ICD-9 code (International Classification of Diseases) was attributed to each case. These were compared to the codes given in each country. Correction indices were calculated, giving new estimates of maternal mortality rates. SUBJECTS: There were....... This change was substantial in three countries (P mortality rate for participating countries was 7.7 per...... and consequently affect maternal mortality rates. Differences in classification of death must be taken into account when comparing maternal mortality rates, as well as differences in obstetric care, underreporting of maternal deaths and other factors such as the age distribution of mothers....

  7. Empowering members of a rural southern community in Nigeria to plan to take action to prevent maternal mortality: A participatory action research project.

    Science.gov (United States)

    Esienumoh, Ekpoanwan E; Allotey, Janette; Waterman, Heather

    2018-03-01

    To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In this article, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Participatory action research was utilized. Twelve volunteers were recruited as co-researchers into the study through purposive and snowball sampling who, following an orientation workshop, undertook participatory qualitative data collection with an additional 29 community members. Participatory thematic analysis of the data was undertaken which formed the basis of the plan of action. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Interventions to prevent maternal deaths should include community empowerment to have better understanding of their circumstances as well as their collaboration with

  8. Maternal mortality: a global overview.

    Science.gov (United States)

    Choolani, M; Ratnam, S S

    1995-02-01

    Reduction of maternal mortality in developing countries is possible through elimination of unsafe abortion, active management of labor, appropriate management of pregnancy complications, and availability of adequate facilities. Prevention and early recognition are key factors in preventing maternal deaths due to ruptured uteri. A well equipped hospital is the appropriate place for delivery of mothers with a history of previous cesarean sections, a grossly contracted pelvis, previous myomectomies, previous multiple births, and previous abnormal births or complications during delivery. Complicated procedures, use of oxytocins, and administration of anesthesia should be performed with experienced, trained medical personnel. Surveillance of and correction for anemia should occur during the course of the pregnancy. Infections can be controlled with tetanus toxoid immunization and use of chest X-rays. The health care system should be tiered with primary health care services located in suburbs and rural districts. Services should be situated to account for population distribution, extent of maternal mortality in the region, transportation facilities, and the nearest secondary hospital. Birthing homes with sanitary facilities are an option for rural districts. A two-way referral system should be established between the primary, secondary, and tertiary level hospitals. Audits should be conducted as a means of checking for needed improvements in the system. Planning that includes proper roads, transportation, and communication facilities is important. Funding can come in the form of money, materials, and manpower. Safe motherhood requires the commitment of local people and local governments. The first step in a safe motherhood program is creating awareness among the political and economic elite. Governments are encouraged to shift resources from the military to housing, transportation, communications, education, and health during peace-times. Local professional associations

  9. New paradigm old thinking: the case for emergency obstetric care in the prevention of maternal mortality in Nigeria

    Directory of Open Access Journals (Sweden)

    Esimai Olapeju A

    2010-02-01

    Full Text Available Abstract Background The continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC and investigated the contents of antenatal care (ANC counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria. Methods The study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers employed in the maternity units of all the public health facilities (n = 22 offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics. Results Ninety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS. Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the

  10. New paradigm old thinking: The case for emergency obstetric care in the prevention of maternal mortality in Nigeria.

    Science.gov (United States)

    Ijadunola, Kayode T; Ijadunola, Macellina Y; Esimai, Olapeju A; Abiona, Titilayo C

    2010-02-17

    The continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria. The study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics. Ninety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant

  11. EDITORIAL UNSAFE ABORTION AND MATERNAL MORTALITY: IS ...

    African Journals Online (AJOL)

    hi-tech

    February 2004. EAST AFRICAN MEDICAL JOURNAL. 61. EDITORIAL. UNSAFE ABORTION AND MATERNAL MORTALITY: IS AFRICA PREPARED. TO FACE THE REALITY? Sub-Saharan Africa has, by far, the highest maternal mortality ratio today. It is estimated that the risk of dying from pregnancy-related cause for a girl ...

  12. Maternal mortality among migrants in Western Europe

    DEFF Research Database (Denmark)

    Pedersen, Grete Skøtt; Grøntved, Anders; Mortensen, Laust Hvas

    2014-01-01

    To examine whether an excess risk of maternal mortality exists among migrant women in Western Europe. We searched electronic databases for studies published 1970 through 2013 for all observational studies comparing maternal mortality between the host country and a defined migrant population...

  13. Reducing Maternal Mortality by Strengthening Community Maternal ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    translated from Hausa to English language. Using a pre-determined coding framework, coding and thematic analyses were carried out on the qualitative data collected from the baseline. LGA. Community. Estimated. Community. Population. Community maternal support systems established. Community savings. Emergency.

  14. Maternal mortality – a public health problem

    Directory of Open Access Journals (Sweden)

    Sonia Shirin

    2012-07-01

    Full Text Available Maternal mortality is an important indicator which reflects the health status of a community. It can be calculated by maternal mortality ratio (MMR, maternal mortality rate (MMRate, and adult life time risk of maternal death. MMR estimates are based on varieties of methods that include household surveys, sisterhood methods, reproductive-age mortality studies (RAMOS, verbal autopsies and censuses. Main causes of maternal mortality are hemorrhage, infection, unsafe abortion, hypertensive disorder of pregnancy and obstructed labour. Factors of maternal mortality have been conceptualized by three delays model. Estimates of maternal mortality ratio (MMR trend between 1990 and 2010 (over 20 years period suggest a global reduction (47%, with a greater reduction in developing countries (47% including Bangladesh than in developed countries (39%. However, to meet the challenge of Fifth Millennium Development Goal (MDG5 i.e. to ensure 75% reduction of MMR by the year 2015, the annual rate of MMR decline and increase of skilled attendant at birth need to be still faster. Ibrahim Med. Coll. J. 2012; 6(2: 64-69

  15. Maternal mortality ratio in a Tertiary Hospital offering free maternity ...

    African Journals Online (AJOL)

    AbstRACt. Aim: To determine annual trends of maternal mortality ratio in a tertiary hospital offering free maternity services. settings and Design: This retrospective descriptive study was conducted at the Mother and Child Hospital Akure, Ondo. State, a busy purpose‑built tertiary care facility premised on evidence‑based ...

  16. Trends in maternal mortality for the Greater Harare Maternity Unit ...

    African Journals Online (AJOL)

    Trends in maternal mortality for the Greater Harare Maternity Unit: 1976 to 1996. F Majoko, T Chipato, V Illif. Abstract. No Abstract. Central African Journal of Medicine Vol. 47 (8) 2001: pp. 199-202. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  17. Maternal Mortality in a Nigerian Maternity Hospital | Olopade ...

    African Journals Online (AJOL)

    It is necessary to improve the quality of emergency obstetric service as well as reduce the cost and to educate women of reproductive age in Ibadan on the importance of booking for antenatal care and family planning. (Afr. J. Biomed. Res. 11: 267 - 273). Key words: Maternal mortality, case-control study, maternal death, ...

  18. Maternal Morbidity and Mortality: Identifying Opportunities to Improve Clinical Outcomes.

    Science.gov (United States)

    Witcher, Patricia M; Sisson, Melissa C

    2015-01-01

    A better understanding of why women die during pregnancy, childbirth, or postpartum offers valuable insight into strategies aimed at preventing maternal deaths and arresting the progression in the severity of a complication. The rate of severe maternal morbidity and maternal mortality in the United States has been trending upward in recent years and has garnered national attention with concentration on bolstering reviews of maternal deaths and implementing patient safety initiatives. The obstetric nurse is in a unique position to improve maternal outcomes through the anticipation, recognition, and communication of the early warning signs of impending deterioration in maternal condition. Presented in the context of the conceptual model of Stephen Covey's Circle of Influence, the professional nurse can proactively influence maternal outcomes directly, with actions defined by the scope of professional nursing practice or indirectly through professional interactions with others. Advancing one's education, knowledge, and technical skills broadens the influential capacity.

  19. Campaign for the prevention of maternal mortality and morbidity. Abortion: we shall no longer be silent about it] Sixth call for action, International Day of Action for Women's Health, May 28, 1993.

    Science.gov (United States)

    1993-01-01

    The annual Campaign for the Prevention of Maternal Mortality and Morbidity to be held on May 28 will focus upon abortion-related maternal mortality with the goal of mobilizing women to discuss abortion and turn it into an issue of public debate. First, however, people must stop blaming women for abortion. People say women are responsible for abortion because they failed to use contraception, they had sexual intercourse outside of marriage, they were behaving immorally, and/or they violated religious precepts. However, blaming women for abortion simply denies reality. This paper explains what is known and not known about abortion and its related maternal morbidity and mortality, and counters some myths about the criminalization and legalization of abortion, religious prohibition of abortion, who has abortions, whether women will always be traumatized by an abortion, the health risks of induced abortion, and the need for abortion services. The history of the campaign is also described.

  20. Maternal Mortality in the United States

    Science.gov (United States)

    Lee, Anne S.

    1977-01-01

    Figures from 1800 through 1973 are used to demonstrate that black women have had substantially higher rates of death in childbirth than white women. As mortality has declined, the relative difference between whites and blacks has actually increased. Factors affecting mortality and future prospects for reducing maternal deaths are discussed. (GC)

  1. Maternal mortality audit in Suriname between 2010 and 2014, a reproductive age mortality survey.

    Science.gov (United States)

    Kodan, Lachmi R; Verschueren, Kim J C; van Roosmalen, Jos; Kanhai, Humphrey H H; Bloemenkamp, Kitty W M

    2017-08-29

    The fifth Millennium Development Goal (MDG-5) aimed to improve maternal health, targeting a maternal mortality ratio (MMR) reduction of 75% between 1990 and 2015. The objective of this study was to identify all maternal deaths in Suriname, determine the extent of underreporting, estimate the reduction, audit the maternal deaths and assess underlying causes and substandard care factors. A reproductive age mortality survey was conducted in Suriname (South-American upper-middle income country) between 2010 and 2014 to identify all maternal deaths in the country. MMR was compared to vital statistics and a previous confidential enquiry from 1991 to 1993 with a MMR 226. A maternal mortality committee audited the maternal deaths and identified underlying causes and substandard care factors. In the study period 65 maternal deaths were identified in 50,051 live births, indicating a MMR of 130 per 100.000 live births and implicating a 42% reduction of maternal deaths in the past 25 years. Vital registration indicated a MMR of 96, which marks underreporting of 26%. Maternal deaths mostly occurred in the urban hospitals (84%) and the causes were classified as direct (63%), indirect (32%) or unspecified (5%). Major underlying causes were obstetric and non-obstetric sepsis (27%) and haemorrhage (20%). Substandard care factors (95%) were mostly health professional related (80%) due to delay in diagnosis (59%), delay or wrong treatment (78%) or inadequate monitoring (59%). Substandard care factors most likely led to death in 47% of the cases. Despite the reduction in maternal mortality, Suriname did not reach MDG-5 in 2015. Steps to reach the Sustainable Development Goal in 2030 (MMR ≤ 70 per 100.000 live births) and eliminate preventable deaths include improving data surveillance, installing a maternal death review committee, and implementing national guidelines for prevention and management of major complications of pregnancy, childbirth and puerperium.

  2. [Human rights, maternal mortality and reproductive health].

    Science.gov (United States)

    Cook, R J

    1993-06-01

    This work examines reproductive health within the framework of human rights assured by various international conventions, and analyzes the high maternal mortality rates of developing countries as a violation of several guaranteed rights. The 1st of 3 main sections of the report discusses the failure of governments to make protection of women's reproductive health a priority. Historically, women's principal role has been to bear children, and no recognition was given to the cost in health of accomplishing this duty. Women's reproductive health has created controversies in many traditional juridical systems because of its relation to human sexuality and morals. WHO has estimated that some 500,000 maternal deaths occur each year, with 25-50% resulting from unsafe abortions. The causes of maternal mortality often have their roots in the poor nutrition or inadequate health care provided to the woman long before the 1st pregnancy. Early and frequent pregnancies and heavy physical labor are among the many factors that contribute to maternal death. Laws to protect women's health may be lacking or may not be applied. For example, many countries have no legal minimum age for marriage. To combat the traditional negligence, a new viewpoint is emerging which views women's reproductive health as a condition in which childbearing occurs in a state of physical, mental, and social wellbeing. It implies that women have the capacity to reproduce, regulate their fertility, and enjoy sexual relations. Laws that deny access to reproductive health services or place obstacles or conditions in the way are coming under question as violations of basic human rights of women protected by international conventions. The main such convention discussed in this article is the Convention on the Elimination of All Forms of Discrimination Against Women, although several other conventions are relevant to protecting women's reproductive health. If international law on human rights is to become truly

  3. Maternal Mortality Trend in Ethiopia

    African Journals Online (AJOL)

    Bernt Lindtjorn

    disappearing in recent studies while deaths due to HIV are appearing. Malaria is also noted in some of the regions as a major cause of maternal death. Malaria might be an important cause of MD in malarious areas. The increasing trend and no change in the case fatality rates documented for ruptured uterus/ obstructed ...

  4. Maternal Mortality in Women with Epilepsy

    LENUS (Irish Health Repository)

    Holohan, M

    2016-10-01

    It is estimated that, in Ireland, there are 10,000 women with epilepsy of childbearing potential1. In this paper the maternal mortality rate for women with epilepsy attending the Rotunda Hospital Epilepsy Clinic 2004 - 2013 was determined. There were 3 maternal deaths in women with epilepsy during this time, which represents a mortality rate of 0.8%. In those women who died, there were concerns in relation to risks to the foetus by taking Anti-Epileptic Drugs (AED) and also issues with access to neurology services before pregnancy, acceptance of specialist support and lack of consistency in advice from health care professionals outside of Ireland. Implementing the nationally agreed care plan for women with epilepsy will improve the quality of care given and potentially we will see a reduction in maternal mortality in these women.

  5. Determinants of Maternal Mortality in Eritrea.

    African Journals Online (AJOL)

    Eritrea, Demographic and Health survey, 2002. 2. National Statistics and Evaluation Office, Asmara, Eritrea and. ORC Macro, Calverton, Maryland, USA. Eritrea, Demographic and Health survey, 1997. 3. World Bank, Koblinsky M. Editor, Reducing Maternal Mortality. Learning from Bolivia, China, Egypt, Honduras, Indonesia,.

  6. Tackling maternal mortality in Africa after 2015

    African Journals Online (AJOL)

    AJRH Managing Editor

    daunting and unmet problem in development in sub-Saharan Africa after 2015. The countries which have recorded successes in reducing maternal mortality provide a glimmer of hope indicating that this goal ... address social justice and human development issues was the ... to address the problems of social inequity and.

  7. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study.

    Science.gov (United States)

    Almerie, Yara; Almerie, Muhammad Q; Matar, Hosam E; Shahrour, Yasser; Al Chamat, Ahmad Abo; Abdulsalam, Asmaa

    2010-10-19

    Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. There were 28,025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100,000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU). Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health

  8. Maternal Mortality in Nepal: Unraveling the Complexity

    Directory of Open Access Journals (Sweden)

    Suwal, Juhee V.

    2008-01-01

    Full Text Available EnglishMaternal mortality has been recognised as a public health problem in the developing countries. The situation concerning maternal mortality in Nepal remained unexplored and vague until the early 1990s. By using 1996 Nepal Family Health Survey, this study discusses the maternal mortality situation in Nepal and analyses the differentials in maternal mortality by place of residence,region, ethnic and religious groups, age at death, and parity. Almost 28 percent of deaths of women in reproductive age was accountable to maternal causes.Logistic regression analysis shows ‘ethnicity,’ ‘age of women,’ and ‘number of births’ as strong predictors of maternal mortality. A number of policy recommendations are suggested to help lower maternal mortality.FrenchLa mortalité liée à la maternité est un des phénomènes de santé qui a étéidentifié dans les pays en voie de développement. La situation de la mortalitéliée à la maternité au Népal est restée inexplorée et assez vague jusqu’au débutdes années 1990. En utilisant les données du Nepal Family Health Survey de1996, cet article examine la situation de la mortalité liée à la maternité au Népalet analyse les différentiels des taux de mortalité par lieu de résidence, région,groupe ethnique et religieux, âge au décès, et parité. Presque 28 pourcent desdécès de femmes en âge de procréer sont liés à la maternité. L’analyse derégression logique démontre que « l’ethnicité », « l’âge des femmes », et le« nombre de naissances » sont de forts prédicteurs du taux des mortalités liées àla maternité.

  9. Underreporting of maternal mortality in Taiwan: A data linkage study

    Directory of Open Access Journals (Sweden)

    Tung-Pi Wu

    2015-12-01

    Conclusion: Approximately two-thirds of the maternal deaths in Taiwan were unreported in the officially published mortality data. Hence, routine nationwide data linkage is essential to monitor maternal mortality in Taiwan accurately.

  10. Investigating Maternal Mortality in a Public Teaching Hospital ...

    African Journals Online (AJOL)

    Background: Maternal mortality in sub.Saharan Africa has remained high and this is a reflection of the poor quality of maternal services. Aim: To determine the causes, trends, and level of maternal mortality rate in Abakaliki, Ebonyi. Materials and Methods: This was a review of the records of all maternal deaths related to ...

  11. Maternal mortality in Denmark, 1985-1994

    DEFF Research Database (Denmark)

    Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit

    2008-01-01

    OBJECTIVES: In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them...... of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. RESULTS: 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from...

  12. Trends and Causes of Maternal Mortality at the Wa Regional ...

    African Journals Online (AJOL)

    2016-05-01

    May 1, 2016 ... a comprehensive maternal mortality audit at the Wa Regional Hospital in order to discover the trends and causes of maternal mortality at the hospital, and suggest ways of improving the situation. The study involved a retrospective examination of maternal mortality cases from January. 1, 2005 to December ...

  13. Maternal mortality and morbidity in the developing countries like India.

    Science.gov (United States)

    Coyaji, B J

    1991-01-01

    Safe motherhood will require a multi-faceted strategy of improving girls' education and employment opportunities, providing primary and reproductive health care for women, taking a high risk approach with referral for all at-risk pregnant women, and including maternal mortality as part of the quality of life index. The World Health Organization in 1986 reported that 99% of maternal mortality occurred in developing countries: 640 per 100,000 live births in Africa, 420/100,000 in Asia, 270/100,000 in Latin America, 100/100,000 in Oceania, 450/100,000 in developing countries on average, and 30/100,000 in developed countries. The chances of maternal death ranges in the extremes from 1/9850 in northern Europe to 1/21 in Africa. In India, the chance of maternal mortality was estimated at 1/18; the surviving also might suffer from perineal tears, genital infections, uterovaginal prolapse, and vesico-vaginal fistula. Direct obstetric causes include those directly related to pregnancy, labor, and the postpartum period. Indirect causes include those resulting from previous existing diseases that were aggravated by the pregnancy. 75% of maternal mortality was caused by hemorrhage, obstructed labor, infection, eclampsia, and abortion. Proper handling could prevent maternal mortality in an estimated 63-80% of direct causes and 88-98% of all causes. Risk factors for postpartum hemorrhage include multiparity, age over 35 years with stretched uterus, and slight episodes of bleeding. Treatment must be immediate and sustained with oxytocic drugs and plasma expanders; the means of referral to an equipped facility must be available to women with hemorrhage. Risk factors for obstructed labor include very young age, height below 145 cms, previous prolonged labor or stillbirth, and previous cesarean, abnormal presentation, or labor progression. Delivery for these women must be in a facility offering trained doctors and well-equipped operating rooms. Prevention of infection is possible

  14. Trends and factors associated with maternal mortality in Abakaliki ...

    African Journals Online (AJOL)

    Maternal health indices are poor in Nigeria. Regular audit of maternal deaths is vital to planning and maternal care delivery. The aim of the study was ... especially immediate postpartum are advocated to reduce maternal mortality to the barest minimum in Nigeria. Keywords: trend, maternal death, delay, unbooked, referral.

  15. Maternal education and child mortality in Zimbabwe.

    Science.gov (United States)

    Grépin, Karen A; Bharadwaj, Prashant

    2015-12-01

    In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policies were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Maternal mortality in India: current status and strategies for reduction.

    Science.gov (United States)

    Prakash, A; Swain, S; Seth, A

    1991-12-01

    The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the

  17. A review of maternal mortality at Jimma Hospital, Southwestern ...

    African Journals Online (AJOL)

    A retrospective review of hospital maternal deaths at Jimma Hospital, Southwestern Ethiopia, covering the period from September 1990 to May 1999 was conducted with the objectives of determining the overall maternal mortality rate, observing trend of maternal mortality during the period, and identifying major causes of ...

  18. Pattern of Maternal Mortality in A General Hospital, South Western ...

    African Journals Online (AJOL)

    Type III delay, low literacy level and low utilization of antenatal services were associated with maternal death. There is need to put in place a sustainable, timely and sfae blood ... 5 that is reduction of maternal mortality in a general hospital set up. Keywords: Maternal Mortality, Audit, Haemorrhage, Induce abortion, illiteracy.

  19. Estimation of maternal mortality using the indirect sisterhood method ...

    African Journals Online (AJOL)

    FinePrint

    is also useful for monitoring the trends of maternal mortality and evaluating the impact of safe motherhood initiative and improving maternal survival and achieving the MDGs. REFERENCES. 1. Lech M and Zwane A. Survey on maternal mortality in Swaziland using the Sisterhood method. Paedr Perinat Epidemiol; 2002: 16:.

  20. Contribution of indirect obstetric deaths to maternal mortality at ...

    African Journals Online (AJOL)

    Introduction: Maternal death is unacceptably high in this center like in most centers in the developing world. Objective: To determine the maternal mortality ratio and the contribution of the direct and indirect obstetric complications to maternal deaths. Method: A retrospective review of all maternal deaths at Nnamdi Azikiwe ...

  1. STUDY OF MATERNAL MORTALITY AT A TERTIARY REFERRAL CENTER

    Directory of Open Access Journals (Sweden)

    Padmanalini Potula

    2017-12-01

    Full Text Available BACKGROUND Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the causes of maternal mortality. MATERIALS AND METHODS This is a longitudinal prospective study. Study group: consisting of 50 cases of maternal deaths. Study period: 13 months i.e., from November 2016 to November 2017. This study was carried out at Government general hospital Kakinada attached to Rangaraya Medical College, Kakinada. RESULTS In this study, 10% maternal deaths seen in 1st trimester of pregnancy. 10% maternal deaths before delivery. 80% maternal deaths occurred after delivery. Among these, 60% maternal deaths after lower segment caesarean section. 20% maternal deaths after normal vaginal delivery. In this study, direct causes of maternal mortality 66%. Among these: preeclampsia - 15 cases (30%, Haemorrhage - 9 cases (18%, Infections – 4 cases (8%. Indirect causes of maternal mortality 34%. In these Anaemia – 4 cases (8%, Jaundice – 4 cases (8%. 60% maternal deaths are referral cases. CONCLUSION In our hospital, maternal mortality rate is 437 per 100,000 live births. It is very high because, in this center most of the cases. About 60% are referral cases from surrounding area. Unbooked cases are 74%. Most of cases about 70% cases are from rural area. Among these, 80% maternal deaths occurred after delivery. 60% maternal deaths occurred after lower segment caesarean section. 20% maternal deaths occurred after vaginal delivery. In this study 66% maternal deaths occurred because of direct cause. Among these Preeclampsia (15 cases - 30%, Haemorrhage (9 cases - 18%, Infection (4 cases - 8%. In our study indirect causes of maternal deaths 34%. Among these, anaemia (4 cases - 8%, jaundice (4 cases - 8%.

  2. Audit of Maternal Mortality Ratio and Causes of Maternal Deaths in ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    This study examined maternal deaths at Cairo University Maternity Hospital between January 2008 and December 2009. The aim was to calculate Maternal Mortality Ratio (MMR) as well as identify the causes and predisposing factors to maternal deaths. Data were collected from the files of the hospitalized pregnant women ...

  3. Maternal Obesity: Consequences and Prevention Strategies

    Directory of Open Access Journals (Sweden)

    Emre Yanikkerem

    2012-06-01

    Full Text Available Obesity is a medical condition in which excess body fat that it may have an adverse effect on health, leading to life expectancy and increased health problems. In keeping with the general international trend of rising prevalence of obesity, maternal obesity prevalence is rising. According to WHO, the prevalence of obesity in pregnancy ranges from 1.8 to 25.3%. Maternal obesity has been identified to be a risk factor for maternal and perinatal mortality. The aim of this article was reviewed in research about maternal obesity in Pubmed, which published between 2009 and 2010. 7 reviews and 13 studies was examined and they presented under this headings: impacts of maternal obesity in pregnancy, obstetric outcomes of maternal obesity, postpartum outcomes of maternal obesity, impact of maternal obesity on breastfeeding, impact of maternal obesity on procedure of anomaly scan and risk determination, maternal obesity and fetal complications, impact of maternal obesity on Apgar scores, obesity and infertility, pregnancy following bariatric surgery, long term effects of obesity, management of maternal obesity. [TAF Prev Med Bull 2012; 11(3.000: 353-364

  4. Contribution of ruptured uterus to maternal mortality in rural South ...

    African Journals Online (AJOL)

    Context: Maternal mortality statistics in Nigeria derive mainly from urban based hospital data. In rural areas of the country where available medical facilities and trained medical personnel are inadequate, the incidence, and major causes of maternal death may differ. Aims and Objectives: To provide information on maternal ...

  5. Maternal Mortality In Imo State University Teaching Hospital, Orlu: A ...

    African Journals Online (AJOL)

    Conclusion: The tragedy of maternal death continues unabated. Most deaths were avoidable. The government needs to show strong commitment to reducing maternal mortality. Measures suggested include free maternity services, legalisation of abortion, training of midwives, improved family planning services and strategic ...

  6. Maternal mortality audit in a tertiary health institution in Nigeria ...

    African Journals Online (AJOL)

    Introduction: Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital. Materials and Methods: It was a prospective audit of all consecutive maternal deaths in the hospital over a ...

  7. Factors Contributing to Maternal Mortality in Uganda | Atuhaire ...

    African Journals Online (AJOL)

    Maternal education, especially at secondary and tertiary levels increases the likelihood of using and attending ANC hence reducing maternal mortality. The study recommends that the government of Uganda and other stakeholders should increase efforts to enhance female education to attain favorable maternal health ...

  8. Maternal Mortality at Federal Medical Centre Yola, Adamawa State ...

    African Journals Online (AJOL)

    stoicism during labor and delivery. Serious complications could therefore be concealed by this misplaced stoicism, leading to maternal mortality.[13]. It is universally accepted that non‑attendance of antenatal care (ANC) is associated with high maternal mortality.[8]. Twenty‑five percent each of our cases booked at the FMCY ...

  9. Trends in Maternal Mortality at the Lagos University Teaching ...

    African Journals Online (AJOL)

    Background: Recent reports suggest that the burden of maternal mortality remains heavy in Sub-Saharan Africa; and that the fifth millennium development goal might not be achieved. As the target date 2015 draws near, we carried out a review of maternal mortality in a Teaching Hospital unit to assess the current situation.

  10. Maternal Mortality At The State Specialist Hospital Bauchi, Northern ...

    African Journals Online (AJOL)

    Objective: To analyse and document our experiences with maternal mortality with the view of finding the trends over the last seven years, common causes and attributing socio-demographic factors. Design: A prospective analysis of maternal mortality. Setting: State Specialists Hospital Bauchi, Bauchi Northeastern Nigeria.

  11. Eclapmsia: The major cause of maternal mortality in eastern India ...

    African Journals Online (AJOL)

    In spite of several global and regional interventions and initiatives from governments and other concerned agencies, maternal mortality is still very high in India, with eclampsia as a major cause. This study was conducted to determine the mode of deaths and incidence of maternal mortality associated with eclampsia and to ...

  12. Predictors of maternal mortality among women of reproductive age ...

    African Journals Online (AJOL)

    Predictors of maternal mortality among women of reproductive age seeking health care services at Kisii Level 5 Hospital. ... lack of access to quality care, poor health infrastructure, women empowerment and socio-economic issues. Key words: Maternal mortality, Quality of care, Women empowerment, Health infrastructure ...

  13. The struggle to reduce high maternal mortality in Nigeria | Harrison ...

    African Journals Online (AJOL)

    According to UNICEF estimates for Nigeria, maternal mortality ratio is 1100 per 100,000 live births, antenatal care coverage 47 percent, institutional delivery rate 33 percent, and each woman bears six children on the average. Reducing the high maternal mortality ratio, which is the prime concern, has hitherto concentrated ...

  14. An equity analysis of maternal mortality in Malawi

    African Journals Online (AJOL)

    Background: Malawi has one of the highest maternal mortality ratios (MMR) in the world at 1,120 per 100,000 live births. Maternal mortality is therefore a priority issue for the Ministry of Health. The Health Sector Wide Approach (SWAp) Equity and Access Subgroup commissioned a synthesis study to explore issues of ...

  15. Rising trend in maternal mortality at the university of Maiduguri ...

    African Journals Online (AJOL)

    Context: Various interventions have been introduced to reduce the very high maternal mortality ratio in our environmentbut to date the success is only marginal at best. Objective: To determine the trend in maternal mortality in University of Maiduguri Teaching Hospital (UMTH). Methods: Analysis of records of all women who ...

  16. Causes of Maternal Mortality in Ethiopia: A Significant Decline in ...

    African Journals Online (AJOL)

    BACKGROUND: Although the common direct obstetric causes of maternal mortality are known from the literature, the contribution of each cause and the change in trend over decades is unknown in Ethiopia. The objective of this review was to assess the trend of proportion of maternal mortality due to the common direct ...

  17. Maternal vaccination to prevent pertussis in infants

    African Journals Online (AJOL)

    2016-09-09

    Sep 9, 2016 ... that maternal immunisation with the Tdap (tetanus, diphtheria and acellular pertussis) vaccine is safe. Indeed, maternal vaccination is now recommended to prevent pertussis infection in vulnerable young infants. In the USA and UK, the immunisation of pregnant women with a Tdap or dTaP/IPV (diphtheria, ...

  18. A ten year audit of maternal mortality: Millennium development still a distant goal

    Directory of Open Access Journals (Sweden)

    Anshuja Singla

    2017-01-01

    Full Text Available Objective: To assess various causes of maternal mortality over a ten year period Design: Retrospective audit of hospital case records Setting: Tertiary care hospital Population: Pregnant women who expired in the premises of GTB Hospital. Materials and Methods: A retrospective audit of case records of maternal deaths was conducted for a ten year period (January 2005 to December 2014. Results: There were a total of 647 maternal deaths out of 1,16,641 live births. Sixty-eight percent (n = 445 of women were aged 21-30 years, while 10.5% (n = 68 were <20 years of age. The most common direct causes of maternal mortality were preeclampsia/eclampsia in 24.4% (n = 158, obstetric hemorrhage in 19.1% (n = 124 and puerperal sepsis in 14.5% (n = 94. With regards to indirect causes, anemia accounted for 15.3% (n = 99 mortality. There was only 1 (0.1% mortality because of HIV/AIDS. Other notable causes of maternal mortality were infective hepatitis in 7.1% (n = 46. Tuberculosis, that is a disease of tropical countries, accounted for 3.0% (n = 20 of the total deaths. Conclusion: High maternal mortality in GTB hospital can be due to it being a tertiary hospital with referrals from all neighbouring states. Accessible antenatal care can help prevent these maternal deaths. Female education can be of immense help in dealing with the problem and improving the utilization of public health facilities.

  19. Information management in Iranian Maternal Mortality Surveillance System.

    Science.gov (United States)

    Sadoughi, Farahnaz; Karimi, Afsaneh; Erfannia, Leila

    2017-07-01

    Maternal mortality is preventable by proper information management and is the main target of the Maternal Mortality Surveillance System (MMSS). This study aimed to determine the status of information management in the Iranian Maternal Mortality Surveillance System (IMMSS). The population of this descriptive and analytical study, which was conducted in 2016, included 96 administrative staff of health and treatment deputies of universities of medical sciences and the Ministry of Health in Iran. Data were gathered by a five-part questionnaire with confirmed validity and reliability. A total of 76 questionnaires were completed, and data were analyzed using SPSS software, version 19, by descriptive and inferential statistics. The relationship between variables "organizational unit" and the four studied axes was studied using Kendall's correlation coefficient test. The status of information management in IMMSS was desirable. Data gathering and storage axis and data processing and compilation axis achieved the highest (2.7±0.46) and the lowest (2.4±0.49) mean scores, respectively. The data-gathering method, control of a sample of women deaths in reproductive age in the universities of medical sciences, use of international classification of disease, and use of this system information by management teams to set resources allocation achieved the lowest mean scores in studied axes. Treatment deputy staff had a more positive attitude toward the status of information management of IMMSS than the health deputy staff (p=0.004). Although the status of information management in IMMSS was desirable, it could be improved by modification of the data-gathering method; creating communication links between different data resources; a periodic sample control of women deaths in reproductive age in the universities of medical sciences; and implementing ICD-MM and integration of its rules on a unified system of death.

  20. Female education and maternal mortality: a worldwide survey.

    Science.gov (United States)

    McAlister, Chryssa; Baskett, Thomas F

    2006-11-01

    In terms of social and political development, women's human rights have not evolved in many developing countries to the same extent as they have in the developed world. We examined the relationship between women's status and human development and maternal mortality. Using polynomial regression analysis with a sample of 148 countries, we investigated the impact of gender-related predictors, including education, political activity, economic status, and health, and human development predictors, such as infant mortality and Human Development Index, using data from the United Nations Human Development Report 2003. The Human Development Index and Gender Development Index are powerful predictors of both maternal and infant mortality rates. Female literacy rate and combined enrolment in educational programs are moderate predictors of maternal mortality rates. Strategic investment to improve quality of life through female education will have the greatest impact on maternal mortality reduction.

  1. An appraisal of the maternal mortality decline in Nepal.

    Directory of Open Access Journals (Sweden)

    Julia Hussein

    Full Text Available BACKGROUND: A decline in the national maternal mortality ratio in Nepal has been observed from surveys conducted between 1996 and 2008. This paper aims to assess the plausibility of the decline and to identify drivers of change. METHODS: National and sub-national trends in mortality data were investigated using existing demographic and health surveys and maternal mortality and morbidity surveys. Potential drivers of the variation in maternal mortality between districts were identified by regressing district-level indicators from the Nepal demographic health surveys against maternal mortality estimates. RESULTS: A statistically significant decline of the maternal mortality ratio from 539 maternal deaths to 281 per 100,000 (95% CI 91,507 live births between 1993 and 2003 was demonstrated. The sub-national changes are of similar magnitude and direction to those observed nationally, and in the terai region (plains the differences are statistically significant with a reduction of 361 per 100,000 live births (95% CI 36,686 during the same time period. The reduction in fertility, changes in education and wealth, improvements in components of the human development index, gender empowerment and anaemia each explained more than 10% of the district variation in maternal mortality. A number of limitations in each of the data sources used were identified. Of these, the most important relate to the underestimation of numbers of deaths. CONCLUSION: It is likely that there has been a decline in Nepal's maternal mortality since 1993. This is good news for the country's sustained commitments in this area. Conclusions on the magnitude, pattern of the change and drivers of the decline are constrained by lack of data. We recommend close tracking of maternal mortality and its determinants in Nepal, attention to the communication of future estimates, and various options for bridging data gaps.

  2. Global justice, poverty and maternal mortality

    Directory of Open Access Journals (Sweden)

    Flor de María Cáceres M

    2010-11-01

    Full Text Available Global justice is currently situated in an ambiance of tension and debate, facing a series of statements attempting to explain relationships among countries, based on the background of agreements already accomplished by supranational agencies. This network of relationships, not always fair nor equitable, has resulted in an increased accumulation of wealth in just a few hands and poverty in a growing number of people in poor countries and geographic areas with restrictions to access both to resources and to technological and scientific advances. Poverty, exclusion and inequalities limit all together the opportunities for development in these communities, with the outcome of serious consequences such as the deterioration in basic indicators of development. Maternal mortality rate (mm is considered a sentinel indicator since it belongs in most cases to premature deaths which would be avoidable through proper measures in education, health promotion and timely access to quality health services. The purpose of this essay is to defend the thesis that the lack of global justice has limited the scope of the goals related to poverty and mm reduction

  3. Improving the measurement of maternal mortality: the sisterhood method revisited.

    Directory of Open Access Journals (Sweden)

    Leena Merdad

    Full Text Available BACKGROUND: Over the past several decades the efforts to improve maternal survival and the consequent demand for accurate estimates of maternal mortality have increased. However, measuring maternal mortality remains a difficult task especially in developing countries with weak information systems. Sibling histories included in household surveys (most notably the Demographic and Health Surveys (DHS have emerged as an important source of maternal mortality data. Data have been mainly collected from women and have not been widely collected from men due to concerns about data quality. We assess data quality of histories obtained from men and the potential to improve the efficiency of surveys measuring maternal mortality by collecting such data. METHODS AND FINDINGS: We used data from 10 Demographic and Health Surveys (DHS that have included a full sibling history in both their women's and men's questionnaires. We estimated adult and maternal mortality indicators from histories obtained from men and women. We assessed the completeness and accuracy of these histories using several indicators of data quality. Our study finds that mortality estimates based on sibling histories obtained from men do not systematically or significantly differ from those obtained from women. Quality indicators were similar when comparing data from men and women. Pooling data obtained from men and women produced narrower confidence intervals. CONCLUSION: From experience across nine developing countries, sibling history data obtained from men appear to be a reliable source of information on adult and maternal mortality. Given that there are no significant differences between mortality estimates based on data obtained from men and women, data can be pooled to increase efficiency. This finding improves the feasibility for countries to generate robust empirical estimates of adult and maternal mortality from surveys. Further we recommend that male sibling histories be collected

  4. Maternal mortality ratio – trends in the vital registration data

    African Journals Online (AJOL)

    Tracking the level of maternal mortality reliably in developing countries is extremely challenging. In an ideal setting, vital statistics, based on good-quality medical certification of the cause of death, would provide the number of deaths from maternal causes. In developed countries it is sometimes necessary to supplement.

  5. Policy and Programs for Reducing Maternal Mortality in Enugu State ...

    African Journals Online (AJOL)

    Admin

    The programme built on the policy is fully operational now in the public sector. All public hospitals give free treatment to mothers from ante natal, delivery and post delivery…. Available programme relating to reduction of maternal mortality. A number of pogrammes are put in place to promote maternal health in Enugu State.

  6. Determining the Level of Maternal Mortality in Eritrea using RAMOS ...

    African Journals Online (AJOL)

    Introduction. A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental causes 1. Maternal mortality risks are ...

  7. Maternal Mortality in Ribat University Hospital, Khartoum, Sudan ...

    African Journals Online (AJOL)

    Background: Maternal death is a tragedy that leaves an enormous negative impact on the family. The objectives of the study were to determine the rate and causes of maternal mortality in Ribat University Hospital Methods: This was a descriptive, hospital-based study conducted in Ribat University Hospital, Khartoum, Sudan ...

  8. the policies and production in maternal mortality reduction in cross

    African Journals Online (AJOL)

    Dr. T. U. Agan

    The study was designed to determine the status of maternal health in Cross River State, a state in the Niger-Delta region of Nigeria with high rate of maternal mortality. The study consisted of analysis of clinical data, desk reviews of published and unpublished materials and interviews with policymakers and service providers ...

  9. Maternal and perinatal mortality figures in 249 South African ...

    African Journals Online (AJOL)

    Objective. To detennine maternal and perinatal mortalrty ratios in a large number of South African hospitals and assess the differences in mortality figures among the main ethnic groups. Design. Questionnaire survey involving confidential reports on maternal and perinatal deaths submitted over the 5-year period 1988 ...

  10. Determinants of Post-Partum Maternal Mortality at Queen Elizabeth ...

    African Journals Online (AJOL)

    The aim of this research is to identify the clinical, demographic and service-based determinants of postpartum maternal mortality within Queen Elizabeth Central Hospital, Blantyre, Malawi, during 2001 and 2002. The study uses a case-control design using all postpartum maternal deaths in 2001 and 2002 as cases, with ...

  11. Review of Policies and Programs for Reducing Maternal Mortality ...

    African Journals Online (AJOL)

    The study was designed to determine the status of maternal health in Cross River State, a state in the Niger-Delta region of Nigeria with high rate of maternal mortality. The study consisted of analysis of clinical data, desk reviews of published and unpublished materials and interviews with policymakers and service providers ...

  12. Trends in health facility based maternal mortality in Central Region ...

    African Journals Online (AJOL)

    A maternal death was defined according to ICD-10 criterion. The variables reviewed included socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality ratio for each year and overall for the four year period using a standard equation and ...

  13. Prevenção da mortalidade materna: desafio para o enfermeiro Prevención de la mortalidad materna: un desafío para la enfermera Maternal mortality prevention: a challenge for nurses

    Directory of Open Access Journals (Sweden)

    Patrícia Santos Barbastefano

    2009-04-01

    Full Text Available Neste artigo analisamos os principais aspectos sobre a mortalidade materna, tendo como objetivo a promoção de ações preventivas para a morte materna evitável. Verifica-se que entidades como a ADVOCACY têm significativa participação nos projetos visando redução das taxas de mortalidade materna e o ajustamento de condutas de proteção aos direitos da mulher. Observa-se ainda que a SES, através das Resoluções nº 1.052/95 e nº 1.642/2001, expressa a política estadual para redução do problema. Conclui-se que há indícios de vontade política nas propostas e projetos para redução das taxas de mortalidade materna evitável, porém não há cobrança da sua efetividade. Profissionais da saúde como o enfermeiro, precisam reunir esforços, conscientização e sensibilização em suas ações preventivas.En este artículo se analizan los aspectos principales sobre mortalidad maternal que tiene como objetivo la promoción de acciones preventivas para la muerte materna evitable. Se verifica que las entidades como la ADVOCACY tienen participación significante en los proyectos que buscan la reducción de la tasa de mortalidad materna y el ajuste de procedimientos de protección de los derechos de la mujer. También se observa que la Secretaria Estatal de Salud, a través de las Resoluciones nº 1.052/95 y nº1.642/2001, expresa las políticas estatales para la reducción del problema. Se concluye que hay indicaciones de voluntad política sobre las propuestas y proyectos para reducir las tasas de mortalidad materna evitables. Sin embargo no hay demandas sobre su efectividad. Los profesionales de salud como enfermeras necesitan recoger los esfuerzos, y también una actitud de comprensión y sensibilidad en sus acciones preventivas.In this article theprincipal aspects about maternal mortality are analyzed, with the objective the promotion of preventive actions for the avoidable maternal death. It is verified that entities as ADVOCACY have

  14. Intervenções benéficas no pré-natal para prevenção da mortalidade materna Beneficial interventions for maternal mortality prevention in the prenatal period

    Directory of Open Access Journals (Sweden)

    Iracema de Mattos Paranhos Calderon

    2006-05-01

    Full Text Available A razão de mortalidade materna (MM é indicador da qualidade de saúde, influenciada diretamente pelo grau de desenvolvimento econômico-cultural-tecnológico de um país. Os dados oficiais de MM no Brasil, ainda que subestimados, sinalizam a falta de qualidade dos serviços de assistência à gestação, parto e puerpério. Esta característica é comum entre os países em desenvolvimento, onde estão as gestantes mais necessitadas e com maior dificuldade de acesso a assistência de qualidade. A assistência pré-natal não pode prevenir as principais complicações do parto, causas importantes de MM, mas algumas intervenções no pré-natal poderão favorecer o prognóstico materno e prevenir a MM. Neste contexto, o artigo faz uma atualização, embasada em evidências científicas, sobre intervenções efetivas no pré-natal para prevenção da mortalidade materna. As estratégias mais importantes constituem um tripé, com intervenções específicas relacionadas a promoção da saúde materna, prevenção dos riscos e garantia de suporte nutricional durante a gestação, além de critérios para investigação do risco gestacional e inclusão da gestante no componente básico do modelo de assistência pré-natal. Finaliza com a definição de prioridades na prevenção de MM relacionada à eclâmpsia/pré-eclâmpsia e reforça a importância da normatização dos sistemas de referência para os casos de emergência obstétrica.Maternal mortality rate (MM is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are

  15. Maternal mortality in Matlab, Bangladesh: 1976-85.

    Science.gov (United States)

    Koenig, M A; Fauveau, V; Chowdhury, A I; Chakraborty, J; Khan, M A

    1988-01-01

    This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.

  16. Acknowledging HIV and malaria as major causes of maternal mortality in Mozambique.

    Science.gov (United States)

    Singh, Kavita; Moran, Allisyn; Story, William; Bailey, Patricia; Chavane, Leonardo

    2014-10-01

    To review national data on HIV and malaria as causes of maternal death and to determine the importance of looking at maternal mortality at a subnational level in Mozambique. Three national data surveys were used to document HIV and malaria as causes of maternal mortality and to assess HIV and malaria prevention services for pregnant women. Data were collected between 2007 and 2011, and included population-level verbal autopsy data and household survey data. Verbal autopsy data indicated that 18.2% of maternal deaths were due to HIV and 23.1% were due to malaria. Only 19.6% of recently pregnant women received at least two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment, and only 42.3% of pregnant women were sleeping under an insecticide-treated net. Only 37.5% of recently pregnant women had been counseled, tested, and received an HIV test result. Coverage of prevention services varied substantially by province. Triangulation of information on cause of death and coverage of interventions can enable appropriate targeting of maternal health interventions. Such information could also help countries in Sub-Saharan Africa to recognize and take action against malaria and HIV in an effort to decrease maternal mortality. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Predictors of maternal mortality among critically ill obstetric patients

    African Journals Online (AJOL)

    et al.,15 that absence of prenatal care was a predictor of maternal mortality in critically ill obstetric patients, the booking status in this study was not a predictor of mortality. This could be because the delay in recognition of the need for ICU care and delays in presentation could have removed the otherwise expected beneficial ...

  18. Maternal mortality associated with eclampsia in Sokoto, Nigeria ...

    African Journals Online (AJOL)

    However, it was only in Glasgow coma score that a significant difference in case mortality was observed (p = 0.000). The perinatal death associated with eclampsia was 24.7%, and 61.5% of them occurred amongst mothers who died from eclampsia. Conclusion: Eclampsia is a major contributor to maternal mortality in the ...

  19. An analysis of anemia and pregnancy-related maternal mortality

    NARCIS (Netherlands)

    Brabin, B. J.; Hakimi, M.; Pelletier, D.

    2001-01-01

    The relationship of anemia as a risk factor for maternal mortality was analyzed by using cross-sectional, longitudinal and case-control studies because randomized trials were not available for analysis. The following six methods of estimation of mortality risk were adopted: 1) the correlation of

  20. Factors Underlying the Temporal Increase in Maternal Mortality in the United States.

    Science.gov (United States)

    Joseph, K S; Lisonkova, Sarka; Muraca, Giulia M; Razaz, Neda; Sabr, Yasser; Mehrabadi, Azar; Schisterman, Enrique F

    2017-01-01

    To identify the factors underlying the recent increase in maternal mortality ratios (maternal deaths per 100,000 live births) in the United States. We carried out a retrospective study with data on maternal deaths and live births in the United States from 1993 to 2014 obtained from the birth and death files of the Centers for Disease Control and Prevention. Underlying causes of death were examined between 1999 and 2014 using International Classification of Diseases, 10th Revision (ICD-10) codes. Poisson regression was used to estimate maternal mortality rate ratios (RRs) and 95% confidence intervals (CIs) after adjusting for the introduction of a separate pregnancy question and the standard pregnancy checkbox on death certificates and adoption of ICD-10. Maternal mortality ratios increased from 7.55 in 1993, to 9.88 in 1999, and to 21.5 per 100,000 live births in 2014 (RR 2014 compared with 1993 2.84, 95% CI 2.49-3.24; RR 2014 compared with 1999 2.17, 95% CI 1.93-2.45). The increase in maternal deaths from 1999 to 2014 was mainly the result of increases in maternal deaths associated with two new ICD-10 codes (O26.8, ie, primarily renal disease; and O99, ie, other maternal diseases classifiable elsewhere); exclusion of such deaths abolished the increase in mortality (RR 1.09, 95% CI 0.94-1.27). Regression adjustment for improvements in surveillance also abolished the temporal increase in maternal mortality ratios (adjusted maternal mortality ratios 7.55 in 1993, 8.00 per 100,000 live births in 2013; adjusted RR 2013 compared with 1993 1.06, 95% CI 0.90-1.25). Recent increases in maternal mortality ratios in the United States are likely an artifact of improvements in surveillance and highlight past underestimation of maternal death. Complete ascertainment of maternal death in populations remains a challenge even in countries with good systems for civil registration and vital statistics.

  1. Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale.

    Science.gov (United States)

    Ronsmans, C; Vanneste, A M; Chakraborty, J; van Ginneken, J

    A study in Matlab, Bangladesh, has provided evidence favouring a community-based maternity-care delivery system. 3 years of this programme coincided with a significant reduction in direct obstetric mortality compared with the 3 years before the programme. We have examined whether the effects of the programme are sustained over time. Using data from the continuing demographic survelliance system and from special investigations into the rates and causes of maternal mortality during 1976-93, we compared the trends in direct obstetric maternal mortality ratios in the Maternal and Child Health and Family Planning (MCH-FP) area (which has received extensive services in health and family planning since 1977) with those in the comparison area (with no such intensive health inputs). We divided the areas and time periods into discrete groups that best represented the effects of the introduction of the maternity-care programme. Direct obstetric mortality declined by 3% per year (rate ratio 0.97 per year [95% CI 0.95-0.99]); there was no difference between the MCH-FP and comparison areas (1.00 [0.96-1.05]). Direct obstetric mortality halved between 1976-86 and 1987-89 in the northern MCH-FP area, where the maternity-care programme was initiated in 1987 (0.50 [0.22-0.99]), but showed no change in the southern MCH-FP area, which had no such intervention at that time (1.07 [0.64-1.72]). After 1990, when the programme was expanded throughout the MCH-FP area, the southern part showed a downward (non-significant) trend in direct obstetric mortality (0.68 [0.35-1.32]). However, direct obstetric mortality also declined between 1987 and 1989 in the southern comparison area (0.48 [0.26-0.83]) in the absence of an intense maternity-care programme, and remained stable thereafter. In the northern comparison area, there was no such decline in direct obstetric mortality (0.78 [0.40-1.40]). Although the introduction of the maternity-care programme coincided with declining trends in direct

  2. Third delay of maternal mortality in a tertiary hospital

    International Nuclear Information System (INIS)

    Shah, N.; Khan, N.H.

    2007-01-01

    To assess the magnitude, causes and substandard care factors responsible for the third delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil Hospital, Karachi. This Cross-sectional, retrospective study was carried out on 152 mothers who died over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all maternal deaths were reviewed from death registers and were studied for substandard care factors which could have been responsible for the third delay of maternal mortality. The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was 29+-6.49 years and mean parity was 3.24+-3.25. The main causes of death were hypertensive disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152 (10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases. Substandard care factors were present in 76.7% of patients, which included inappropriate management of pulmonary edema, delay in arranging blood for hemorrhaging patients and delay in surgical intervention. Substandard care factors were present in majority of cases of maternal deaths. Improvement of maternity care services in Civil Hospital Karachi is needed on an urgent basis. (author)

  3. Causes of maternal mortality decline in Matlab, Bangladesh.

    Science.gov (United States)

    Chowdhury, Mahbub Elahi; Ahmed, Anisuddin; Kalim, Nahid; Koblinsky, Marge

    2009-04-01

    Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor

  4. Maternal mortality at Queen Elizabeth Central Hospital, 1989 to 1990.

    Science.gov (United States)

    Wiebenga, J E

    1992-04-01

    An obstetrician examined records of all maternal deaths that occurred in the Chatinkha Maternity Wing of Queen Elizabeth Central Hospital in Blantyre, Malawi, during 1989-1990. None of the deaths were caused by conditions unrelated to pregnancy. In 1989 there were 78 maternal deaths out of 14,272 live births (a maternal mortality ratio of 546/100,000 live births). In 1990 there were 73 maternal deaths out of 14,281 live births (a maternal mortality ratio of 511/100,000 live births). In each year, 37 women died directly from complications of pregnancy, delivery, or their management. In 1989, the leading cause of maternal death was postabortal sepsis (15 cases), followed by obstructed labor (8 cases) and puerperal sepsis (6 cases). In 1990, the leading causes were puerperal sepsis (13 cases) and postabortal sepsis (10 cases). The number of HIV-seropositive women among direct maternal deaths was 8 for both years. In 1990, the cesarean section rate was 6.5%. Women who had undergone a cesarean section faced a risk of puerperal sepsis-related death 8.5 times greater than that of women who had delivered vaginally. The 1990 mortality rate among induced abortion cases may have been as high as 8%. There were 41 and 36 indirect maternal deaths in 1989 and 1990, respectively. The leading causes of indirect maternal death were fever (8 cases) and bacterial meningitis (5 cases). The cause could not be determined in 15 cases. By 1990, the leading causes of indirect maternal death were bacterial meningitis (8 cases) and AIDS (6 cases). 5 of the 8 bacterial meningitis cases tested positive for HIV. The 4 patients with tuberculosis and 3 patients with septicemia were HIV positive. 41% and 56% of maternal deaths in 1989 and 1990, respectively, were avoidable. When one excluded uncertain avoidable factors, 21% and 45% of maternal deaths could not be avoided. The leading avoidable factors were deficient hospital care (18 cases), patient's delay (12 cases), and illegal abortion (10

  5. Causes of Maternal Mortality Decline in Matlab, Bangladesh

    Science.gov (United States)

    Ahmed, Anisuddin; Kalim, Nahid; Koblinsky, Marge

    2009-01-01

    Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality—86.7% and 78.3%—in the ICDDR,B and government service areas respectively. Education of women was a strong

  6. Awareness and perception of maternal mortality among women in a ...

    African Journals Online (AJOL)

    2010-02-08

    Feb 8, 2010 ... This study shows that a good proportion of subjects was aware of maternal mortality and also had a good perception of it. Conclusion: Efforts should be directed towards educating women about the risk of delivering in homes of traditional birth attendants ..... prompt presentation at the hospital when in labor.

  7. Understanding Maternal Mortality in Colombia : the Influence of ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Institution. Asociación Colombiana de la Salud. Institution Country. Colombia. Outputs. Reports. Understanding maternal mortality in Colombia : the influence of health insurance; final report. Download PDF. Related content. Call for new OWSD Fellowships for Early Career Women Scientists now open. In partnership with ...

  8. Impact of Training traditional birth attendants on maternal mortality ...

    African Journals Online (AJOL)

    TBAs) on overall improvement of reproductive health care with focus on reducing the high rate of maternal and new-born mortality in rural settings in sub-Saharan Africa. The importance of TBAs for years has been denied by professional ...

  9. Trends In Maternal Mortality at University of Maiduguri Teaching ...

    African Journals Online (AJOL)

    the leading cause accounting for 5.3%. Basic but professional antenatal care, skilled attendance at birth, community mobilization and health education messages for a healthy pregnancy and safe birth will help to reduce the unacceptably high maternal mortality ratio in Borno state and the country at large. Niger Med J. Vol.

  10. A critic of maternal mortality reduction efforts in Nigeria | Adinma ...

    African Journals Online (AJOL)

    Gaps identified to militate against maternal mortality reduction efforts include discontinuity and disconnect in government policies and programmes; legislation and other services emanating from change in government or between the executive and legislature within the same government; poor leadership of the health sector ...

  11. Maternal mortality in the Cape Province, 1990 - 1992

    African Journals Online (AJOL)

    province were compared. Setting. A11111 Cape provincial hospitals and hospitals supported by the Cape Provincial Administration. SUbjects. Matemal deaths notified from January 1990 to. December 1992. Outcome measures. The maternal mortality rate (MMR), characteristics of the patients who died and causes of death.

  12. Determinants of Maternal Mortality in Eritrea | Ghebrehiwet | Journal ...

    African Journals Online (AJOL)

    Objective: This study was undertaken with a general objective of determining the determinants of maternal mortality in Eritrea. Methods: The study was a case control study which compared 50 women whose pregnancies led to death with 50 individually matched women that survived a severe life threatening obstetric ...

  13. (SOGON) Plan for Sustainable Reduction in Maternal Mortality

    African Journals Online (AJOL)

    Erah

    safe abortion, improved education and nutri- tion for women and women empowerment. These involved sensitization of people and government to the high maternal mortality .... ment for running expenses. Monitoring and Evaluation. Monitoring and evaluation of the programme in the state will be organized by the state.

  14. Reasons for Persistently High Maternal and Perinatal Mortalities in ...

    African Journals Online (AJOL)

    For the majority of the data, regression analysis and Pearson correlation coefficient were used as a proxy indicator for the association of variables with maternal, fetal and neonatal mortality. RESULTS: Although there were variations in the methods for estimation, the TFR of women in Ethiopia declined from 5.9 to 4.8 in the ...

  15. Maternal Mortality at Federal Medical Centre Yola, Adamawa State ...

    African Journals Online (AJOL)

    6] Although regional variation in maternal mortality exist in Nigeria, the North. East has one of the worst indices in Nigeria.[7] The average MMR for Nigeria is 545/100,000 live births,[7] while that of Borno state ..... Eko Le Meridien Hotel. Victoria ...

  16. Stagnating maternal mortality in Tanzania: what went wrong and ...

    African Journals Online (AJOL)

    Background: This paper presents and analyses the trend of maternal mortality ratio in Tanzania against major events, policy, economic and political decisions which may have influenced this trend. The impact of several initiatives related to Health Systems Strengthening are discussed and alternative strategies for effective ...

  17. Maternal and perinatal morbidity and mortality of Caesarean ...

    African Journals Online (AJOL)

    Maternal and perinatal morbidity and mortality of Caesarean delivery in the late first stage and second stage of labour. ... Results: There was no difference between cases and controls for the following variables: age, gravidity, parity, past obstetric history, gestational age, HIV status, cardiotocography (CTG) tracing, labour ...

  18. Maternal Mortality in Ghana: the Other Side | Senah | Research ...

    African Journals Online (AJOL)

    ... perspective. However, the determinants of maternal mortality are a complex web of biology and culture. This paper presents the 'other side' of the story: a wider overview of the casual pathways by which simple interventions may produce the desired effect. (Institute of African Studies Research Review: 2003 19(1): 47-56) ...

  19. Maternal mortality from hemorrhage in the State of Santa Catarina, Brazil

    Directory of Open Access Journals (Sweden)

    Haimee Emerich Lentz Martins

    2013-10-01

    Full Text Available Hemorrhage represents a set of causes that focuses on women during the pregnancy and puerperal period, and that, with improper attention, results in death. The authors aimed to analyze maternal deaths related to hemorrhage that occurred in the state of Santa Catarina, Brazil. The data were obtained from the Mortality Information System and Live Births Information System from the Brazilian Ministry of Health. This was a descriptive study, in which 491 maternal deaths that occurred in the period 1997-2010 were analyzed. Of these, 61 were related to hemorrhage, corresponding to 12.42%; postpartum hemorrhage was the most prevalent cause, with 26 deaths, followed by placental abruption with 15, representing 67.21% of the cases. The maternal mortality from hemorrhage is a public health problem in the state of Santa Catarina, due to its high prevalence and the fact that its underlying causes are preventable.

  20. EDITORIAL UNSAFE ABORTION AND MATERNAL MORTALITY: IS ...

    African Journals Online (AJOL)

    hi-tech

    Almost all (95%) unsafe abortions occur in developing countries because the developed world has made it possible for women to easily prevent unwanted pregnancy by using contraceptives and having access to safe legal termination when needed(3,7). When carried out according to appropriate clinical guidelines and ...

  1. Mortalidade materna por cardiopatia Maternal mortality due to heart disease

    Directory of Open Access Journals (Sweden)

    Helvécio N. Feitosa

    1991-12-01

    Full Text Available Realizou-se estudo retrospectivo da mortalidade materna por cardiopatia, no período de janeiro de 1979 a dezembro de 1989. Dentre um total de 16.423 internações, houve 694 gestantes com o diagnóstico de cardiopatia (4,2%. No mesmo período, ocorreram 51 óbitos maternos, correspondendo a um coeficiente de mortalidade materna de 428,2/100.000 nascidos vivos. Houve 12 óbitos maternos por cardiopatia. A análise estatística permitiu a identificação de alguns fatores associados a maior risco de morte nas pacientes cardiopatas: primeira gravidez, primiparidade, ausência de assistência pré-natal, realização de cirurgia cardíaca anterior à gravidez e/ou na gestação. O maior número de mortes ocorreu no puerpério. A classificação funcional (NYHA não se constituiu em parâmetro seguro para avaliar o prognóstico materno, pois 91,7% dos casos de óbito foram incluídos no grupo considerado favorável (classes I e II ao iniciar a gestação.A retrospective study on maternal mortality in pregnant women with cardiac disease over a period of eleven years (January 1979 to December 1989 was undertaken. The objetive was an analysis of the main aspects of this association. Cardiac disease was diagnosed in 694 patients (4.2% of a total of 16,423 admitted to the Obstetrics Department of the Escola Paulista de Medicina. As for etiology, rheumatic disease (52.3%; Chagas's disease (19.3% and congenital disease (8.1% were the most frequent causes. There were 51 maternal deaths, according to FIGO's definition (1967, corresponding to a maternal mortality rate of 428.2/100,000 livebirths during the same period. Twelve of these maternal deaths were due to cardiac disease (maternal mortality rate of 100.8/100,000 livebirths. The statistical analysis identified the following aspects associated with maternal mortality among patients with cardiac disease: primigravida, lack of adequate prenatal care, and cardiac surgery performed previously to and

  2. [Analysis of maternal mortality in the Czech Republic in 2000].

    Science.gov (United States)

    Srp, B; Velebil, P

    2002-09-01

    Analysis of maternal mortality in the Czech Republic in 2000. Retrospective statistical and clinical analysis. Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2, Institute for the Care of Mother and Child, Prague. We present an annual analysis of maternal mortality in the Czech Republic, organized into two parts: 1) international statistical part, and 2) clinical part in Czech only with abbreviated anonymous analysis of individual cases of maternal death. We are aware that follow-up analysis cannot fully express dramatic situations around all cases or reproduce in details all their aspects. We though believe that this form will help to our gynecologists to learn about courses of the deaths, particularly when the frequency of such cases is low and circumstances are unusual. Individual analyses include also conclusions of expert committees or analyses performed by the Czech Medical Chamber. Comments and notes however are not for forensic purposes and are used only for medical ones. We used a database of 10 cases of maternal deaths in the Czech Republic in 2000. We analyzed their causes, clinical courses, especially in connection to obstetrical surgery, and adequacy of provided care. There were 10 reported maternal deaths in connection to pregnancy, labor and delivery or within 42 days after delivery in the Czech Republic in 2000. There were 90,910 live-born babies and total, gross maternal mortality (A + B + C) was 0.11 per 1000, i.e. 11 deaths per 100,000 live-born babies. This is only 0.02 per 1000 better than results in 1999 (Table 3 shows data on maternal mortality for last 10 years). In 2000, there was one maternal death unrelated to gestation--category C, therefore maternal mortality in connection to gestation (A + B) was 0.099 per 1000 i.e. 9.9 deaths per 100,000 live-born babies compared to 10.1 deaths in 1999. The causes of deaths were different. Only two women were within group

  3. The State of Maternal Mortality in South Africa | Lalthapersad-Pillay ...

    African Journals Online (AJOL)

    ... upward trend. The Post -2015 Development Agenda accords both maternal health and SRHR key prominence, thereby reaffirming the need for reliable maternal mortality estimates in the future. Keywords: Maternal deaths, maternal mortality, women, Africa, Sexual and Reproductive Health Rights, abortion, contraception, ...

  4. Engendering the Attainment of the SDG-3 in Africa: Overcoming the Socio Cultural Factors Contributing to Maternal Mortality.

    Science.gov (United States)

    Ogu, Rosemary N; Agholor, Kingsley N; Okonofua, Friday E

    2016-09-01

    At the conclusion of the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) provide an opportunity to ensure healthy lives, promote the social well-being of women and end preventable maternal death. However, inequities in health and avoidable health inequalities occasioned by adverse social, cultural and economic influences and policies are major determinants as to whether a woman can access evidence-based clinical and preventative interventions for reducing maternal mortality. This review discusses sociocultural influences that contribute to the high rate of maternal mortality in Nigeria, a country categorised as having made -no progress‖ towards achieving MDG 5. We highlight the need for key interventions to mitigate the impact of negative sociocultural practices and social inequality that decrease women's access to evidence-based reproductive health services that lead to high rate of maternal mortality. Strategies to overcome identified negative sociocultural influences and ultimately galvanize efforts towards achieving one of the tenets of SDG-3 are recommended.

  5. Maternal mortality in Campinas: evolution, under-registration and avoidanc

    Directory of Open Access Journals (Sweden)

    José Guilherme Cecatti

    1999-01-01

    Full Text Available CONTEXT: Up until a few years ago, maternal mortality did not merit much attention as a worldwide public health issue. The health and social development indicator almost exclusively used was infant death. OBJECTIVE: To study the number, characteristics, basic causes and avoidance of maternal mortality (MM among women living in the city of Campinas, which occurred between 1985 and 1991, identified from all death certificates of women aged 10 through 49 years. DESIGN: Retrospective and descriptive population-based study. SETTING: University Referal Center. SAMPLES: All eligible death certificates classified as declared and presumed maternal deaths according to the Laurenti criteria for the cause of death were selected and complementary studies of the clinical records were performed. MAIN MEASURES: Day of the week and place of occurrence of death; period of occurrence; transfer from another hospital; number of days from delivery/abortion to death; blood transfusion; opportunity for transfusion; complications; autopsy; basic cause of death. RESULTS: Initially 39 declared maternal deaths were identified and a total of 62 were confirmed by the end of the study. This corresponds to an under-registration rate of 37.1% and to an MM ratio of 45.5 per 100,000 live births. Around three-fourths of these maternal deaths were due to a direct obstetrical cause and were considered avoidable. CONCLUSION: Maternal mortality still is high in the municipality of Campinas, although lower than the mean estimated for Brazil. The predominance of direct obstetric causes and avoidable deaths reinforces the need for public health interventions directed towards avoiding them

  6. Maternal mortality in Henan Province, China: changes between 1996 and 2009.

    Directory of Open Access Journals (Sweden)

    Fengzhi You

    Full Text Available BACKGROUND: Maternal deaths occur mostly in developing countries and the majority of them are preventable. This study analyzes changes in maternal mortality and related causes in Henan Province, China, between 1996 and 2009, in an attempt to provide a reliable basis for introducing effective interventions to reduce the maternal mortality ratio (MMR, part of the fifth Millennium Development Goal. METHODS AND FINDINGS: This population-based maternal mortality survey in Henan Province was carried out from 1996 to 2009. Basic information was obtained from the health care network for women and children and the vital statistics system, from specially trained monitoring personnel in 25 selected monitoring sites and by household survey in each case of maternal death. This data was subsequently reported to the Henan Provincial Maternal and Child Healthcare Hospital. The total MMR in Henan Province declined by 78.4%, from 80.1 per 100 000 live births in 1996 to 17.3 per 100 000 live births in 2009. The decline was more pronounced in rural than in urban areas. The most common causes of maternal death during this period were obstetric hemorrhage (43.8%, pregnancy-induced hypertension (15.8%, amniotic fluid embolism (13.9% and heart disease (8.0%. The MMR was higher in rural areas with lower income, less education and poorer health care. CONCLUSION: There was a remarkable decrease in the MMR in Henan Province between 1996 and 2009 mainly in the rural areas and MMR due to direct obstetric causes such as obstetric hemorrhage. This study indicates that improving the health care network for women, training of obstetric staff at basic-level units, promoting maternal education, and increasing household income are important interventional strategies to reduce the MMR further.

  7. Socio-Economic and Cultural Factors in Maternal Mortality in Nigeria ...

    African Journals Online (AJOL)

    The issue of maternal mortality has been very topical due to recent focus on sustainable development and because of the fact that maternal mortality is very high in many developing countries. In Nigeria, maternal mortality is very high and one of the highest in the world. There are cultural and social factors that exacerbate ...

  8. [Main causes of maternal mortality in Mexicali, Baja California (Mexico)].

    Science.gov (United States)

    Medina-Ramírez', Maria Concepción; Leal-Anaya, Paula; Aguilera-Romero, Tricia Nohemí; Leyva-Quintero, Elizabeth

    2015-11-01

    The objective of this study is to determine the main causes of maternal mortality in the period 2009 to 2013 in Mexicali, Baja California, Mexico. Epidemiological, observational, descriptive, cross-sectional, and retrospective study was conducted with a universe of 30 cases of maternal death. The information was collected from death certificates and records of cases obtained from the Institute of State Public Service Health of University Xochicalco. The average age of patients were 26.6 ± 5.6 years. Educational level and marital status was with junior school 15 (50%) and free union 12 (40%) respectively, 21 (70%) had no prenatal care. The mean gestational age was 28.8 ± 3.72 weeks, there was no difference in the place of residence, urban and rural, 15(50%). The main cause of death was hemorrhage 9(30%). The highest mortality was during the postpartum period 23 (77%). During the study period, the mortality rate was 36.8 x 100,000 live births. The increased frequency of maternal mortality was in young women, 70% had no prenatal care. Bleeding from ectopic pregnancy was the leading cause of death.

  9. Success in reducing maternal and child mortality in Afghanistan.

    Science.gov (United States)

    Rasooly, Mohammad Hafiz; Govindasamy, Pav; Aqil, Anwer; Rutstein, Shea; Arnold, Fred; Noormal, Bashiruddin; Way, Ann; Brock, Susan; Shadoul, Ahmed

    2014-01-01

    After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

  10. Maternal mortality in rural South Africa: the impact of case definition on levels and trends

    Directory of Open Access Journals (Sweden)

    Garenne M

    2013-08-01

    Full Text Available Michel Garenne,1–3 Kathleen Kahn,1,4,5 Mark A Collinson,1,4,5 F Xavier Gómez-Olivé,1,5 Stephen Tollman1,4,51MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France; 3Institut de Recherche pour le Développement, UMI Résiliences, Centre Ile de France, Bondy, France; 4Centre for Global Health Research, Umeå University, Umeå, Sweden; 5INDEPTH Network, East Legon, Accra, GhanaBackground: Uncertainty in the levels of global maternal mortality reflects data deficiencies, as well as differences in methods and definitions. This study presents levels and trends in maternal mortality in Agincourt, a rural subdistrict of South Africa, under long-term health and sociodemographic surveillance.Methods: All deaths of women aged 15 years–49 years occurring in the study area between 1992 and 2010 were investigated, and causes of death were assessed by verbal autopsy. Two case definitions were used: “obstetrical” (direct causes, defined as deaths caused by conditions listed under O00-O95 in International Classification of Diseases-10; and “pregnancy-related deaths”, defined as any death occurring during the maternal risk period (pregnancy, delivery, 6 weeks postpartum, irrespective of cause.Results: The case definition had a major impact on levels and trends in maternal mortality. The obstetric mortality ratio averaged 185 per 100,000 live births over the period (60 deaths, whereas the pregnancy-related mortality ratio averaged 423 per 100,000 live births (137 deaths. Results from both calculations increased over the period, with a peak around 2006, followed by a decline coincident with the national roll-out of Prevention of Mother-to-Child Transmission of HIV and antiretroviral treatment programs. Mortality increase from direct causes was

  11. [Maternal mortality trends in the Sfax region from 1979 to 2000].

    Science.gov (United States)

    Ben Amara, Fethi; Dhouib, Mohamed; Khemiri, Henda; Jaouadi, Mohamed; Ben Ayed, Belhassen; Idrissi, Ali; Ben Amar, Sondes; Bouzid, Faouzi; Rekik, Saida

    2004-02-01

    We report a retrospective study about maternal mortality in Sfax (Tunisia) between 1979 and 2000. Maternal mortality rate has fallen strikingly from 76.8 per 100,000 mortality cases in 1979 to 40.1 per 100,000 mortality cases in 20,000. However deaths from unavoidable causes have fallen much more slowly than avoidable causes.

  12. Socio-economic improvements and health system strengthening of maternity care are contributing to maternal mortality reduction in Cambodia.

    Science.gov (United States)

    Liljestrand, Jerker; Sambath, Mean Reatanak

    2012-06-01

    Maternal mortality has been falling significantly in Cambodia since 2005 though it had been stagnant for at least 15 years before that. This paper analyzes the evolution of some major societal and health system factors based on recent national and international reports. The maternal mortality ratio fell from 472 per 100,000 live births in 2000-2005 to 206 in 2006-2010. Background factors have included peace and stability, economic growth and poverty reduction, improved primary education, especially for girls, improved roads, improved access to information on health and health services via TV, radio and cellphones, and increased ability to communicate with and within the health system. Specific health system improvements include a rapid increase in facility-based births and skilled birth attendance, notably investment in midwifery training and numbers of midwives providing antenatal care and deliveries within an expanding primary health care network, a monetary incentive for facility-based midwives for every live birth conducted, and an expanding system of health equity funds, making health care free of cost for poor people. Several major challenges remain, including post-partum care, family planning, prevention and treatment of breast and cervical cancer, and addressing sexual violence against women, which need the same priority attention as maternity care. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  13. Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

    Science.gov (United States)

    Vogel, J P; Souza, J P; Mori, R; Morisaki, N; Lumbiganon, P; Laopaiboon, M; Ortiz-Panozo, E; Hernandez, B; Pérez-Cuevas, R; Roy, M; Mittal, S; Cecatti, J G; Tunçalp, Ö; Gülmezoglu, A M

    2014-03-01

    We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). A total of 359 participating facilities in 29 countries. A total of 308 392 singleton deliveries. We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs. The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia. Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  14. Global, regional, and national levels and causes of maternal mortality during 1990-2013

    DEFF Research Database (Denmark)

    Kassebaum, Nicholas J; Bertozzi-Villa, Amelia; Coggeshall, Megan S

    2014-01-01

    BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contri...

  15. Maternal mortality at the Central Hospital, Benin City Nigeria: A ten ...

    African Journals Online (AJOL)

    Low literacy, high poverty levels, extremes of parity and non-utilization of maternity services were associated with maternal mortality. Recommendations are made for public enlightenment campaign and advocacy activities aimed at mobilizing resources for reducing maternal mortality. Also, female education and poverty ...

  16. Maternal morbidity and mortality associated with delivery after intrauterine death

    International Nuclear Information System (INIS)

    Ifnan, F.; Jameel, M.B.

    2006-01-01

    To determine the maternal morbidity and mortality associated with delivery after intrauterine fetal death (IUFD) and to find out the place of fetal destructive procedures and cesarean section. All women were included in the present study who presented before the onset of labour pains, after intrauterine fetal death at 26 weeks or onward with singleton pregnancy. Assessment of maternal demographic characteristics, gestational age at fetal demise, delivery-IUFD interval, mode of delivery; vaginal with or without fetal destructive procedures/cesarean section and maternal complications were the main outcome measures. There were 1834 live birth and 63 deliveries with intrauterine fetal death. Mode of delivery was vaginal in 87.4% and cesarean section in 12.6% of the cases. Twelve (21%) of the vaginal deliveries were complicated by lower urogenital tract injuries in certain cases, whereas 75% (6/8) of patients delivered by cesarean section developed major postoperative complications like postpartum haemorrhage, shock, endometritis, peritonitis and wound dehiscence. No maternal death was identified. Rate of delivery with intrauterine fetal death was 34.3/1000 live-birth deliveries. (author)

  17. One in Five Maternal Deaths in Bangladesh Associated with Acute Jaundice: Results from a National Maternal Mortality Survey.

    Science.gov (United States)

    Shah, Rupal; Nahar, Quamrun; Gurley, Emily S

    2016-03-01

    We estimated the proportion of maternal deaths in Bangladesh associated with acute onset of jaundice. We used verbal autopsy data from a nationally representative maternal mortality survey to calculate the proportion of maternal deaths associated with jaundice and compared it to previously published estimates. Of all maternal deaths between 2008 and 2010, 23% were associated with jaundice, compared with 19% from 1998 to 2001. Approximately one of five maternal deaths was preceded by jaundice, unchanged in 10 years. Our findings highlight the need to better understand the etiology of these maternal deaths in Bangladesh. © The American Society of Tropical Medicine and Hygiene.

  18. Cardiovascular mortality: how can it be prevented?

    Science.gov (United States)

    Estruch, Ramón

    2014-01-01

    The first step in the prevention and treatment of many chronic diseases such as cardiovascular diseases is to follow a healthy diet. Several epidemiological studies have observed that following a traditional Mediterranean diet reduces overall and cardiovascular mortality, as well as the incidence of chronic diseases such as cardiovascular diseases, cancer and neurodegenerative diseases. However, up to now, only one study has analysed the effects of the Mediterranean diet on the primary prevention of cardiovascular disease, the PREDIMED (PREvención con DIeta MEDiterránea) study. This trial included 7447 high vascular risk individuals who were randomly divided into three dietary intervention groups: Mediterranean diet supplemented with extra-virgin olive oil, Mediterranean diet supplemented with nuts, and a control diet (low in all types of fat). Analyses of intermediate markers demonstrated beneficial effects of the Mediterranean diet on blood pressure, lipid profile, lipoprotein particles, oxidative stress and inflammation markers and carotid atherosclerosis. However, the most important finding was the 30% reduction in the relative risk of major cardiovascular complications (heart attack, stroke and cardiovascular mortality) in both Mediterranean diet groups compared to those who followed a low-fat diet. The results of the PREDIMED trial demonstrate that a high unsaturated fat, antioxidant and anti-inflammatory diet plan such as the Mediterranean diet is a useful tool in reducing overall mortality and in preventing cardiovascular disease.

  19. Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

    Science.gov (United States)

    Ebeigbe, P N

    2013-06-01

    Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

  20. Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997–2012

    Directory of Open Access Journals (Sweden)

    Nádia Cristina Pinheiro Rodrigues

    2016-11-01

    Conclusion: Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals. Public policies and intersectoral efforts may contribute to improvements in these health indicators.

  1. Tracking maternal mortality declines in Mongolia between 1992 and 2007: the importance of collaboration.

    Science.gov (United States)

    Yadamsuren, Buyanjargal; Merialdi, Mario; Davaadorj, Ishnyam; Requejo, Jennifer Harris; Betrán, Ana Pilar; Ahmad, Asima; Nymadawa, Pagvajav; Erkhembaatar, Tudevdorj; Barcelona, Delia; Ba-Thike, Katherine; Hagan, Robert J; Prado, Richard; Wagner, Wolf; Khishgee, Seded; Sodnompil, Tserendorj; Tsedmaa, Baatar; Jav, Baldan; Govind, Salik R; Purevsuren, Genden; Tsevelmaa, Baldan; Soyoltuya, Bayaraa; Johnson, Brooke R; Fajans, Peter; Van Look, Paul Fa; Otgonbold, Altankhuyag

    2010-03-01

    To describe the declining trend in maternal mortality observed in Mongolia from 1992 to 2007 and its acceleration after 2001 following implementation of the Maternal Mortality Reduction Strategy by the Ministry of Health and other partners. We performed a descriptive analysis of maternal mortality data collected through Mongolia's vital registration system and provided by the Mongolian Ministry of Health. The observed declining mortality trend was analysed for statistical significance using simple linear regression. We present the maternal mortality ratios from 1992 to 2007 by year and review the basic components of Mongolia's Maternal Mortality Reduction Strategy for 2001-2004 and 2005-2010. Mongolia achieved a statistically significant annual decrease in its maternal mortality ratio of almost 10 deaths per 100 000 live births over the period 1992-2007. From 2001 to 2007, the maternal mortality ratio in Mongolia decreased approximately 47%, from 169 to 89.6 deaths per 100 000 live births. Disparities in maternal mortality represent one of the major persisting health inequities between low- and high-resource countries. Nonetheless, important reductions in low-resource settings are possible through collaborative strategies based on a horizontal approach and the coordinated involvement of key partners, including health ministries, national and international agencies and donors, health-care professionals, the media, nongovernmental organizations and the general public.

  2. Effect of free maternal health services on maternal mortality: An experience from Niger Delta, Nigeria

    Directory of Open Access Journals (Sweden)

    Samuel O Azubuike

    2015-01-01

    Full Text Available Background: Free maternal health care was launched by Delta State Government in 2007. This development was laudable as poverty has been identified as a big hindrance to accessing health care services among mothers in rural communities. There was need, however, to ascertain the effectiveness of this program. Aim: The study aimed at determining maternal mortality rate (MMR from 2005 to 2009, its correlates, obstetric cause of death and to evaluate the effect of free maternal care on MMR. Methodology: MMRs were computed based on all maternal deaths and live births available in summary health report of Ika South local government area from 2005 to 2009. Correlational analysis was done to determine the correlates of MMRs. Statistical Package for Social Sciences (SPSS version 16 (USA, 2007 was used in the analysis. Results: There was a reduction in MMR from 932/100,000 in 2005 to 604/100,000 in 2009. This reduction negatively correlated (r =−;0.74, P = 0.15 with an increase in antenatal care registration within the period. The gradual increase in proportion of child delivery in health facilities from 59% in 2007 to 74.6% (2288/3065 in 2009 negatively correlated (r =−;0.5, P = 0.4 with a reduction in MMR from 836/100,000 to 604/100,000. The number of skilled staff employed increased by 36.4% (51/140 since 2005 and negatively correlated (r =−;0.34, P = 0.56 with MMR reduction of 328/100,000 since that period, with the employment of nurses being the stronger correlate (r =−;0.48, P = 0.41. Hemorrhage (44% was the leading obstetric cause of death. Conclusion: The study showed that MMR has been on a gradual downward trend since the introduction of free maternal health services in Delta State, Nigeria.

  3. Trends of maternal mortality in Eden Hospital during 1976.

    Science.gov (United States)

    Sikdar, K; Konar, M

    1979-01-01

    83 cases of maternal deaths in Eden Hospital, Calcutta, India, during 1976 are analyzed and high-risk cases were sorted out in relation to hospital admission. 60% of the 83 deaths occurred in patients aged 21-30 years, a period of high obstetric admissions. 23% were under age 20, 16% were aged 31-40 years, and 1.2% were over 40 years of age at time of death. The grand multiparas were the high-risk patients: 26% of deaths were in primiparas, 23% in 2nd gravida, 20% in 3rd, 6% in 4th, and 24% in 5th+ gravidas. Sepsis was responsible for 22.9% of deaths, toxemia for 21.4%, hemorrhages for 7.2%, and anemia for 7.2%; uterine rupture accounted for 3.6% of deaths. Abortions individually accounted for 18.4% of deaths (92% of these were illegal procedures). Overall, maternal mortality rate at Eden was 10.32 or 8.46/1000 total births including and excluding abortions. The high-ranking causes of death were sepsis (22.9%), which included cases of septic abortion, toxemia, jaundice, anemia, and hemorrhages, in descending order. However, when the percentages of deaths caused by individual conditions were viewed against their hospital admission, jaundice, anemia, and acute obstetrical emergencies were the highest risk cases in terms of likelihood of death.

  4. hiv-aids related maternal mortality in benin city, ni- geria

    African Journals Online (AJOL)

    David Ofori-Adjei

    2011-06-01

    Jun 1, 2011 ... SUMMARY. Objective: To determine the causes and characteristics of maternal deaths in HIV-infected women. Design: A retrospective study of maternal deaths in a cohort of HIV-infected women. Setting: A facility-based maternal death review using case records and mortality summaries. Methods: Thirty ...

  5. Review of Maternal Mortality in Ethiopia: A Story of the Past 30 Years

    African Journals Online (AJOL)

    BACKGROUND: Ethiopia is one of the six countries which have contributed to more than 50% of all maternal deaths across the world. This country has adopted the millennium development goals (MDGs) including reducing the maternal mortality by three-quarter, and put improvement in maternal health as one of the health ...

  6. Emergency obstetric care as the priority intervention to reduce maternal mortality in Uganda.

    Science.gov (United States)

    Mbonye, A K; Asimwe, J B; Kabarangira, J; Nanda, G; Orinda, V

    2007-03-01

    We conducted a survey to determine availability of emergency obstetric care (EmOC) to provide baseline data for monitoring provision of obstetric care services in Uganda. The survey, covering 54 districts and 553 health facilities, assessed availability of EmOC signal functions. Following this, performance improvement process was implemented in 20 district hospitals to scale-up EmOC services. A maternal mortality ratio (MMR) of 671/100,000 live births was recorded. Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and malaria accounted for 65.5% of the indirect causes. Among the obstetric complications, abortion accounted for 38.9% of direct and malaria 87.4% of indirect causes. Removal of retained products (OR 3.3, PEmOC, 349 (97.2%) were not offering them. Using the performance improvement process, availability of EmOC in the 20 hospitals improved significantly. An integrated programming approach aiming at increasing access to EmOC, malaria treatment and prevention services could reduce maternal mortality in Uganda.

  7. Maternal Mortality in the First Year of the New Millennium at the ...

    African Journals Online (AJOL)

    Conclusion: Any intervention to reduce maternal mortality here should be directed towards eliminating poverty, illiteracy and ignorance which are the major factors that create the unbooked mothers. Key Words: First year, New millennium, maternal mortality, Port Harcourt Journal of College of Medicine Vol.9(1) 2004: 25-27 ...

  8. A new approach to maternal mortality: the role of HIV in pregnancy.

    Science.gov (United States)

    Gorman, Sara E

    2013-01-01

    As 2015 quickly approaches, we have been made increasingly aware of our progress toward Millennium Development Goals (MDGs). However, one MDG has been particularly recalcitrant to progress: MDG 5, namely, improving maternal health. Few countries are on track to achieve the first part of MDG 5's goals, reducing maternal mortality by 75%. This article addresses the key priority issues of maternal health as part of sexual and reproductive health issues and maternal health and communicable diseases. It argues that only an integrative approach to the twin challenges of HIV and maternal mortality can help reduce devastatingly high rates of maternal deaths worldwide, especially in sub-Saharan Africa. The article reenvisions the MDGs not as separate, independent tasks, but as related, cohesive issues for which a holistic approach is needed. New causes of the relationship between HIV and maternal mortality are considered, and possible solutions are broached.

  9. Optimal breastfeeding durations for HIV-exposed infants: the impact of maternal ART use, infant mortality and replacement feeding risk.

    Science.gov (United States)

    Mallampati, Divya; MacLean, Rachel L; Shapiro, Roger; Dabis, Francois; Engelsmann, Barbara; Freedberg, Kenneth A; Leroy, Valeriane; Lockman, Shahin; Walensky, Rochelle; Rollins, Nigel; Ciaranello, Andrea

    2018-04-01

    In 2010, the WHO recommended women living with HIV breastfeed for 12 months while taking antiretroviral therapy (ART) to balance breastfeeding benefits against HIV transmission risks. To inform the 2016 WHO guidelines, we updated prior research on the impact of breastfeeding duration on HIV-free infant survival (HFS) by incorporating maternal ART duration, infant/child mortality and mother-to-child transmission data. Using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Infant model, we simulated the impact of breastfeeding duration on 24-month HFS among HIV-exposed, uninfected infants. We defined "optimal" breastfeeding durations as those maximizing 24-month HFS. We varied maternal ART duration, mortality rates among breastfed infants/children, and relative risk of mortality associated with replacement feeding ("RRRF"), modelled as a multiplier on all-cause mortality for replacement-fed infants/children (range: 1 [no additional risk] to 6). The base-case simulated RRRF = 3, median infant mortality, and 24-month maternal ART duration. In the base-case, HFS ranged from 83.1% (no breastfeeding) to 90.2% (12-months breastfeeding). Optimal breastfeeding durations increased with higher RRRF values and longer maternal ART durations, but did not change substantially with variation in infant mortality rates. Optimal breastfeeding durations often exceeded the previous WHO recommendation of 12 months. In settings with high RRRF and long maternal ART durations, HFS is maximized when mothers breastfeed longer than the previously-recommended 12 months. In settings with low RRRF or short maternal ART durations, shorter breastfeeding durations optimize HFS. If mothers are supported to use ART for longer periods of time, it is possible to reduce transmission risks and gain the benefits of longer breastfeeding durations. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

  10. The use of educational video to promote maternal self-efficacy in preventing early childhood diarrhoea.

    Science.gov (United States)

    Joventino, Emanuella Silva; Ximenes, Lorena Barbosa; da Penha, Jardeliny Corrêa; Andrade, Lucilande Cordeiro de Oliveira; de Almeida, Paulo César

    2017-06-01

    Diarrhoea is responsible for high rates of infant morbidity and mortality. It is multifactorial, manifested by socioeconomic, hygienic, and maternal factors. The aim of this study is to evaluate the effects of an educational video on maternal self-efficacy for the prevention of childhood diarrhoea. This was a randomized trial conducted in the state of Ceará, Brazil. Participants were 2 groups (comparison and intervention), composed of mothers of children under 5 years of age. Group membership was allocated by cluster randomization. Outcomes were maternal self-efficacy measured using the Maternal Self-efficacy Scale for Prevention of Early Childhood Diarrhoea; outcome data collectors were blinded to group allocation. Ninety participants were randomized to each group; 83 intervention group and 80 comparison group members were contained in the final analysis. Maternal self-efficacy in preventing childhood diarrhoea increased in both groups, but average scores of the intervention group were higher at all time than those of the comparison group. The educational video had a significant effect on maternal self-efficacy. © 2017 John Wiley & Sons Australia, Ltd.

  11. Maternal mortality in Kassala State - Eastern Sudan: community-based study using Reproductive age mortality survey (RAMOS

    Directory of Open Access Journals (Sweden)

    Mohammed Abdalla A

    2011-12-01

    Full Text Available Abstract Background The maternal mortality ratio in Sudan was estimated at 750/100,000 live births. Sudan was one of eleven countries that are responsible for 65% of global maternal deaths according to a recent World Health Organization (WHO estimate. Maternal mortality in Kassala State was high in national demographic surveys. This study was conducted to investigate the causes and contributing factors of maternal deaths and to identify any discrepancies in rates and causes between different areas. Methods A reproductive age mortality survey (RAMOS was conducted to study maternal mortality in Kassala State. Deaths of women of reproductive age (WRA in four purposively selected areas were identified by interviewing key informants in each village followed by verbal autopsy. Results Over a three-year period, 168 maternal deaths were identified among 26,066 WRA. Verbal autopsies were conducted in 148 (88.1% of these cases. Of these, 64 (43.2% were due to pregnancy and childbirth complications. Maternal mortality rates and ratios were 80.6 per 100,000 WRA and 713.6 per 100,000 live births (LB, respectively. There was a wide discrepancy between urban and rural maternal mortality ratios (369 and 872100,000 LB, respectively. Direct obstetric causes were responsible for 58.4% of deaths. Severe anemia (20.3% and acute febrile illness (9.4% were the major indirect causes of maternal death whereas obstetric hemorrhage (15.6%, obstructed labor (14.1% and puerperal sepsis (10.9% were the major obstetric causes. Of the contributing factors, we found delay of referral in 73.4% of cases in spite of a high problem recognition rate (75%. 67.2% of deaths occurred at home, indicating under utilization of health facilities, and transportation problems were found in 54.7% of deaths. There was a high illiteracy rate among the deceased and their husbands (62.5% and 48.4%, respectively. Conclusions Maternal mortality rates and ratios were found to be high, with a wide

  12. Social inequalities in maternal mortality among the provinces of Ecuador.

    Science.gov (United States)

    Sanhueza, Antonio; Roldán, Jakeline Calle; Ríos-Quituizaca, Paulina; Acuña, Maria Cecilia; Espinosa, Isabel

    2017-06-08

    This study set out to describe the association between the maternal mortality ratio (MMR) estimates and a set of socioeconomic indicators and compute the MMR inequalities among the provinces of Ecuador. A cross-sectional ecological study was conducted, using data for 2014 from the country's 24 provinces. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed. Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service. Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities. In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.

  13. Social inequalities in maternal mortality among the provinces of Ecuador

    Directory of Open Access Journals (Sweden)

    Antonio Sanhueza

    2017-06-01

    Full Text Available ABSTRACT Objective This study set out to describe the association between the maternal mortality ratio (MMR estimates and a set of socioeconomic indicators and compute the MMR inequalities among the provinces of Ecuador. Methods A cross-sectional ecological study was conducted, using data for 2014 from the country’s 24 provinces. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed. Results Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service. Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. Conclusions This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities. In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.

  14. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study

    Directory of Open Access Journals (Sweden)

    Hernández Valentín

    2009-12-01

    Full Text Available Abstract Background Maternal health is one of the major worldwide health challenges. Currently, the unacceptably high levels of maternal mortality are a common subject in global health and development discussions. Although some countries have made remarkable progress, half of the maternal deaths in the world still take place in Sub-Saharan Africa where little or no progress has been made. There is no single simple, straightforward intervention that will significantly decrease maternal mortality alone; however, there is a consensus on the importance of a strong health system, skilled delivery attendants, and women's rights for maternal health. Our objective was to describe and determine different factors associated with the maternal mortality ratio in Sub-Saharan countries. Methods An ecological multi-group study compared variables between many countries in Sub-Saharan Africa using data collected between 1997 and 2006. The dependent variable was the maternal mortality ratio, and Health care system-related, educational and economic indicators were the independent variables. Information sources included the WHO, World Bank, UNICEF and UNDP. Results Maternal mortality ratio values in Sub-Saharan Africa were demonstrated to be high and vary enormously among countries. A relationship between the maternal mortality ratio and some educational, sanitary and economic factors was observed. There was an inverse and significant correlation of the maternal mortality ratio with prenatal care coverage, births assisted by skilled health personnel, access to an improved water source, adult literacy rate, primary female enrolment rate, education index, the Gross National Income per capita and the per-capita government expenditure on health. Conclusions Education and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others.

  15. Maternal Mortality at Kamuzu Central Hospital for 1985:

    African Journals Online (AJOL)

    Introduction. The World Health Organisation defines mater- nal death as one that occurs during or within six weeks of the end of pregnancy. The maternal death rate is the number of maternal deaths per. 100,000 live births. This number includes direct indirect and non-maternal deaths occuring withi~ the defined period.

  16. Maternal mortality and delay: Socio-demographic characteristics of ...

    African Journals Online (AJOL)

    This study assessed the contribution of delay to maternal deaths and also determined the socio¬demographic characteristics of patients with maternal deaths with associated delay. Methods: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital, Nigeria between January 1999 ...

  17. Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention

    Science.gov (United States)

    Pass, Robert F.; Arav-Boger, Ravit

    2018-01-01

    Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection. PMID:29560263

  18. Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria.

    Science.gov (United States)

    Igwegbe, Anthony O; Eleje, George U; Ugboaja, Joseph O; Ofiaeli, Robinson O

    2012-03-01

    To evaluate the impact of the introduction of the Service Compact with all Nigerians (SERVICOM) contract on maternal health at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. A retrospective and comparative study of maternal deaths between 2004 and 2010 was carried out. The main outcome measures were yearly maternal mortality ratio (MMR), relative risk (RR) of maternal mortality, and presentation-intervention interval. The yearly MMR and the RR of maternal mortality were compared with the figures from 2004, which represented the pre-SERVICOM era. There were 4916 live births and 54 maternal deaths during the study period, giving an MMR of 1098 per 100,000 live births. Pre-eclampsia/eclampsia was the most common direct cause (25.0%), followed by hemorrhage (18.8%) and sepsis (8.3%). Anemia (12.5%) was the most common indirect cause. There was a progressive reduction in MMR and RR of maternal mortality, with a corresponding increase in live births. The presentation-intervention interval improved significantly from 2006. A positive change in the attitude of health workers and the elimination of fee-for-service in emergency obstetric care would reduce type 3 delays in public health facilities, and consequently reduce maternal mortality. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  19. Achieving the millennium development goal of reducing maternal mortality in rural Africa: an experience from Burundi.

    Science.gov (United States)

    Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; Van den Bergh, R; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christaens, B; Ndelema, B; Kabangu, A; Manirampa, J; Harries, A D

    2013-02-01

    To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100,000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100,000 live births). Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa. © 2012 Blackwell Publishing Ltd.

  20. A new approach to maternal mortality: the role of HIV in pregnancy

    Directory of Open Access Journals (Sweden)

    Gorman SE

    2013-05-01

    Full Text Available Sara E GormanDepartment of Epidemiology, Harvard University, Boston, MA, USAAbstract: As 2015 quickly approaches, we have been made increasingly aware of our progress toward Millennium Development Goals (MDGs. However, one MDG has been particularly recalcitrant to progress: MDG 5, namely, improving maternal health. Few countries are on track to achieve the first part of MDG 5's goals, reducing maternal mortality by 75%. This article addresses the key priority issues of maternal health as part of sexual and reproductive health issues and maternal health and communicable diseases. It argues that only an integrative approach to the twin challenges of HIV and maternal mortality can help reduce devastatingly high rates of maternal deaths worldwide, especially in sub-Saharan Africa. The article reenvisions the MDGs not as separate, independent tasks, but as related, cohesive issues for which a holistic approach is needed. New causes of the relationship between HIV and maternal mortality are considered, and possible solutions are broached.Keywords: HIV, maternal mortality, Millennium Development Goals, integrated approach to maternal health

  1. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Sue J Goldie

    2010-04-01

    Full Text Available BACKGROUND: Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. METHODS AND FINDINGS: Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants. Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35% without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC. An integrated and stepwise approach was

  2. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

    Science.gov (United States)

    Goldie, Sue J; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-04-20

    Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately prevent four of five

  3. Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

    Science.gov (United States)

    Goldie, Sue J.; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-01-01

    Background Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Methods and Findings Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold (∼23%–35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately

  4. [Problems of the health system in Mexican states with high incidence of maternal mortality].

    Science.gov (United States)

    Rouvier, Mariel; González-Block, Miguel Ángel; Sesia, Paola; Becerril-Montekio, Víctor

    2013-04-01

    To identify and prioritize problems in states' health systems which limit the efficacy of interventions to prevent maternal mortality. We made a conceptual mapping of priority problems perceived as such by communities of practice (COP) in four states with high ratios of maternal mortality in Mexico. Then, the four COP reviewed the literature and refined their formulation of previously identified problems. Priority problems focused on emergency obstetric care (EmOC), specifically: inadequate financial resources (Guerrero), substandard training among available EmOC providers (State of Mexico), inefficiencies in existing EmOC networks (Oaxaca) and inadequate knowledge of, and/or compliance to, standard EmOC protocols (Veracruz). The literature review confirmed the pertinence of problems previously identified by COP through conceptual mapping. CONCLUSIONS. The four COP showed a high level of congruency between their original perception of problems in the states' health systems and international scientific evidence. Identified problems and their reformulation based on evidence help identify solutions adaptable to local contexts.

  5. Risk factors of maternal mortality in Sistan region: 10-year report

    Directory of Open Access Journals (Sweden)

    Mohammad Sarani

    2014-12-01

    Conclusion: Based on our findings, some factors including multiparity, pregnancy his-tory more than 4 times, short interval between pregnancies lower than 2 years and ma-ternal age more than 35 years were some risk factors for maternal death. Maternal mortality in the postpartum period was more than pre-delivery period. Bleeding was the main cause of maternal mortality. Therefore monitoring of vital signs in the post-partum period and the proper management of bleeding are very important. It is sug-gested that risk assessment should be done for pregnant women in delivery ward for detecting high risk pregnant women. Suitable management for these women especially for patients with postpartum hemorrhage plays an important role to decrease the ma-ternal mortality.

  6. The role of the social condition of women in the decline of maternal and female mortality.

    Science.gov (United States)

    Cortés-Majó, M; García-Gil, C; Viciana, F

    1990-01-01

    The objective of this article is to study the changes that have occurred in the mortality pattern of women of fertile age in Spain throughout the 20th century, the significance of maternal mortality in the development of this pattern, and the other causes of death that have contributed most to such changes. Female mortality has most often been approached from the perspective of the genetic differences from males--particularly from the sexual-biological, basically reproductive, aspect--without considering other possible (social) differences. We have studied the female mortality pattern from the double incline of date of death (period) and of date of birth (cohort). Using the mortality theory of competing risks as our basis, we excluded in turn maternal mortality and mortality due to tuberculosis from overall mortality, and analyzed the transformations produced in the mortality pattern. Our results show that maternal mortality alone cannot be held responsible for the excess female mortality of the 1910s and 1920s, or for the mortality pattern among women of fertile age during the first half of this century. We suggest that the social discrimination against females from infancy has been responsible for most of the differences observed in mortality patterns.

  7. A 10 years autopsy‑based study of maternal mortality in Lagos State ...

    African Journals Online (AJOL)

    Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. Nigeria is among the six countries that record over 50% of all maternal deaths in the world. There are few papers on autopsy based causes of ...

  8. A 10 years autopsy‑based study of maternal mortality in Lagos State ...

    African Journals Online (AJOL)

    2016-03-05

    Mar 5, 2016 ... Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. Nigeria is among the six countries that record over 50% of all maternal deaths in the world. There are few papers on autopsy based ...

  9. millennium development goal 5: a review of maternal mortality at the ...

    African Journals Online (AJOL)

    hi-tech

    2006-01-01

    Jan 1, 2006 ... 3. 1.5. Pulmonary embolism. 1. 0.5. Others. 10. 4.9. Total. 203. 100. Direct obstetric causes of maternal mortality accounted for 68.5% of maternal deaths out of which sepsis (postabortal and puerperal) amounted to 42.8% of the total followed by haemorrhage 10.8%. Majority of haemorrhage was postpartum ...

  10. Impact of inter-facility transport on maternal mortality in the Free ...

    African Journals Online (AJOL)

    Aim. In December 2011, having identified inter-facility transport as a problem in the maternity service, the Free State Department of Health procured and issued 48 vehicles including 18 dedicated to maternity care. Subsequently, a sustained reduction in mortality was observed. We probed the role of inter-facility transport in ...

  11. Time series analysis of maternal mortality in Africa from 1990 to 2005

    NARCIS (Netherlands)

    Dersarkissian, Maral; Thompson, Caroline A.; Arah, Onyebuchi A.

    2013-01-01

    Most global maternal deaths occur in Africa and Asia. In response, the Millennium Development Goal (MDG-5) calls for a 75% reduction in maternal mortality from 1990 to 2015. To assess the potential for progress in MDG-5 in Africa, we examined the cross-sectional and longitudinal associations of

  12. Is poor maternal mortality index in Nigeria a problem of care ...

    African Journals Online (AJOL)

    Administrator

    A case study of Anambra State. Ibeh, Christian C. ABSTRACT. Maternal mortality in Nigeria is unacceptably high. Some of the reasons may include poor socioeconomic development, weak ... sampling technique was used to select 800 nursing mothers from the State who were interviewed on the use of maternal services ...

  13. Maternal mortality: the shameful state in the Sudan What role can ...

    African Journals Online (AJOL)

    Maternal death is the death of a woman while pregnant, or within 42 days of termination of the pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.1. The maternal mortality ratio (MMR) ...

  14. Anesthesia-Related Maternal Mortality in the United States : 1979-2002

    NARCIS (Netherlands)

    Hawkins, Joy L.; Chang, Jeani; Palmer, Susan K.; Gibbs, Charles P.; Callaghan, William M.

    OBJECTIVE: To examine 12 years of anesthesia-related maternal deaths from 1991 to 2002 and compare them with data from 1979 to 1990, to estimate trends in anesthesia-related maternal mortality over time, and to compare the risks of general and regional anesthesia during cesarean delivery. METHODS:

  15. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.

    Science.gov (United States)

    Alkema, Leontine; Chou, Doris; Hogan, Daniel; Zhang, Sanqian; Moller, Ann-Beth; Gemmill, Alison; Fat, Doris Ma; Boerma, Ties; Temmerman, Marleen; Mathers, Colin; Say, Lale

    2016-01-30

    Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country

  16. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan.

    Science.gov (United States)

    Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki

    2016-03-21

    To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Descriptive study. Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). The preventability and problems in each maternal death. Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1-3 h. A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Suboptimal care and maternal mortality among foreign-born women in Sweden

    DEFF Research Database (Denmark)

    Esscher, Annika; Binder-Finnema, Pauline; Bødker, Birgit

    2014-01-01

    BACKGROUND: Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths...... that occurred in Sweden from 1988-2010. METHODS: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases...... of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal...

  18. Causes and Risk Factors for Maternal Mortality in Rural Tanzania ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Salud. Publica de Mexico 2006;48(3):183-92. 28. Mbonye A. Risk factors associated with maternal deaths in health units in Uganda. African Journal of. Reproductive Health 2001;5(3). 29. Evjen-Olsen B, Hinderaker SG, Lie RT, Bergsjo P,. Gasheka P, Kvale G. Risk factors for maternal death in the highlands of rural northern ...

  19. Reducing Maternal Mortality in Nigeria: An Approach through Policy ...

    African Journals Online (AJOL)

    f.okonofua

    if the present trend continues. This trepidation has created an .... health. If current efforts at improving maternal health and reducing maternal .... services gratuits. En plus, le Président a nommé un. Conseiller Honoraire chargé de la Santé qui devait travailler avec le gouvernement aux niveaux sous- nationaux pour mettre la ...

  20. Maternal Mortality in Nigerian and Public Health Interventions ...

    African Journals Online (AJOL)

    In the last decade, so much has been said concerning maternal death in Nigeria, the Millennium Development Goals and political will of the government in achieving these goals. Health related goals are majorly driven by public health interventions, and some good progress has been noticed in issues relating to maternal ...

  1. Community perception of the causes of maternal mortality among ...

    African Journals Online (AJOL)

    The most common causes of maternal death highlighted by the participants were spiritual attack from enemies and punishment by the Gods for infidelity. Suggestions made by the participants to reduce maternal death included, education of women on the need to be faithful to their husbands, acceptance of Christianity by all ...

  2. Wernicke's encephalopathy: a preventable cause of maternal death.

    Science.gov (United States)

    Wedisinghe, Lilantha; Jayakody, Kaushadh; Arambage, Kirana

    2011-01-01

    Wernicke's encephalopathy is a rare cause of maternal death. It is a difficult diagnosis to make but prevention and treatment is straightforward. Severe thiamine deficiency causes Wernicke-Korsakoff syndrome. Correct diagnosis and treatment with thiamine will decrease the case fatality rate.

  3. Improving maternal and child health systems in Fiji through a perinatal mortality audit.

    Science.gov (United States)

    Raman, Shanti; Iljadica, Alexandra; Gyaneshwar, Rajat; Taito, Rigamoto; Fong, James

    2015-05-01

    To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji. In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12. Key informant interviews identified factors influencing PMA uptake. Overall, 141 stillbirths and neonatal deaths were analyzed (57 from hospital A and 84 from hospital B; forms from hospital C excluded because incomplete/illegible). Between-site variations in mortality were recorded on the basis of the level of tertiary care available; 28 (49%) stillbirths were recorded in hospital A compared with 53 (63%) in hospital B. Substantial health system factors contributing to preventable deaths were identified, and included inadequate staffing, problems with medical equipment, and lack of clinical skills. Leadership, teamwork, communication, and having a standardized process were associated with uptake of PMA. The use of PMAs by health workers in Fiji and other Pacific island countries could potentially rectify gaps in maternal and neonatal service delivery. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: exploring pathways for maternal mortality reduction

    Directory of Open Access Journals (Sweden)

    Solange da Cruz Chaves

    2015-05-01

    Full Text Available OBJECTIVE: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. METHODS: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. RESULTS: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. CONCLUSIONS: This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.

  5. The abortion paradox in Uganda: fertility regulator or cause of maternal mortality.

    Science.gov (United States)

    Gorrette, Nalwadda; Nabukera, Sarah; Salihu, Hamisu M

    2005-11-01

    Both fertility and maternal mortality indices are high among Ugandan mothers. The expected benefits in fertility and maternal mortality reduction from a rising contraceptive uptake in the country (from 5% in 1991 to 23% by the year 2000) have not been forthcoming because the increase in contraceptive prevalence rate (CPR) was below the critical level required to cause any meaningful change in overall fertility and maternal mortality. The strong desire among couples to limit family size coupled with the lack of access to modern methods of contraception by many women, especially in the rural areas of the country, have contributed to the increasing use of abortion as a means of averting unplanned or mistimed motherhood. In contrast to the expected results of a typical fertility regulator, however, abortion seems to up-regulate instead of down-regulate the occurrence of maternal mortality. This paradoxical relationship is explained mainly by the illegality of the procedure, which converts it to a clandestine activity performed by poorly trained individuals operating, in many instances, in septic settings. A practical solution is to make modern and effective methods of contraception widely available, especially among rural-dwellers. Through this and coupled with training of personnel, as well as demystification of abortion by dismantling the stigma of "illegality" associated with it, down-regulation of fertility and maternal mortality can both be achieved in a country like Uganda where population explosion is further complicated by a high incidence of maternal demise.

  6. Programs and Policies for Reducing Maternal Mortality in Kano ...

    African Journals Online (AJOL)

    . This study is aimed to document policies and programs that are directed towards addressing maternal health issues in Kano state of Nigeria. Relevant data was obtained from the state hospital management board, NDHS 2008, and national ...

  7. High maternal and neonatal mortality rates in northern Nigeria: an 8-month observational study

    Directory of Open Access Journals (Sweden)

    Guerrier G

    2013-08-01

    Full Text Available Gilles Guerrier,1 Bukola Oluyide,2 Maria Keramarou,1 Rebecca Grais1 1Epicentre, Paris, France; 2Médecins Sans Frontières, Paris, France Background: Despite considerable efforts to reduce the maternal mortality ratio, numerous pregnant women continue to die in many developing countries, including Nigeria. We conducted a study to determine the incidence and causes of maternal mortality over an 8-month period in a rural-based secondary health facility located in Jahun, northern Nigeria. Methods: A retrospective observational study was performed in a 41-bed obstetric ward. From October 2010 to May 2011, demographic data, obstetric characteristics, and outcome were collected from all pregnant women admitted. The total number of live births during the study period was recorded in order to calculate the maternal mortality ratio. Results: There were 2,177 deliveries and 39 maternal deaths during the study period, with a maternal mortality ratio of 1,791/100,000 live births. The most common causes of maternal mortality were hemorrhage (26%, puerperal sepsis (19%, and obstructed labor (5%. No significant difference (P = 0.07 in mean time to reach the hospital was noted between fatal cases (1.9 hours, 95% confidence interval [CI] 1.1–2.6 and nonfatal cases (1.4 hours, 95% CI 1.4–1.5. Two hundred and sixty-six women were admitted presenting with stillbirth. Maternal mortality was higher for unbooked patients than for booked patients (odds ratio 5.1, 95% CI 3.5–6.2, P < 0.0001. The neonatal mortality rate was calculated at 46/1,000 live births. The main primary causes of neonatal deaths were prematurity (44% and birth asphyxia (22%. Conclusion: Maternal and neonatal mortality remains unacceptably high in this setting. Reducing unbooked emergencies should be a priority with continuous programs including orthodox practices in order to meet the fifth Millennium Development Goal. Keywords: fetal mortality, maternal mortality, Nigeria, antenatal care

  8. Health Services, Maternal Intrinsic and Socio-Cultural Factors and Perinatal Mortality

    OpenAIRE

    Diaz Viera, Andika Alexander; Pellokila, M R; Paun, Rafael

    2017-01-01

    This study question was how significant the determination of health services, maternal intrinsic risk factors and socio-cultural factors on perinatal mortality. Its objective was to construct a model of perinatal mortality pattern by case-control design. The case population was all mothers with perinatal mortality. The sample-size was 35 by simple random sampling with case-control ratio of 1:1 (35:35). The data analysis applied Bivariate using Chi Square Test and Multivariate using Logist...

  9. Maternal mortality in Mexico, beyond millennial development objectives: An age-period-cohort model.

    Science.gov (United States)

    Rodríguez-Aguilar, Román

    2018-01-01

    The maternal mortality situation is analyzed in México as an indicator that reflects the social development level of the country and was one of the millennial development objectives. The effect of a maternal death in the related social group has multiplier effects, since it involves family dislocation, economic impact and disruption of the orphans' normal social development. Two perspectives that causes of maternal mortality were analyzed, on one hand, their relationship with social determinants and on the other, factors directly related to the health system. Evidence shows that comparing populations based on group of selected variables according to social conditions and health care access, statistically significant differences prevail according to education and marginalization levels, and access to medical care. In addition, the Age-Period-Cohort model raised, shows significant progress in terms of a downward trend in maternal mortality in a generational level. Those women born before 1980 had a greater probability of maternal death in relation to recent generations, which is a reflection of the improvement in social determinants and in the Health System. The age effect shows a problem in maternal mortality in women under 15 years old, so teen pregnancy is a priority in health and must be addressed in short term. There is no clear evidence of a period effect.

  10. Maternal tetanus toxoid vaccination and neonatal mortality in rural north India.

    Science.gov (United States)

    Singh, Abhishek; Pallikadavath, Saseendran; Ogollah, Reuben; Stones, William

    2012-01-01

    Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. Using the third round of the Indian National Family Health Survey (NFHS) 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose.

  11. An analysis of the determinants of maternal mortality in sub-Saharan Africa.

    Science.gov (United States)

    Buor, Daniel; Bream, Kent

    2004-10-01

    To establish what population characteristics affect the high maternal mortality rate in the sub-Saharan Africa region and to propose possible solutions to reduce this rate. This study is a secondary analysis of existing data sources from the World Bank, the World Health Organization (WHO), as well as direct and indirect sources from UNAIDS, the United Nations, Demographic and Health Surveys (DHS), Macro International, and national statistical offices. Instead of looking at continentwide or individual nation models, it develops a regional model. Sociodemographic population variables are used as independent variables to predict the dependent variable, maternal mortality. Additionally, a new country-specific political stability independent variable is introduced into the model. Data from 28 sub-Saharan African countries are used. Bivariate correlations are used to establish associations among the variables, whereas cross-tabulations, using Kendall's tau-c values, and regression lines are used to establish impacts. In the sub-Saharan Africa region, births attended by skilled health personnel and life expectancy at birth strongly correlate with maternal mortality. Gross national product (GNP) per capita and health expenditure per capita also have strong association with maternal mortality. The availability of skilled delivery personnel, life expectancy, national economic wealth, and health expenditure per capita predict the maternal mortality rate of a country. Based on these findings, it is recommended that structural arrangements be made to train skilled health personnel to take care of maternal health problems. In view of the high cost of training physicians, middle-level health personnel may offer an affordable alternative to handle emergency obstetrical cases to address the shortage of physicians. In addition, the allocation of adequate resources to the health sector could improve maternal mortality. The economic wealth of a country and life expectancy at birth are

  12. Global Reduction in HIV-related Maternal Mortality: ART as a Key Strategy

    Directory of Open Access Journals (Sweden)

    Hamisu M. Salihu, MD, PhD

    2015-12-01

    Full Text Available Dr. Holtz and colleagues present a synthesis of evidence from published studies over the previous decade on the collective impact of HIV-targeted interventions on maternal mortality. Amongst an assortment of interventions [that include antiretroviral therapy (ART, micronutrients (multivitamins, vitamin A and selenium, and antibiotics], only ART reduced maternal mortality among HIV-infected pregnant and post-partum mothers. These findings have fundamental and global strategic implications. They are also timely since they provide the evidence that ART reduces HIV-related maternal mortality, and by further enhancing access to ART in HIV-challenged and poor regions of the world, significant improvement in maternal morbidity and mortality indices could be attained. The paper bears good tidings and sound scientific proof that the financial investment made globally by government and non-governmental organizations and agencies to reduce the global burden of HIV/AIDS primarily by making ART more accessible to regions of the world most affected by the epidemic is beginning to show beneficial effects not only in terms of numerical reductions in the rates of new cases of HIV/AIDS among women, but also in maternal mortality levels.

  13. Retained Placenta: Still a cause of maternal morbidity and mortality ...

    African Journals Online (AJOL)

    Background: Retained placenta is associated with morbidity and mortality when left untreated. This study was done to determine the occurrence of retained placenta in our setting as well as to ascertain the possible risk factors, morbidities and mortality. Method of study: This was a retrospective review of all cases of retained ...

  14. Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality.

    Science.gov (United States)

    Ganatra, Bela; Faundes, Anibal

    2016-10-01

    Access to contraception reduces maternal deaths by preventing or delaying pregnancy in women who do not intend to be pregnant or those at higher risk of complications. However, not all unintended pregnancies can be prevented through increase in contraceptive use, and access to safe abortion is needed to prevent unsafe abortions. Despite not preventing the problem, provision of emergency care for complications can help prevent deaths from such unsafe abortions. Safe abortion in early pregnancy can be provided at primary care level and by non-physician providers, and the risks of mortality associated with such safe, legal abortions are minimal. Although entirely preventable, unsafe abortions continue to occur because of numerous barriers such as legal and policy restrictions, service delivery issues and provider attitudes to abortion stigma. Overall, the provision of contraception and safe abortion is important not just to prevent maternal deaths but as a measure of our ability to respect women's decisions and ensure that they have access to timely, evidence-based care that protects their health and human rights. Copyright © 2016. Published by Elsevier Ltd.

  15. Audit of Maternal Mortality Ratio and Causes of Maternal Deaths in ...

    African Journals Online (AJOL)

    Substandard medical care and the delay in seeking of medical advice were two contributing factors to maternal deaths recorded. The need for audit and publication of all obstetric hospitals MMR to compare and identify areas of improvements is recommended. (Afr J Reprod Health 2013; 17[3]: 105-109). Keywords: Maternal ...

  16. Community Perception of Maternal Mortality in Northeastern Nigeria

    African Journals Online (AJOL)

    Erah

    and transferred on to a profoma already designed for the study. Qualitative information was analyzed descriptively, paying attention to the issues and matters that were mentioned by the majority of the respondents and capturing any unique experiences reported. Results. Knowledge and Perception of maternal death in the ...

  17. Stagnating maternal mortality in Tanzania: what went wrong and ...

    African Journals Online (AJOL)

    Rumishael Shoo

    Unless planning, budgeting and financial management skills are developed and systems of accountability built, service delivery will not improve. Efforts have concentrated on the supply aspects but little has been done on the demand side. Low prioritization of maternal and new-born health. The Tanzania 2015 Countdown ...

  18. Maternal Mortality in a Tertiary Care Centre in Nepal | Goswami ...

    African Journals Online (AJOL)

    The majority (93.18%) of deaths were due to direct causes. The most common cause of maternal death was sepsis (43.18%) of which septic abortion was the leading cause (27.27%). Hypertensive disorders accounted for 29.54% of deaths and out of these, eclampsia was the leading disorder. Haemorrhage accounted for ...

  19. Progress and inequities in maternal mortality in Afghanistan (RAMOS-II: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    Linda Bartlett, DrMD

    2017-05-01

    Full Text Available Summary: Background: The risk of maternal death in Afghanistan is among the highest in the world; however, the risks within the country are poorly understood. Subnational maternal mortality estimates are needed along with a broader understanding of determinants to guide future maternal health programmes. Here we aimed to study maternal mortality risk and causes, care-seeking patterns, and costs within the country. Methods: We did a household survey (RAMOS-II in the urban area of Kabul city and the rural area of Ragh, Badakshan. Questionnaires were administered to senior female household members and data were collected by a team of female interviewers with secondary school education. Information was collected about all deaths, livebirths, stillbirths, health-care access and costs, household income, and assets. Births were documented using a pregnancy history. We investigated all deaths in women of reproductive age (12–49 years since January, 2008, using verbal autopsy. Community members; service providers; and district, provincial, and national officials in each district were interviewed to elicit perceptions of changes in maternal mortality risk and health service provision, along with programme and policy documentation of maternal care coverage. Findings: Data were collected between March 2, 2011, and Oct 16, 2011, from 130 688 participants: 63 329 in Kabul and 67 359 in Ragh. The maternal mortality ratio in Ragh was quadruple that in Kabul (713 per 100 000 livebirths, 95% CI 553–873 in Ragh vs 166, 63–270 in Kabul. We recorded similar patterns for all other maternal death indicators, including the maternal mortality rate (1·7 per 1000 women of reproductive age, 95% CI 1·3–2·1 in Ragh vs 0·2, 0·1–0·3 in Kabul. Infant mortality also differed significantly between the two areas (115·5 per 1000 livebirths, 95% CI 108·6–122·3 in Ragh vs 24·8, 20·5–29·0 in Kabul. In Kabul, 5594 (82% of 6789 women reported a skilled

  20. Progress and inequities in maternal mortality in Afghanistan (RAMOS-II): a retrospective observational study.

    Science.gov (United States)

    Bartlett, Linda; LeFevre, Amnesty; Zimmerman, Linnea; Saeedzai, Sayed Ataullah; Turkmani, Sabera; Zabih, Weeda; Tappis, Hannah; Becker, Stan; Winch, Peter; Koblinsky, Marge; Rahmanzai, Ahmed Javed

    2017-05-01

    The risk of maternal death in Afghanistan is among the highest in the world; however, the risks within the country are poorly understood. Subnational maternal mortality estimates are needed along with a broader understanding of determinants to guide future maternal health programmes. Here we aimed to study maternal mortality risk and causes, care-seeking patterns, and costs within the country. We did a household survey (RAMOS-II) in the urban area of Kabul city and the rural area of Ragh, Badakshan. Questionnaires were administered to senior female household members and data were collected by a team of female interviewers with secondary school education. Information was collected about all deaths, livebirths, stillbirths, health-care access and costs, household income, and assets. Births were documented using a pregnancy history. We investigated all deaths in women of reproductive age (12-49 years) since January, 2008, using verbal autopsy. Community members; service providers; and district, provincial, and national officials in each district were interviewed to elicit perceptions of changes in maternal mortality risk and health service provision, along with programme and policy documentation of maternal care coverage. Data were collected between March 2, 2011, and Oct 16, 2011, from 130 688 participants: 63 329 in Kabul and 67 359 in Ragh. The maternal mortality ratio in Ragh was quadruple that in Kabul (713 per 100 000 livebirths, 95% CI 553-873 in Ragh vs 166, 63-270 in Kabul). We recorded similar patterns for all other maternal death indicators, including the maternal mortality rate (1·7 per 1000 women of reproductive age, 95% CI 1·3-2·1 in Ragh vs 0·2, 0·1-0·3 in Kabul). Infant mortality also differed significantly between the two areas (115·5 per 1000 livebirths, 95% CI 108·6-122·3 in Ragh vs 24·8, 20·5-29·0 in Kabul). In Kabul, 5594 (82%) of 6789 women reported a skilled attendant during recent deliveries compared with 381 (3%) of 11

  1. Prevention and management of maternal obesity in pregnancy

    OpenAIRE

    E. Alexopoulou; N. Giannousi; I. K. Thanasas

    2017-01-01

    Nowadays obesity is one of the most important nutritional problems with features contemporary epidemic which concerns not only the developed but also the developing countries. Obesity during pregnancy associate with maternal and perinatal risks that make the management of obesity, before and during pregnancy imperative. The best and most effective treatment of obesity in pregnancy is prevention. A healthy diet and regular exercise of pregnant woman is crucial for the normal dev...

  2. Potential Gains in Reproductive-Aged Life Expectancy by Eliminating Maternal Mortality

    DEFF Research Database (Denmark)

    Canudas-Romo, Vladimir; Liu, L; Zimmerman, L

    2014-01-01

    Objective: We assessed the change over time in the contribution of maternal mortality to a life expectancy calculated between ages 15 and 49, or Reproductive-Aged Life Expectancy (RALE). Our goal was to estimate the increase in RALE in developed countries over the twentieth century and the hypoth......Objective: We assessed the change over time in the contribution of maternal mortality to a life expectancy calculated between ages 15 and 49, or Reproductive-Aged Life Expectancy (RALE). Our goal was to estimate the increase in RALE in developed countries over the twentieth century....... Findings: In developed countries, five years in RALE were gained over the twentieth century, of which approximately 10%, or half a year, was attributable to reductions in maternal mortality. In sub-Saharan African countries, the possible achievable gains fluctuate between 0.24 and 1.47 years, or 6% and 44...

  3. Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia.

    Science.gov (United States)

    Dennis, Alicia T

    2018-01-01

    Papua New Guinea has one of the world's highest maternal mortality rates with approximately 215 women dying per 100,000 live births. The sustainable development goals outline key priority areas for achieving a reduction in maternal mortality including a focus on universal health coverage with safe surgery and anesthesia for all pregnant women. This narrative review addresses the issue of reducing maternal mortality in Papua New Guinea by contextualizing the need for safe obstetric surgery and anesthesia within a structure of enabling environments at key times in a woman's life. The 3 pillars of enabling environments are as follows: a stable humanitarian government; a safe, secure, and clean environment; and a strong health system. Key times, and their associated specific issues, in a woman's life include prepregnancy, antenatal, birth and the postpartum period, childhood, adolescence and young womanhood, and the postchildbearing years.

  4. Declining maternal mortality ratio in Uganda: priority interventions to achieve the Millennium Development Goal.

    Science.gov (United States)

    Mbonye, A K; Mutabazi, M G; Asimwe, J B; Sentumbwe, O; Kabarangira, J; Nanda, G; Orinda, V

    2007-09-01

    We conducted a survey to determine availability of emergency obstetric care (EmOC) and to provide data for advocating for improved maternal and newborn health in Uganda. The survey, covering 54 districts and 553 health facilities, assessed availability of EmOC signal functions, documented maternal deaths and the related causes. Three levels of health facilities were covered. Few health units had running water; electricity or a functional operating theater. Yet having these items had a protective effect on maternal deaths as follows: theater (OR 0.56, PEmOC, were not doing so. This is the likely explanation for the high health facility-based maternal death rate of 671/100,000 live births in Uganda. Addressing health system issues, especially human resources, and increasingaccess to EmOC could reduce maternal mortality in Uganda and enable the country to achieve the Millennium Development Goal (MDG).

  5. Technology use, cesarean section rates, and perinatal mortality at Danish maternity wards

    DEFF Research Database (Denmark)

    Lidegaard, O; Jensen, L M; Weber, Tom

    1994-01-01

    Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... index (0-10) was calculated for each maternity unit according to its use of ante and intra partum fetal heart rate monitoring (FHM), hormone analysis (human placental lactogen (HPL) and/or estriol (O3)), fetal blood samples (scalp-pH), intrauterine catheter and umbilical cord-pH. Maternity units using...

  6. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis

    Directory of Open Access Journals (Sweden)

    Jahnavi Daru, MBBS

    2018-05-01

    Full Text Available Summary: Background: Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. Methods: We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. Findings: 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60–3·48. In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39–2·49]. Interpretation: Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. Funding: Barts and the London Charity.

  7. Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978-2012.

    Science.gov (United States)

    Davis, Nicole L; Hoyert, Donna L; Goodman, David A; Hirai, Ashley H; Callaghan, William M

    2017-09-01

    Maternal mortality ratios (MMR) appear to have increased in the United States over the last decade. Three potential contributing factors are (1) a shifting maternal age distribution, (2) changes in age-specific MMR, and (3) the addition of a checkbox indicating recent pregnancy on the death certificate. To determine the contribution of increasing maternal age on changes in MMR from 1978 to 2012 and estimate the contribution of the pregnancy checkbox on increases in MMR over the last decade. Kitagawa decomposition analyses were conducted to partition the maternal age contribution to the MMR increase into 2 components: changes due to a shifting maternal age distribution and changes due to greater age-specific mortality ratios. We used National Vital Statistics System natality and mortality data. The following 5-year groupings were used: 1978-1982, 1988-1992, 1998-2002, and 2008-2012. Changes in age-specific MMRs among states that adopted the standard pregnancy checkbox onto their death certificate before 2008 (n = 23) were compared with states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (n = 11) to estimate the percentage increase in the MMR due to the pregnancy checkbox. Overall US MMRs for 1978-1982, 1988-1992, and 1998-2002 were 9.0, 8.1, and 9.1 deaths per 100,000 live births, respectively. There was a modest increase in the MMR between 1998-2002 and 2008-2012 in the 11 states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (8.6 and 9.9 deaths per 100,000, respectively). However, the MMR more than doubled between 1998-2002 and 2008-2012 in the 23 states that adopted the standard pregnancy checkbox (9.0-22.4); this dramatic increase was almost entirely attributable to increases in age-specific MMRs (94.9%) as opposed to increases in maternal age (5.1%), with an estimated 90% of the observed change reflecting the change in maternal death identification rather

  8. The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings

    Science.gov (United States)

    McClure, Elizabeth M; Goldenberg, Robert L; Brandes, Neal; Darmstadt, Gary L; Wright, Linda L

    2009-01-01

    Of the 4 million neonatal deaths and 500,000 maternal deaths that occur annually worldwide, almost 99% are in developing countries and one-third are associated with infections. Implementation of proven interventions and targeted research on a select number of promising high-impact preventative and curative interventions are essential to achieve Millennium Development Goals for reduction of child and maternal mortality. Feasible, simple, low-cost interventions have the potential to significantly reduce the mortality and severe morbidity associated with infection in these settings. Studies of chlorhexidine in developing countries have focused on three primary uses: 1) intrapartum vaginal and neonatal wiping, 2) neonatal wiping alone, and 3) umbilical cord cleansing. A study of vaginal wiping and neonatal skin cleansing with chlorhexidine, conducted in Malawi in the 1990s suggested that chlorhexidine has potential to reduce neonatal infectious morbidity and mortality. A recent trial of cord cleansing conducted in Nepal also demonstrated benefit. Although studies have shown promise, widespread acceptance and implementation of chlorhexidine use has not yet occurred. This paper is derived in part from data presented at a conference on the use of chlorhexidine in developing countries and reviews the available evidence related to chlorhexidine use to reduce mortality and severe morbidity due to infections in mothers and neonates in low-resource settings. It also summarizes issues related to programmatic implementation. PMID:17399714

  9. Prevention of Treacher Collins syndrome craniofacial anomalies in mouse models via maternal antioxidant supplementation.

    Science.gov (United States)

    Sakai, Daisuke; Dixon, Jill; Achilleos, Annita; Dixon, Michael; Trainor, Paul A

    2016-01-21

    Craniofacial anomalies account for approximately one-third of all birth defects and are a significant cause of infant mortality. Since the majority of the bones, cartilage and connective tissues that comprise the head and face are derived from a multipotent migratory progenitor cell population called the neural crest, craniofacial disorders are typically attributed to defects in neural crest cell development. Treacher Collins syndrome (TCS) is a disorder of craniofacial development and although TCS arises primarily through autosomal dominant mutations in TCOF1, no clear genotype-phenotype correlation has been documented. Here we show that Tcof1 haploinsufficiency results in oxidative stress-induced DNA damage and neuroepithelial cell death. Consistent with this discovery, maternal treatment with antioxidants minimizes cell death in the neuroepithelium and substantially ameliorates or prevents the pathogenesis of craniofacial anomalies in Tcof1(+/-) mice. Thus maternal antioxidant dietary supplementation may provide an avenue for protection against the pathogenesis of TCS and similar neurocristopathies.

  10. Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

    Directory of Open Access Journals (Sweden)

    Frank Chirowa

    2013-01-01

    Full Text Available Background: This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality.Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA. A unique analysis was used to correlate the Gender Inequality Index (GII, Health Expenditure and Maternal Mortality Ratio (MMR. The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.Method: An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique,South Africa, Zambia and Zimbabwe.Results: Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.Conclusion: A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

  11. Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

    Science.gov (United States)

    Atwood, Stephen; Van der Putten, Marc

    2013-01-01

    Abstract Background This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality. Objective The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR. Method An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe. Results Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more. Conclusion A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

  12. Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

    Directory of Open Access Journals (Sweden)

    Frank Chirowa

    2013-08-01

    Full Text Available Background: This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality. Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA. A unique analysis was used to correlate the Gender Inequality Index (GII, Health Expenditure and Maternal Mortality Ratio (MMR. The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR. Method: An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique,South Africa, Zambia and Zimbabwe. Results: Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more. Conclusion: A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

  13. The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

    Directory of Open Access Journals (Sweden)

    Gülmezoglu A Metin

    2011-07-01

    Full Text Available Abstract Background Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships. Methods Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America and 2007-2008 (in Asia as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths. Results In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years, those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects

  14. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health.

    Science.gov (United States)

    Karlsen, Saffron; Say, Lale; Souza, João-Paulo; Hogue, Carol J; Calles, Dinorah L; Gülmezoglu, A Metin; Raine, Rosalind

    2011-07-29

    Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships. Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America) and 2007-2008 (in Asia) as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths. In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years), those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects relating to country of residence which were not explained

  15. Correlates of Abortion Related Maternal Mortality at the Lagos State ...

    African Journals Online (AJOL)

    This study was carried out to highlight the probable correlates of mortality among patients managed for abortion related complications at the Lagos State University Teaching Hospital, Ikeja. All patients managed for abortion related complications between 1st January 2000 and 31st December 2003 were studied. Certain ...

  16. determinants of maternal mortality among women of reproductive

    African Journals Online (AJOL)

    2013-08-01

    Aug 1, 2013 ... The model proposes that pregnancy-related mortality is overwhelmingly contributed to by delay in three phases: 1. Deciding to seek appropriate medical help for an obstetric emergency which is influenced by the factors involved in decision-making; socio- cultural factors; distance from the health facility;.

  17. Maternal and perinatal mortality figures in 249 South African ...

    African Journals Online (AJOL)

    the PMR for the black population is considerably hi9her than for the other ethnic groups. That said, perinatal mortality levels in South African blacks still compare favourably with figures from other African cQuntries.12. In conclusion, the MMRs and PMRs found in our survey of. 249 South African hospitals - though not truly.

  18. MATERNAL HEALTH-SEEKING BEHAVIOUR AND UNDER-FIVE MORTALITY IN ZIMBABWE.

    Science.gov (United States)

    Chadoka-Mutanda, Nyasha; Odimegwu, Clifford O

    2017-05-01

    Under-five mortality remains a major public health challenge in sub-Saharan Africa. Zimbabwe is one of the countries in the region that failed to achieve Millennium Developmental Goal 4 in 2015. The objective of this study was to examine the extent to which maternal health-seeking behaviour prior to and during pregnancy and post-delivery influences the likelihood of under-five mortality among Zimbabwean children. The study was cross-sectional and data were extracted from the 2010/11 Zimbabwe Demographic and Health Survey (ZDHS). The study sample comprised 5155 children who were born five years preceding the 2010/11 ZDHS to a sample of 4128 women of reproductive age (15-49 years). Cox Proportional Hazard regression modelling was used to examine the relationship between maternal health-seeking behaviour and under-five mortality. The results showed that maternal health-seeking behaviour factors are associated with the risk of dying during childhood. Children born to mothers who had ever used contraceptives (HR: 0.38, CI 0.28-0.51) had a lower risk of dying during childhood compared with children born to mothers who had never used any contraceptive method. The risk of under-five mortality among children who had a postnatal check-up within two months after birth (HR: 0.36, CI 0.23-0.56) was lower than that of children who did not receive postnatal care. Small birth size (HR: 1.70, CI 1.20-2.41) and higher birth order (2+) increased the risk of under-five mortality. Good maternal health-seeking behaviour practices at the three critical stages around childbirth have the potential to reduce under-five mortality. Therefore, public health programmes should focus on influencing health-seeking behaviour among women and removing obstacles to effective maternal health-seeking behaviour in Zimbabwe.

  19. Delivery as Trauma: A Prospective Time-Cohort Study of Maternal and Perinatal Mortality in Rural Cambodia.

    Science.gov (United States)

    Houy, Chandy; Ha, Sam Ol; Steinholt, Margit; Skjerve, Eystein; Husum, Hans

    2017-04-01

    The majority of maternal and perinatal deaths are preventable, but still women and newborns die due to insufficient Basic Life Support in low-resource communities. Drawing on experiences from successful wartime trauma systems, a three-tier chain-of-survival model was introduced as a means to reduce rural maternal and perinatal mortality. A study area of 266 villages in landmine-infested Northwestern Cambodia were selected based on remoteness and poverty. The five-year intervention from 2005 through 2009 was carried out as a prospective study. The years of formation in 2005 and 2006 were used as a baseline cohort for comparisons with later annual cohorts. Non-professional and professional birth attendants at village level, rural health centers (HCs), and three hospitals were merged with an operational prehospital trauma system. Staff at all levels were trained in life support and emergency obstetrics. Findings The maternal mortality rate was reduced from a baseline level of 0.73% to 0.12% in the year 2009 (95% CI Diff, 0.27-0.98; PCambodia. Prehosp Disaster Med. 2017;32(2):180-186.

  20. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study.

    NARCIS (Netherlands)

    Nelissen, E.J.T.; Mduma, E.; Ersdal, H.L.; Evjen-Olsen, B.; van Roosmalen, J.; van Stekelenburg, J.

    2013-01-01

    Background: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study

  1. Impact of relaxation of the one-child policy on maternal mortality in Guangzhou, China.

    Science.gov (United States)

    Sun, Wen; Liu, Shiliang; He, Fang; Du, Lili; Guo, Yanfang; El-Chaar, Darine; Wen, Shi Wu; Chen, Dunjin

    2018-01-19

    To assess the impact of the one-child policy in China on maternal mortality. The present retrospective study included maternal death data from Guangdong, China, from January 1, 2006, to December 31, 2015; data from 2013 were excluded because they were not available. Maternal deaths were divided into legal and illegal pregnancies based on adherence to the one-child policy. The maternal mortality ratio (MMR) was compared between the groups, temporal trends in the MMR were examined, and comparisons were made of the causes of death and access to maternity care. The final analysis included 847 520 live deliveries and 383 maternal deaths. The MMR among legal pregnancies declined moderately from 18.5 deaths per 100 000 live deliveries in 2006 to 12.2 deaths per 100 000 live deliveries in 2015 (P=0.029), whereas the MMR among illegal pregnancies declined dramatically from 1268.4 deaths per 100 000 live deliveries to 177.5 deaths per 100 000 live deliveries (Pone-child policy in China. © 2018 International Federation of Gynecology and Obstetrics.

  2. Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

    NARCIS (Netherlands)

    Schutte, J. M.; Schuitemaker, N. W. E.; van Roosmalen, J.; Steegers, E. A. P.

    Objective To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement. Design Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified. Setting

  3. Maternal and perinatal mortality in ward a, ikosi-isheri lcda in lagos ...

    African Journals Online (AJOL)

    Background: The problem of authentic statistics on maternal and peri-natal mortality has persisted in Nigeria probably because of inadequate involvement of community members in data management. Objective: The objective of this study was to improve the accuracy of information on pregnancy outcome in a ward in Lagos ...

  4. Facility-based delivery and maternal and early neonatal mortality in ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    One of the most important ways to address some of the key factors ... services, facility-based delivery, facility delivery, institutional delivery ..... Percent of women reporting delivering in a health facility. Quintile* ranking of facility- based delivery. Maternal. Mortality. Ration. (MMR) per. 1000 Live. Births. African. MMR quintile*.

  5. A Strategy for the Evaluation of Activities to Reduce Maternal Mortality in Developing Countries.

    Science.gov (United States)

    Ward, Victoria M.; And Others

    1994-01-01

    An evaluation strategy in which a set of process indicators is applied to programs to reduce maternal mortality in developing countries is presented. The four-stage strategy is illustrated for three interventions: (1) providing safe abortion services; (2) increasing knowledge of obstetric complications; and (3) improving medical care quality. (SLD)

  6. The role of human rights litigation in improving access to reproductive health care and achieving reductions in maternal mortality.

    Science.gov (United States)

    Dunn, Jennifer Templeton; Lesyna, Katherine; Zaret, Anna

    2017-11-08

    Improving maternal health, reducing global maternal mortality, and working toward universal access to reproductive health care are global priorities for United Nations agencies, national governments, and civil society organizations. Human rights lawyers have joined this global movement, using international law and domestic constitutions to hold nations accountable for preventable maternal death and for failing to provide access to reproductive health care services. This article discusses three decisions in which international treaty bodies find the nations of Brazil and Peru responsible for violations of the Convention on the Elimination of All Forms of Discrimination Against Women and the International Covenant on Civil and Political Rights and also two domestic decisions alleging constitutional violations in India and Uganda. The authors analyze the impact of these decisions on access to maternal and other reproductive health services in Brazil, Peru, India, and Uganda and conclude that litigation is most effective when aligned with ongoing efforts by the public health community and civil society organizations. In filing these complaints and cases on behalf of individual women and their families, legal advocates highlight health system failures and challenge the historical structures and hierarchies that discriminate against and devalue women. These international and domestic decisions empower women and their communities and inspire nations and other stakeholders to commit to broader social, economic, and political change. Human rights litigation brings attention to existing public health campaigns and supports the development of local and global movements and coalitions to improve women's health.

  7. Maternal mortality in South Africa in 2001: From demographic census to epidemiological investigation

    Directory of Open Access Journals (Sweden)

    McCaa Robert

    2008-08-01

    Full Text Available Abstract Background Maternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS. Methods The 2001 census of South Africa included a question on deaths in the previous 12 months, and two questions on external causes and maternal mortality, defined as "pregnancy-related deaths". A microdata sample from the census permits researchers to assess levels and differentials in maternal mortality, in a country severely affected by high death rates from HIV/AIDS and from external causes. Results After correcting for several minor biases, our estimate of the Maternal Mortality Ratio (MMR in 2001 was 542 per 100,000 live births. This level is much higher than previous estimates dating from pre-HIV/AIDS times. This high level occurred despite a relatively low proportion of maternal deaths (6.4% among deaths of women aged 15–49 years, and was due to the astonishingly high level of adult mortality, some 4.7 times higher than expected from mortality below age 15 or above age 50. The main reasons for these excessive levels were HIV/AIDS and external causes of deaths. Our regional estimates of MMR were found to be consistent with other findings in the Cape Town area, and with the Agincourt DSS. The differentials in MMR were considerable: 1 to 9.2 for population groups (race, 1 to 3.2 for provinces, and 1 to 2.4 for levels of education. Relationship with income and wealth were complex, with highest values for middle income and middle wealth index. The effect of urbanization was small, and reversed in a multivariate analysis. Higher risks in provinces were not necessarily associated with lower income, lower education or higher proportions of home delivery, but correlated primarily with the prevalence of HIV/AIDS. Conclusion Demographic census microdata offer the opportunity to conduct an epidemiologic analysis of maternal mortality. In the case of South Africa, the level of MMR increased dramatically

  8. Major Determinants of Maternal Near-Miss and Mortality at the Maternity Teaching Hospital, Erbil city, Iraq

    Directory of Open Access Journals (Sweden)

    Vian Sabri Akrawi

    2017-09-01

    Full Text Available Objectives: To find out the major determinants of maternal near-miss (NMand maternal deaths (MDs in Erbil city, Iraq, by comparative analysis of maternal NMs and MDs. Methods: We conducted a hospital-based cross-sectional study in the Maternity Teaching Hospital in Erbil city from 1 June to 31 December 2013. All MDs and NMs that occurred in the hospital during the study period were included in the study. Systematic identification of all eligible women was done. This identification included a baseline assessment of the severe pregnancy-related complications using the World Health Organization NM criteria. Results: Severe preeclampsia and postpartum hemorrhage (PPH constituted the highest proportions of complications in women with potentially life-threatening conditions (PLTCs (30.5% and 30.0%, respectively. The highest mortality indexes were those for ruptured uterus (16.7 and severe complications of placenta previa (14.2. Factors that were significantly associated with MD (compared to NM were hepatic dysfunction (p = 0.046, multiple/unspecified disorders (p = 0.003, arrival as an emergency condition by ambulance (p = 0.015, and history of previous cesarean section (p = 0.013. Conclusions: Severe preeclampsia and PPH are the main complications that lead to PLTCs. Factors found to be associated with MDs are hepatic dysfunction, multiple/unspecified disorders, arrival as an emergency condition by ambulance, and history of a previous cesarean section.

  9. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

    Directory of Open Access Journals (Sweden)

    Sundby Johanne

    2005-05-01

    Full Text Available Abstract Background Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. Methods We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. Results The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. Conclusion Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to

  10. Task shifting: A key strategy in the multipronged approach to reduce maternal mortality in India.

    Science.gov (United States)

    Bhushan, Himanshu; Bhardwaj, Ajey

    2015-10-01

    Task shifting from specialist to nonspecialist doctors (NSDs) is an important strategy that has been implemented in India to overcome the critical shortage of healthcare workers by using the human resources available to serve the vast population, particularly in rural areas. A competency-based training program in comprehensive emergency obstetric care was implemented to train and certify NSDs. Trained NSDs were able to provide key services in maternal health, which contribute toward reductions in maternal morbidity and mortality. The present article provides an overview of the maternal health challenges, shares important steps in program implementation, and shows how challenges can be overcome. The lessons learned from this experience contribute to understanding how task shifting can be used to address large-scale public health issues in low-resource countries and in particular solutions to address maternal health issues. Copyright © 2015. Published by Elsevier Ireland Ltd.

  11. A low-cost uterine balloon tamponade for management of postpartum hemorrhage: modeling the potential impact on maternal mortality and morbidity in sub-Saharan Africa.

    Science.gov (United States)

    Herrick, Tara; Mvundura, Mercy; Burke, Thomas F; Abu-Haydar, Elizabeth

    2017-11-13

    Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide. This study sought to quantify the potential health impact (morbidity and mortality reductions) that a low-cost uterine balloon tamponade (UBT) could have on women suffering from uncontrolled PPH due to uterine atony in sub-Saharan Africa. The Maternal and Neonatal Directed Assessment of Technology (MANDATE) model was used to estimate maternal deaths, surgeries averted, and cases of severe anemia prevented through UBT use among women with PPH who receive a uterotonic drug but fail this therapy in a health facility. Estimates were generated for the year 2018. The main outcome measures were lives saved, surgeries averted, and severe anemia prevented. The base case model estimated that widespread use of a low-cost UBT in clinics and hospitals could save 6547 lives (an 11% reduction in maternal deaths), avert 10,823 surgeries, and prevent 634 severe anemia cases in sub-Saharan Africa annually. A low-cost UBT has a strong potential to save lives and reduce morbidity. It can also potentially reduce costly downstream interventions for women who give birth in a health care facility. This technology may be especially useful for meeting global targets for reducing maternal mortality as identified in Sustainable Development Goal 3.

  12. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.

    Science.gov (United States)

    Lassi, Zohra S; Bhutta, Zulfiqar A

    2015-03-23

    While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions (such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, and/or management of infections in newborns), many require facility-based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packaged interventions which should also be supplemented by developing and strengthening linkages with the local health systems. Some of the recent community-based studies of interventions targeting women of reproductive age have shown variable impacts on maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of maternal and newborn care. To assess the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2014), World Bank's JOLIS (25 May 2014), BLDS at IDS and IDEAS database of unpublished working papers (25 May 2014), Google and Google Scholar (25 May 2014). All prospective randomised, cluster-randomised and quasi-randomised trials evaluating the effectiveness of community-based intervention packages in reducing maternal and neonatal mortality and morbidities, and improving neonatal outcomes. Two review authors independently assessed trials for inclusion, assessed trial quality and extracted the data. Data were checked for accuracy. The review included 26 cluster-randomised/quasi-randomised trials

  13. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France.

    Science.gov (United States)

    Pilkington, Hugo; Blondel, Béatrice; Drewniak, Nicolas; Zeitlin, Jennifer

    2014-12-01

    The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001-08 by distance from mother's municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5-45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

  14. Alcohol-attributable and alcohol-preventable mortality in Denmark

    DEFF Research Database (Denmark)

    Eliasen, Marie; Becker, Ulrik; Grønbæk, Morten

    2014-01-01

    The aim of the study was to quantify alcohol-attributable and -preventable mortality, totally and stratified on alcohol consumption in Denmark 2010, and to estimate alcohol-related mortality assuming different scenarios of changes in alcohol distribution in the population. We estimated alcohol......-attributable and -preventable fractions based on relative risks of conditions causally associated with alcohol from meta-analyses and information on alcohol consumption in Denmark obtained from 14,458 participants in the Danish National Health Survey 2010 and corrected for adult per capita consumption. Cause-specific mortality...... data were obtained from the Danish Register of Causes of Death. In total, 1,373 deaths among women (5.0 % of all deaths) and 2,522 deaths among men (9.5 % of all deaths) were attributable to alcohol, while an estimated number of 765 (2.8 %) and 583 (2.2 %) deaths were prevented by alcohol...

  15. Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units.

    Science.gov (United States)

    Ray, Joel G; Urquia, Marcelo L; Berger, Howard; Vermeulen, Marian J

    2012-12-11

    Concurrent admission of a mother and her newborn to separate intensive care units (herein referred to as co-ICU admission), possibly in different centres, can magnify family discord and stress. We examined the prevalence and predictors of mother-infant separation and mortality associated with co-ICU admissions. We completed a population-based study of all 1 023 978 singleton live births in Ontario between Apr. 1, 2002, and Mar. 31, 2010. We included data for maternal-infant pairs that had co-ICU admission (n = 1216), maternal ICU admission only (n = 897), neonatal ICU (NICU) admission only (n = 123 236) or no ICU admission (n = 898 629). The primary outcome measure was mother-infant separation because of interfacility transfer. The prevalence of co-ICU admissions was 1.2 per 1000 live births and was higher than maternal ICU admissions (0.9 per 1000). Maternal-newborn separation due to interfacility transfer was 30.8 (95% confidence interval [CI] 26.9-35.3) times more common in the co-ICU group than in the no-ICU group and exceeded the prevalence in the maternal ICU group and NICU group. Short-term infant mortality (ICU group (18.1 per 1000 live births; maternal age-adjusted hazard ratio [HR] 27.8, 95% CI 18.2-42.6) than in the NICU group (7.6 per 1000; age-adjusted HR 11.5, 95% CI 10.4-12.7), relative to 0.7 per 1000 in the no-ICU group. Short-term maternal mortality (ICU group (15.6 per 1000; age-adjusted HR 328.7, 95% CI 191.2-565.2) than in the maternal ICU group (6.7 per 1000; age-adjusted HR 140.0, 95% CI 59.5-329.2) or the NICU group (0.2 per 1000; age-adjusted HR 4.6, 95% CI 2.8-7.4). Mother-infant pairs in the co-ICU group had the highest prevalence of separation due to interfacility transfer and the highest mortality compared with those in the maternal ICU and NICU groups.

  16. [Estimations of maternal mortality using the sisterhood survival method: Latin American experience].

    Science.gov (United States)

    Wong, L R; Simons, H; Graham, W; Schkolnik, S

    1990-08-01

    The method of surviving sisters for indirectly estimating maternal mortality is still under development but shows promise for countries lacking alternative sources of data and good statistics. This work uses census or survey data to apply the method to rural villages in Gambia; Mapuche settlements in Cautin, Chile; marginal populations on the outskirts of Lima, Peru; and rural villages of Avaroa, Bolivia. The method is explained in detail following presentation of the results. The necessary basic information is outlined, and the particularities of its application to each Latin American case are discussed. The surviving sisters method was developed by Graham and Brass to derive indicators of maternal mortality based on the proportion of sisters who arrive at fertile age and die during pregnancy, delivery, or the postpartum period. The method transforms the proportions of sisters who died of maternal causes obtained from a census or survey into conventional probabilities of death. The basic information required concerns the numbers of sisters entering the reproductive period (excluding the respondent is she is a woman), the number surviving and decreased at the survey data, and the number who died during pregnancy, delivery, or the postpartum period. The probabilities of dying from a maternal cause were estimated on the basis of the sister survival method at 1/98 in Lima, 1/53 in Cautin, 1/17 in Gambia, and 1/10 in Bolivia. These probabilities correspond to ratios of maternal mortality per 100,000 live births of 286 in Lima, 414 in Cautin, 1005 in Gambia, and 1379 in Bolivia. The results demonstrate great variability in maternal mortality rates. In the cases of Lima and Cautin there were significant differences between estimates derived from the sister survival method and those derived from vital statistics. The 4 cases demonstrated the familiar association between maternal and infant mortality, fertility, and overall female mortality expressed in life expectancy at

  17. Understanding maternal mortality from top–down and bottom–up perspectives: Case of Tigray region, Ethiopia

    Directory of Open Access Journals (Sweden)

    Hagos Godefay

    2015-06-01

    Full Text Available Background: Unacceptably high levels of preventable maternal mortality persist as a problem across sub–Saharan Africa and much of south Asia. Currently, local assessments of the magnitude of maternal mortality are not often made, so the best available information for health planning may come from global estimates and not reflect local circumstances. Methods: A community–based cross-sectional survey was designed to identify all live births together with all deaths among women aged 15–49 years retrospectively over a one–year period in six randomly selected districts of Tigray Region, northern Ethiopia. After birth and death identification, Health Extension Workers trained to use the WHO 2012 verbal autopsy (VA tool visited households to carry out VAs on all deaths among women aged 15–49 years. All pregnancy–related deaths were identified after processing the VA material using the InterVA–4 model, which corresponds to the WHO 2012 VA. A maternal mortality ratio (MMR was calculated for each District and expressed with a 95% confidence interval (CI. Results: The MMRs across the six sampled Districts ranged from 37 deaths per 100 000 live births (95% CI 1 to 207 to 482 deaths per 100 000 live births (95% CI 309 to 718. The overall MMR for Tigray Region was calculated at 266 deaths per 100 000 live births (95% CI 198 to 350. Direct obstetric causes accounted for 61% of all pregnancy–related deaths. Haemorrhage was the major cause of pregnancy–related death (34%. District–level MMRs were strongly inversely correlated with population density (r2=0.86. Conclusion: This simple but well–designed survey approach enabled estimation of maternal mortality in Tigray Region on a local, contemporary basis. It also provided insights into possible local variations in MMR and their determinants. Consequently, this approach could be implemented at regional level in other large sub–Saharan African countries, or at national level in smaller ones

  18. Black-White Differences in Maternal Age, Maternal Birth Cohort, and Period Effects on Infant Mortality in the U.S. (1983-2002)1

    OpenAIRE

    Powers, Daniel A.

    2013-01-01

    We investigate three interrelated sources of change in infant mortality rates over a 20 year period using the National Center for Health Statistics (NCHS) linked birth and infant death cohort files. The effects of maternal age, maternal birth cohort, and time period of childbirth on infant mortality are estimated using a modified age/period/cohort (APC) model that identifies age, period, cohort effects. We document black-white differences in the patterning of these effects and find that mater...

  19. Reducing maternal morbidity and mortality in the developing world: a simple, cost-effective example

    Directory of Open Access Journals (Sweden)

    Browning A

    2015-02-01

    Full Text Available Andrew Browning,1,2 Birhanu Menber21Maternity Africa, Arusha, Tanzania; 2Vision Maternity Care, Barhirdar, Ethiopia Objectives: To determine the impact of volunteer obstetricians and midwife teams on obstetric services in a rural hospital in Ethiopia.Methods: The intervention was undertaken in Mota district hospital, a rural hospital in the Amhara region of Ethiopia, which is the only hospital for 1.2 million people. Before the placement of volunteer teams it had a rudimentary basic obstetric service, no blood transfusion service, and no operative delivery. The study prospectively analyzed delivery data before, during, and after the placement of volunteer obstetrician and midwife teams. The volunteers established emergency obstetric care, and trained and supervised local staff over a 3-year period. Measurable outcomes consisted of the number of women delivering, the number of referrals of pregnant women, the number of maternal deaths, and the number of referrals of obstetric fistula patients.Results: With the establishment of the service the number of women attending hospital for delivery increased by 40%. In the hospital maternal mortality decreased from 7.1% to <0.5%, and morbidity, as measured by number of obstetric fistulae, decreased from 1.5% deliveries to 0.5% over the 3-year intervention period. The improvements were sustained after handing the project back to the government.Conclusion: The placement of volunteer teams was an effective method of decreasing maternal mortality and morbidity. Keywords: emergency obstetric care, volunteers, obstetric fistula, emergency obstetric care

  20. [Losing one's life giving birth: maternal mortality at Port-Royal 1815-1826].

    Science.gov (United States)

    Beauvalet, S

    1994-01-01

    In this paper, we have studied the "Hospice de la Maternité", created in 1795 to replace the "Office des acouchées of the Paris "Hôtel-Dieu". Our objectives were first to conduct a demographic study of the pregnant women coming to the maternity and second, to evaluate the patterns of maternal mortality. Our data are constituted individual medical reports between 1815 and 1826. 4086 women issued from a quest at the letter B have been observed. Because of the relative low number of deaths in this population (192), we decided to investigate four other years (1817, 1818, 1819 and 1821), where the deaths were exhaustively recorded. Unwed mothers represented 80.4% of the population and their mean age was 25, whereas married women were more than 30 years old. Nearly all these women came from the working class, especially three sectors, sewing (35.4%), servants (31.8%) and workers (20%). More than three quarters dwelled in Paris; among them, less than 20% were born in the city. Mortality was very high, it reached 6%. Forsaking was more prominent for unwed women (81.7%) than for married mothers (58.3%). The stay at the Maternity was rather long, mean 23 days. Maternal mortality was high, 47 for thousand, but we noted important fluctuations amongst years and seasons. The demographic analysis of the population showed that the Maternity appears as a transition structure between the ancient "hospices" and the modern hospital. The poor economic and physiological status of women explained that, despite the noticeable improvement in care, the mortality rate will remain elevated during all the century, and even increase.

  1. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.

    Science.gov (United States)

    Cheng, June J; Schuster-Wallace, Corinne J; Watt, Susan; Newbold, Bruce K; Mente, Andrew

    2012-01-27

    Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key

  2. Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal

    Directory of Open Access Journals (Sweden)

    Junu Shrestha

    2017-12-01

    Full Text Available Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it. Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients.  Data analysis was done using SPSS version 16. Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5. Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5. Most of deaths (73%, n = 11 occurred in the postnatal period and 60% (n = 9 were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4 direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2. Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths. Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers.

  3. Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.

    Science.gov (United States)

    Jat, Tej Ram; Deo, Prakash R; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel

    2015-01-01

    Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens. Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens. All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not

  4. Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti.

    Science.gov (United States)

    Smith-Greenaway, Emily; Thomas, Kevin

    2014-12-01

    Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the prevalence of migration in Haiti, it remains unknown whether Haitian women's diverse patterns of migration influence their children's health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers' internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that, compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti's rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration's association with child health.

  5. Maternal Mortality Risk Factors in Dr. Hasan Sadikin General Hospital, Bandung in 2009−2013

    Directory of Open Access Journals (Sweden)

    Shely Karma Astuti

    2017-09-01

    Full Text Available Objective: To discover the factors affecting the occurrence of maternal deaths. The high maternal mortality rate (MMR in Indonesia is still a common problem which needs urgent solution. Methods: This is an analytic observational, cross-sectional study using a case control approach Fifty two cases were selected as cases, another 52 were selected as control. The sampling was performed by simple random sampling. The instruments used in this study were the medical records of mothers who gave birth in Dr. Hasan Sadikin General Hospital Bandung from 1 January 2009–31 December 2013. Data analysis was performed using chi-square test. Results: In this study, the results showed that the risk factors contributing to maternal deaths were pregnancy complication (p<0.001, delivery complication (p<0.001, puerpural complication (p=0.022, age (p=0.030, parity (p=0.427, prior medical history (p<0.001, antenatal care (p=0.007, maternal education (p=0.527, and area of residence (p=0.049. Conclusions: The risk factors that contribute to maternal deaths include pregnancy complication, delivery complication, puerpural complication, maternal age, prior medical history, antenatal care, and area of residence.

  6. The potential for preventing the delivery and perinatal mortality of ...

    African Journals Online (AJOL)

    Objective. To determine the potentiaJ for preventing the delivery and perinatal mortality of low-birth-weight (LBW) babies in a black urban population. Design. Cross-sectionaJ descriptive study. Setting. All women delivering babies weighing less than 2 500 g at Kalafong Hospital in a 6-month period (December 1991 - May ...

  7. Prevention of maternal mortality by training the birth attendants of ...

    African Journals Online (AJOL)

    Conclusion: We recommend that the midwives attending births in churches and other faith-based healing homes be trained and their practices integrated into the orthodox health care delivery system with regular checks by the health ministry. Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 180-183 ...

  8. Maternal union instability and childhood mortality risk in the Global South, 2010-14.

    Science.gov (United States)

    DeRose, Laurie F; Salazar-Arango, Andrés; Corcuera García, Paúl; Gas-Aixendri, Montserrat; Rivera, Reynaldo

    2017-07-01

    Efforts to improve child survival in lower-income countries typically focus on fundamental factors such as economic resources and infrastructure provision, even though research from post-industrial countries confirms that family instability has important health consequences. We tested the association between maternal union instability and children's mortality risk in Africa, Latin America and the Caribbean, and Asia using children's actual experience of mortality (discrete-time probit hazard models) as well as their experience of untreated morbidity (probit regression). Children of divorced/separated mothers experience compromised survival chances, but children of mothers who have never been in a union generally do not. Among children of partnered women, those whose mothers have experienced prior union transitions have a higher mortality risk. Targeting children of mothers who have experienced union instability-regardless of current union status-may augment ongoing efforts to reduce childhood mortality, especially in Africa and Latin America where union transitions are common.

  9. Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000.

    Science.gov (United States)

    Chen, Jiajian; Xie, Zhenming; Liu, Hongyan

    2007-07-01

    This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.

  10. Mortalidade materna de mulheres negras no Brasil Maternal mortality among black women in Brazil

    Directory of Open Access Journals (Sweden)

    Alaerte Leandro Martins

    2006-11-01

    Full Text Available A cada minuto uma mulher morre no mundo em decorrência do trabalho de parto ou complicações da gravidez. A mortalidade materna configura-se no Brasil como um problema de saúde pública, atingindo desigualmente as várias regiões brasileiras. É consenso que a mulheres acometidas pela morte materna são as de menor renda e escolaridade. Juntamente com as questões sócio-econômicas, emerge a questão racial. A análise é difícil de ser realizada em virtude da dificuldade de entendimento da classificação raça/cor que muitas vezes impede o registro dessa informação. Vários Comitês de Morte Materna estão utilizando o quesito cor e revisando seus dados. Este artigo analisa vários relatórios de Comitês de Morte Materna, mostrando que o risco de mortalidade materna é maior entre as mulheres negras, o que inclui as pretas e pardas, configurando-se em importante expressão de desigualdade social. Ao final, apresenta-se uma revisão de recomendações para diminuição da Mortalidade Materna, enfatizando ações políticas e técnicas que possam contribuir para tal.Every minute a woman dies in the world due to labor or complications of pregnancy. Maternal mortality is a public health problem in Brazil and affects the country's various regions unequally. Researchers agree that maternal death occurs mainly in women with lower income and less schooling. The racial issue emerges in the midst of socioeconomic issues. The analysis is hampered by the difficulty in understanding Brazil's official classification of race/color, which often impedes recording this information. Various Maternal Mortality Committees are applying the color item and reviewing their data. The current article analyzes various Maternal Mortality Committee reports, showing that the risk of maternal mortality is greater among black women (which encompasses two census categories, negra, or black, and parda, or brown, thus representing a major expression of social inequality

  11. Maternal Age and Infant Mortality for White, Black, and Mexican Mothers in the United States

    Directory of Open Access Journals (Sweden)

    Philip N. Cohen

    2016-01-01

    Full Text Available This paper assesses the pattern of infant mortality by maternal age for white, black, and Mexican mothers using the 2013 Period Linked Birth/Infant Death Public Use File from the Centers for Disease Control. The results are consistent with the “weathering” hypothesis, which suggests that white women benefit from delayed childbearing while for black women early childbearing is adaptive because of deteriorating health status through the childbearing years. For white women, the risk (adjusted for covariates of infant death is U-shaped—lowest in the early thirties—while for black women the risk increases linearly with age. Mexican-origin women show a J-shape, with highest risk at the oldest ages. The results underscore the need for understanding the relationship between maternal age and infant mortality in the context of unequal health experiences across race/ethnic groups in the US.

  12. Rate and time trend of perinatal, infant, maternal mortality, natality and natural population growth in kosovo.

    Science.gov (United States)

    Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

    2012-01-01

    THE AIM OF WORK HAS BEEN THE PRESENTATION OF THE RATE AND TIME TRENDS OF SOME INDICATORS OF THE HEATH CONDITION OF MOTHERS AND CHILDREN IN KOSOVO: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. THE DATA WERE TAKEN FROM: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a continuous decrease. Infant mortality

  13. Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

    Science.gov (United States)

    Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

    2012-01-01

    Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a

  14. Prevention and management of maternal obesity in pregnancy

    Directory of Open Access Journals (Sweden)

    E. Alexopoulou

    2017-03-01

    Full Text Available Nowadays obesity is one of the most important nutritional problems with features contemporary epidemic which concerns not only the developed but also the developing countries. Obesity during pregnancy associate with maternal and perinatal risks that make the management of obesity, before and during pregnancy imperative. The best and most effective treatment of obesity in pregnancy is prevention. A healthy diet and regular exercise of pregnant woman is crucial for the normal development of pregnancy. Moreover every obese pregnant woman should be informed about the importance of calorie - intake regulation and weight reduction both before and after pregnancy. Additional therapeutic options are bariatric surgical procedures that a woman can have before pregnancy and anticoagulation therapy during pregnancy. This article attempts brief review on the current scientific knowledge that exists about the role of nutrition and physical activity in controlling the weight of obese pregnant women and its beneficial contribution to the health of both the mother and the newborn.

  15. “Guilty until proven innocent”: the contested use of maternal mortality indicators in global health

    Science.gov (United States)

    Storeng, Katerini T.; Béhague, Dominique P.

    2017-01-01

    Abstract The MMR – maternal mortality ratio – has risen from obscurity to become a major global health indicator, even appearing as an indicator of progress towards the global Sustainable Development Goals. This has happened despite intractable challenges relating to the measurement of maternal mortality. Even after three decades of measurement innovation, maternal mortality data are widely presumed to be of poor quality, or, as one leading measurement expert has put it, ‘guilty until proven innocent’. This paper explores how and why leading epidemiologists, demographers and statisticians have devoted the better part of the last three decades to producing ever more sophisticated and expensive surveys and mathematical models of globally comparable MMR estimates. The development of better metrics is publicly justified by the need to know which interventions save lives and at what cost. We show, however, that measurement experts’ work has also been driven by the need to secure political priority for safe motherhood and by donors’ need to justify and monitor the results of investment flows. We explore the many effects and consequences of this measurement work, including the eclipsing of attention to strengthening much-needed national health information systems. We analyse this measurement work in relation to broader political and economic changes affecting the global health field, not least the incursion of neoliberal, business-oriented donors such as the World Bank and the Bill and Melinda Gates Foundation whose institutional structures have introduced new forms of administrative oversight and accountability that depend on indicators. PMID:28392630

  16. "Guilty until proven innocent": the contested use of maternal mortality indicators in global health.

    Science.gov (United States)

    Storeng, Katerini T; Béhague, Dominique P

    2017-03-15

    The MMR - maternal mortality ratio - has risen from obscurity to become a major global health indicator, even appearing as an indicator of progress towards the global Sustainable Development Goals. This has happened despite intractable challenges relating to the measurement of maternal mortality. Even after three decades of measurement innovation, maternal mortality data are widely presumed to be of poor quality, or, as one leading measurement expert has put it, 'guilty until proven innocent'. This paper explores how and why leading epidemiologists, demographers and statisticians have devoted the better part of the last three decades to producing ever more sophisticated and expensive surveys and mathematical models of globally comparable MMR estimates. The development of better metrics is publicly justified by the need to know which interventions save lives and at what cost. We show, however, that measurement experts' work has also been driven by the need to secure political priority for safe motherhood and by donors' need to justify and monitor the results of investment flows. We explore the many effects and consequences of this measurement work, including the eclipsing of attention to strengthening much-needed national health information systems. We analyse this measurement work in relation to broader political and economic changes affecting the global health field, not least the incursion of neoliberal, business-oriented donors such as the World Bank and the Bill and Melinda Gates Foundation whose institutional structures have introduced new forms of administrative oversight and accountability that depend on indicators.

  17. Integrating interventions on maternal mortality and morbidity and HIV: a human rights-based framework and approach.

    Science.gov (United States)

    Fried, Susanna; Harrison, Brianna; Starcevich, Kelly; Whitaker, Corinne; O'Konek, Tiana

    2012-12-15

    Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both. Shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Further, shared system-related drivers also contribute to a lack of effective access to acceptable, high-quality health services and other development resources from birth forward. HIV and MMM are connected in both outcomes and solutions: in sub-Saharan Africa, HIV is the leading cause of maternal death, while the most recent global report on HIV identifies prevention of unintended pregnancy and access to contraception as two of the most important HIV-related prevention efforts.1 Both are central to reducing unsafe abortion--another leading cause of maternal death globally, and particularly in Africa. A human rights-based framework helps to identify these shared determinants. A human rights-based approach works to establish the health-related human rights standards to which all women are entitled, as well to outline the indivisible and intersecting human rights principles which inform and guide efforts to prevent, protect from, respond to, and provide remedy for human rights violations-in this case related to HIV and maternal mortality and morbidity.The Millennium Declaration and Development Goals (MDGs) help to both set quantifiable goals for achieving the components identified within the human rights-based framework and document the international consensus that no single goal--such as those addressing HIV and MMM--can be achieved without progress on all development goals. Copyright © 2012 Fried et al.. This is an open access article distributed under the terms of the Creative

  18. The triple threat of pregnancy, HIV infection and malaria: reported causes of maternal mortality in two nationwide health facility assessments in Mozambique, 2007 and 2012.

    Science.gov (United States)

    Bailey, Patricia E; Keyes, Emily; Moran, Allisyn C; Singh, Kavita; Chavane, Leonardo; Chilundo, Baltazar

    2015-11-09

    The paper's primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection. Two national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes. In 2007, 2,199 cases of maternal deaths were documented over a 12 month period; in 2012, 459 cases were identified over a three month period. In 2007, data collection also included reviews of maternal deaths when records were available (n = 712). Institutional maternal mortality declined from 541 to 284/100,000 births from 2007 to 2012. The rate of decline among women dying of direct causes was 66% compared to 26% among women dying of indirect causes. Cause-specific mortality ratios fell for all direct causes. Patterns among indirect causes were less conclusive given differences in cause-of-death recording. In absolute numbers, the combination of antepartum and postpartum hemorrhage was the leading direct cause of death each year and HIV and malaria the main non-obstetric causes. Based on maternal death reviews, evidence of HIV infection, malaria or anemia was found in more than 40% of maternal deaths due to abortion, ectopic pregnancy and sepsis. Almost half (49%) of all institutional maternal deaths took place in the largest hospitals in 2007 while in 2012, only 24% occurred in these hospitals. The availability of antiretrovirals and antimalarials increased in all types of facilities, but increases were most dramatic in health centers. The rate at which women died of direct causes in Mozambique's health facilities appears to have declined significantly. Despite a clear improvement in access to antiretrovirals and antimalarials, especially at lower levels of health care

  19. Risk factors for maternal mortality in the west of Iran: a nested case-control study

    Directory of Open Access Journals (Sweden)

    Jalal Poorolajal

    2014-11-01

    Full Text Available OBJECTIVES: With a gradual decline in maternal mortality in recent years in Iran, this study was conducted to identify the remaining risk factors for maternal death. METHODS: This 8-year nested case-control study was conducted in Hamadan Province, in the west of Iran, from April 2006 to March 2014. It included 185 women (37 cases and 148 controls. All maternal deaths that occurred during the study period were considered cases. For every case, four women with a live birth were selected as controls from the same area and date. Conditional logistic regression analysis was performed and the odds ratio (OR and its 95% confidence interval (CI were obtained for each risk factor. RESULTS: The majority of cases were aged 20-34 years, died in hospital, and lived in urban areas. The most common causes of death were bleeding, systemic disease, infection, and pre-eclampsia. The OR estimate of maternal death was 8.48 (95% CI=1.26-56.99 for advanced maternal age (≥35 years; 2.10 (95% CI=0.07-65.43 for underweight and 10.99 (95% CI=1.65-73.22 for overweight or obese women compared to those with normal weight; 1.56 (95% CI=1.08-2.25 for every unit increase in gravidity compared to those with one gravidity; 1.73 (95% CI=0.34-8.88 for preterm labors compared to term labors; and 17.54 (95% CI= 2.71-113.42 for women with systemic diseases. CONCLUSIONS: According to our results, advanced maternal age, abnormal body mass index, multiple gravidity, preterm labor, and systemic disease were the main risk factors for maternal death. However, more evidence based on large cohort studies in different settings is required to confirm our results.

  20. Material consumption and social well-being within the periphery of the world economy: an ecological analysis of maternal mortality.

    Science.gov (United States)

    Rice, James

    2008-12-01

    The degree to which social well-being is predicated upon levels of material consumption remains under-examined from a large-N, quantitative perspective. The present study analyzes the factors influencing levels of maternal mortality in 2005 among 92 peripheral countries. We incorporate into regression analysis the ecological footprint, a comprehensive measure of natural resource consumption, and alternative explanatory variables drawn from previous research. Results illustrate ecological footprint consumption has a moderately strong direct influence shaping lower levels of maternal mortality. Path analysis reveals export commodity concentration has a negative effect on level of ecological footprint demand net the strong positive influence of income per capita. This illustrates cross-national trade dependency relations directly influence natural resource consumption opportunities and thereby indirectly contribute to higher maternal mortality levels within the periphery of the world economy. The results confirm material consumption is an important dimension of improvement in maternal mortality.

  1. Maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Southeast Nigeria: a 10-year review (2003?2012)

    OpenAIRE

    Obiechina, NJ; Okolie, VE; Okechukwu, ZC; Oguejiofor, CF; Udegbunam, OI; Nwajiaku, LSA; Ogbuokiri, C; Egeonu, R

    2013-01-01

    NJ Obiechina, VE Okolie, ZC Okechukwu, CF Oguejiofor, OI Udegbunam, LSA Nwajiaku, C Ogbuokiri, R Egeonu Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria Background: Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless thing...

  2. Prospects for preventing infant invasive GBS disease through maternal vaccination.

    Science.gov (United States)

    Madhi, Shabir A; Dangor, Ziyaad

    2017-08-16

    Group B streptococcus (GBS) is a leading cause of neonatal sepsis, with the highest incidence (1.3 per 1000 live births) reported from Africa. Although the incidence of invasive GBS disease is reportedly low in South Asia, there is disconnect between prevalence of maternal recto-vaginal colonization and the incidence of early-onset disease (EOD). This is possibly due to case-ascertainment biases that omit investigation of newborns dying on day-0 of life, which accounts for >90% of EOD. Furthermore, GBS is associated with approximately 15% of all infection related stillbirths. Vaccination of pregnant women with a serotype-specific polysaccharide epitope vaccine could possibly protect against EOD and late-onset disease (LOD) in their infants through transplacental transfer of serotype-specific capsular antibody. Furthermore, vaccination of pregnant women might also protect against impaired neurodevelopment following GBS associated neonatal sepsis, and fetal loss/stillbirths. Licensure of a GBS vaccine might be feasible based on safety evaluation and a sero-correlate of protection, with vaccine effectiveness subsequently being demonstrated in phase IV studies. A randomized-controlled trial would, however, be best suited as a vaccine-probe to fully characterize the contribution of GBS to neonatal sepsis associated morbidity and mortality and adverse fetal outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?

    Science.gov (United States)

    Kwast, B E

    1996-10-01

    The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality.

  4. Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool.

    Science.gov (United States)

    Jiang, Zhen; Guo, Su Fang; Scherpbier, Robert W; Wen, Chun Mei; Xu, Xiao Chao; Guo, Yan

    2015-08-01

    China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China. Copyright © 2015 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  5. Use of Gastrostomy Tube to Prevent Maternal PKU Syndrome.

    Science.gov (United States)

    Schwoerer, Jessica A Scott; Obernolte, Lisa; Van Calcar, Sandra; Heighway, Susan; Bankowski, Heather; Williams, Phillip; Rice, Gregory

    2012-01-01

    Maternal Phenylketonuria Syndrome (MPKU) can occur in infants born to mothers with PKU with poor metabolic control during pregnancy. Elevated phenylalanine (phe) acts as a teratogen to the developing fetus with consequences including intellectual disability, microcephaly, facial dysmorphism, growth retardation, and congenital heart disease. MPKU can be prevented if metabolic control is achieved by 8-10 weeks gestation. If control is not achieved, there is a significant risk for MPKU. Therefore, in women with poor metabolic control at time of pregnancy, establishing metabolic control quickly is important.Clinically, establishing metabolic control in women with PKU can present challenges. Social issues, psychological issues, and insufficient education about PKU play an important role in a patient's inability to reinstitute this challenging diet. Maintaining phe levels within a range to allow for infant growth, while preventing toxicity, is challenging, particularly for those women who no longer follow the PKU diet. Gastrostomy tube placement is an option to deliver medical formula to women who are unable to restart diet due to severe nausea or palatability issues.Here we discuss two pregnancies in which a gastrostomy tube was placed to achieve metabolic control after other measures failed to reduce phe concentrations into the recommended range. For these two pregnancies, placement of the gastrostomy tube led to improvement in phe levels with normal infant outcomes including normal growth, head circumference, and heart structure.

  6. Hypercaloric diet prevents sexual impairment induced by maternal food restriction.

    Science.gov (United States)

    Bernardi, M M; Macrini, D J; Teodorov, E; Bonamin, L V; Dalboni, L C; Coelho, C P; Chaves-Kirsten, G P; Florio, J C; Queiroz-Hazarbassanov, N; Bondan, E F; Kirsten, T B

    2017-05-01

    Prenatal undernutrition impairs copulatory behavior and increases the tendency to become obese/overweight, which also reduces sexual behavior. Re-feeding rats prenatally undernourished with a normocaloric diet can restore their physiological conditions and copulatory behavior. Thus, the present study investigated whether a hypercaloric diet that is administered in rats during the juvenile period prevents sexual impairments that are caused by maternal food restriction and the tendency to become overweight/obese. Female rats were prenatally fed a 40% restricted diet from gestational day 2 to 18. The pups received a hypercaloric diet from postnatal day (PND) 23 to PND65 (food restricted hypercaloric [FRH] group) or laboratory chow (food restricted control [FRC] group). Pups from non-food-restricted dams received laboratory chow during the entire experiment (non-food-restricted [NFR] group). During the juvenile period and adulthood, body weight gain was evaluated weekly. The day of balanopreputial separation, sexual behavior, sexual organ weight, hypodermal adiposity, striatal dopamine and serotonin, serum testosterone, and tumor necrosis factor α (TNF-α) were evaluated. The FRH group exhibited an increase in body weight on PND58 and PND65. The FRC group exhibited an increase in the latency to the first mount and intromission and an increase in serum TNF-α levels but a reduction of dopaminergic activity. The hypercaloric diet reversed all of these effects but increased adiposity. We concluded that the hypercaloric diet administered during the juvenile period attenuated reproductive impairments that were induced by maternal food restriction through increases in the energy expenditure but not the tendency to become overweight/obese. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Maternal Mortality

    African Journals Online (AJOL)

    Young women, many of them in their teens, those with high parity and those with unwanted pregnancy form high risk groups. The same individuals are likely to come from socioeconomically deprived groups; more likely to be poor, iIIitrate and underusers of available health care facilities. Many of the above factors are opera-.

  8. Maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Southeast Nigeria: a 10-year review (2003-2012).

    Science.gov (United States)

    Obiechina, Nj; Okolie, Ve; Okechukwu, Zc; Oguejiofor, Cf; Udegbunam, Oi; Nwajiaku, Lsa; Ogbuokiri, C; Egeonu, R

    2013-01-01

    Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. This study was conducted to assess NAUTH'S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality.

  9. Maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Southeast Nigeria: a 10-year review (2003–2012)

    Science.gov (United States)

    Obiechina, NJ; Okolie, VE; Okechukwu, ZC; Oguejiofor, CF; Udegbunam, OI; Nwajiaku, LSA; Ogbuokiri, C; Egeonu, R

    2013-01-01

    Background Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives This study was conducted to assess NAUTH’S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. Materials and methods This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. Results During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). Conclusion MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality. PMID:23901299

  10. Cholera in Pregnancy: A Systematic Review and Meta-Analysis of Fetal, Neonatal, and Maternal Mortality.

    Directory of Open Access Journals (Sweden)

    Nguyen-Toan Tran

    Full Text Available Maternal infection with cholera may negatively affect pregnancy outcomes. The objective of this research is to systematically review the literature and determine the risk of fetal, neonatal and maternal death associated with cholera during pregnancy.Medline, Global Health Library, and Cochrane Library databases were searched using the key terms cholera and pregnancy for articles published in any language and at any time before August 2013 to quantitatively summarize estimates of fetal, maternal, and neonatal mortality. 95% confidence intervals (CIs were calculated for each selected study. Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period. Studies from the recent period (1991-2013 were compared with studies from 1969-1990. Relative risk (RR estimates and 95% CIs were obtained by comparing mortality of selected recent studies with published national normative data from the closest year.The meta-analysis included seven studies that together involved 737 pregnant women with cholera from six countries. The pooled fetal death rate for 4 studies during 1991-2013 was 7.9% (95% CIs 5.3-10.4, significantly lower than that of 3 studies from 1969-1990 (31.0%, 95% CIs 25.2-36.8. There was no difference in fetal death rate by trimester. The pooled neonatal death rate for 1991-2013 studies was 0.8% (95% CIs 0.0-1.6, and 6.4% (95% CIs 0.0-20.8 for 1969-1990. The pooled maternal death rate for 1991-2013 studies was 0.2% (95% CIs 0.0-0.7, and 5.0% (95% CIs 0.0-16.0 for 1969-1990. Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3 was calculated for Haiti (2013, 1.8 (95% CIs 0.3-10.4 for Senegal (2007, and 2.6 (95% CIs 0.5-14.9 for Peru (1991; there were no significant differences in the RR for neonatal or maternal death.Results are limited by the inconsistencies found across included studies but suggest that maternal cholera is associated with adverse

  11. The association between government healthcare spending and maternal mortality in the European Union, 1981-2010: a retrospective study.

    Science.gov (United States)

    Maruthappu, M; Ng, K Y B; Williams, C; Atun, R; Agrawal, P; Zeltner, T

    2015-08-01

    To determine the association between reductions in government healthcare spending (GHS) on maternal mortality in 24 countries in the European Union (EU) over a 30-year period, 1981-2010. Retrospective study. Twenty-four EU countries (a total population of 419 million as of 2010). We used multivariate regression analysis, controlling for country-specific differences in healthcare, infrastructure, population size and demographic structure. GHS was measured as a percentage of gross domestic product. Five-year lag-time analyses were performed to estimate longer standing effects. Maternal mortality rates. An annual 1% decrease in GHS is associated with significant rises in maternal mortality rates [regression coefficient [R] 0.0177, P = 0.0021, 95% confidence interval [95% CI] 0.0065-0.0289]. For every annual 1% decrease in GHS, we estimate 89 excess maternal deaths in the EU, a 10.6% annual increase in maternal mortality. The impact on maternal mortality was sustained for up to 1 year (R 0.0150, P = 0.0034, 95% CI 0.0050-0.0250). The associations remained significant after accounting for economic, infrastructure and hospital resource controls, in addition to out-of-pocket expenditure, private health spending and total fertility rate. However, accounting for births attended by skilled staff removed the significance of these effects. Reductions in GHS were significantly associated with increased maternal mortality rates, which may occur through changes in the provision of skilled health professionals attending births. Examples of reduced GHS such as the implementation of austerity measures and budgetary reductions are likely to worsen maternal mortality in the EU. © 2014 Royal College of Obstetricians and Gynaecologists.

  12. What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis.

    Science.gov (United States)

    Russell, Louise B; Pentakota, Sri Ram; Toscano, Cristiana Maria; Cosgriff, Ben; Sinha, Anushua

    2016-12-01

     Despite longstanding infant vaccination programs in low- and middle-income countries (LMICs), pertussis continues to cause deaths in the youngest infants. A maternal monovalent acellular pertussis (aP) vaccine, in development, could prevent many of these deaths. We estimated infant pertussis mortality rates at which maternal vaccination would be a cost-effective use of public health resources in LMICs.  We developed a decision model to evaluate the cost-effectiveness of maternal aP immunization plus routine infant vaccination vs routine infant vaccination alone in Bangladesh, Nigeria, and Brazil. For a range of maternal aP vaccine prices, one-way sensitivity analyses identified the infant pertussis mortality rates required to make maternal immunization cost-effective by alternative benchmarks ($100, 0.5 gross domestic product [GDP] per capita, and GDP per capita per disability-adjusted life-year [DALY]). Probabilistic sensitivity analysis provided uncertainty intervals for these mortality rates.  Infant pertussis mortality rates necessary to make maternal aP immunization cost-effective exceed the rates suggested by current evidence except at low vaccine prices and/or cost-effectiveness benchmarks at the high end of those considered in this report. For example, at a vaccine price of $0.50/dose, pertussis mortality would need to be 0.051 per 1000 infants in Bangladesh, and 0.018 per 1000 in Nigeria, to cost 0.5 per capita GDP per DALY. In Brazil, a middle-income country, at a vaccine price of $4/dose, infant pertussis mortality would need to be 0.043 per 1000 to cost 0.5 per capita GDP per DALY.  For commonly used cost-effectiveness benchmarks, maternal aP immunization would be cost-effective in many LMICs only if the vaccine were offered at less than $1-$2/dose. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

  13. Global, regional, and national levels and causes of maternal mortality during 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013

    NARCIS (Netherlands)

    Kassebaum, Nicholas J.; Bertozzi-Villa, Amelia; Coggeshall, Megan S.; Shackelford, Katya A.; Steiner, Caitlyn; Heuton, Kyle R.; Gonzalez-Medina, Diego; Barber, Ryan; Huynh, Chantal; Dicker, Daniel; Templin, Tara; Wolock, Timothy M.; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsene Kouablan; Adsuar, Jose C.; Agardh, Emilie E.; Akena, Dickens; Alasfoor, Deena; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Al Kahbouri, Mazin J.; Alla, Francois; Allen, Peter J.; AlMazroa, Mohammad A.; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Amankwaa, Adansi A.; Amare, Azmeraw T.; Amini, Hassan; Ammar, Walid; Antonio, Carl A. T.; Anwari, Palwasha; Arnlov, Johan; Arsic Arsenijevic, Valentina S.; Artaman, Ali; Asad, Majed Masoud; Asghar, Rana J.; Assadi, Reza; Atkins, Lydia S.; Badawi, Alaa; Balakrishnan, Kalpana; Basu, Arindam; Basu, Sanjay; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L.; Bernabe, Eduardo; Beyene, Tariku J.; Bhutta, Zulfiqar; Bin Abdulhak, Aref; Blore, Jed D.; Basara, Berrak Bora; Bose, Dipan; Breitborde, Nicholas; Cardenas, Rosario; Castaneda-Orjuela, Carlos A.; Castro, Ruben Estanislao; Catala-Lopez, Ferran; Cavlin, Alanur; Chang, Jung-Chen; Che, Xuan; Christophi, Costas A.; Chugh, Sumeet S.; Cirillo, Massimo; Colquhoun, Samantha M.; Cooper, Leslie Trumbull; Cooper, Cyrus; Leite, Iuri da Costa; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Degenhardt, Louisa; De Leo, Diego; del Pozo-Cruz, Borja; Deribe, Kebede; Dessalegn, Muluken; deVeber, Gabrielle A.; Dharmaratne, Samath D.; Dilmen, Ugur; Ding, Eric L.; Dorrington, Rob E.; Driscoll, Tim R.; Ermakov, Sergei Petrovich; Esteghamati, Alireza; Faraon, Emerito Jose A.; Farzadfar, Farshad; Felicio, Manuela Mendonca; Fereshtehnejad, Seyed-Mohammad; Ferreira de Lima, Graca Maria; Forouzanfar, Mohammad H.; Franca, Elisabeth B.; Gaffikin, Lynne; Gambashidze, Ketevan; Gankpe, Fortune Gbetoho; Garcia, Ana C.; Geleijnse, Johanna M.; Gibney, Katherine B.; Giroud, Maurice; Glaser, Elizabeth L.; Goginashvili, Ketevan; Gona, Philimon; Gonzalez-Castell, Dinorah; Goto, Atsushi; Gouda, Hebe N.; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Hankey, Graeme J.; Harb, Hilda L.; Havmoeller, Rasmus; Hay, Simon I.; Heredia Pi, Ileana B.; Hoek, Hans W.; Hosgood, H. Dean; Hoy, Damian G.; Husseini, Abdullatif; Idrisov, Bulat T.; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H.; Jahangir, Eiman; Jee, Sun Ha; Jensen, Paul N.; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B.; Juel, Knud; Kabagambe, Edmond Kato; Kan, Haidong; Karam, Nadim E.; Karch, Andre; Karema, Corine Kakizi; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kazi, Dhruv S.; Kemp, Andrew H.; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz Ahmed; Khang, Young-Ho; Knibbs, Luke; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kulkarni, Chanda; Kulkarni, Veena S.; Kumar, G. Anil; Kumar, Kaushalendra; Kumar, Ravi B.; Kwan, Gene; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lansingh, Van C.; Larsson, Anders; Lee, Jong-Tae; Leigh, James; Leinsalu, Mall; Leung, Ricky; Li, Xiaohong; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S.; Lin, Hsien-Ho; Lipshultz, Steven E.; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K.; London, Stephanie J.; Lotufo, Paulo A.; Ma, Jixiang; Ma, Stefan; Pedro Machado, Vasco Manuel; Mainoo, Nana Kwaku; Majdan, Marek; Mapoma, Christopher Chabila; Marcenes, Wagner; Barrientos Marzan, Melvin; Mason-Jones, Amanda J.; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Memish, Ziad A.; Mendoza, Walter; Miller, Ted R.; Mills, Edward J.; Mokdad, Ali H.; Mola, Glen Liddell; Monasta, Lorenzo; de la Cruz Monis, Jonathan; Montanez Hernandez, Julio Cesar; Moore, Ami R.; Moradi-Lakeh, Maziar; Mori, Rintaro; Mueller, Ulrich O.; Mukaigawara, Mitsuru; Naheed, Aliya; Naidoo, Kovin S.; Nand, Devina; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Nelson, Robert G.; Neupane, Sudan Prasad; Newton, Charles R.; Ng, Marie; Nieuwenhuijsen, Mark J.; Nisar, Muhammad Imran; Nolte, Sandra; Norheim, Ole F.; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O.; Omer, Saad B.; Opio, John Nelson; Orisakwe, Orish Ebere; Pandian, Jeyaraj D.; Papachristou, Christina; Park, Jae-Hyun; Paternina Caicedo, Angel J.; Patten, Scott B.; Paul, Vinod K.; Pavlin, Boris Igor; Pearce, Neil; Pereira, David M.; Pesudovs, Konrad; Petzold, Max; Poenaru, Dan; Polanczyk, Guilherme V.; Polinder, Suzanne; Pope, Dan; Pourmalek, Farshad; Qato, Dima; Quistberg, D. Alex; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; ur Rahman, Sajjad; Raju, Murugesan; Rana, Saleem M.; Refaat, Amany; Ronfani, Luca; Roy, Nobhojit; Sanchez Pimienta, Tania Georgina; Sahraian, Mohammad Ali; Salomon, Joshua A.; Sampson, Uchechukwu; Santos, Itamar S.; Sawhney, Monika; Sayinzoga, Felix; Schneider, Ione J. C.; Schumacher, Austin; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Servan-Mori, Edson E.; Shakh-Nazarova, Marina; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shiue, Ivy; Sigfusdottir, Inga Dora; Silberberg, Donald H.; Silva, Andrea P.; Singh, Jasvinder A.; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S.; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar T.; Stroumpoulis, Konstantinos; Sturua, Lela; Sykes, Bryan L.; Tabb, Karen M.; Talongwa, Roberto Tchio; Tan, Feng; Teixeira, Carolina Maria; Tenkorang, Eric Yeboah; Terkawi, Abdullah Sulieman; Thorne-Lyman, Andrew L.; Tirschwell, David L.; Towbin, Jeffrey A.; Tran, Bach X.; Tsilimbaris, Miltiadis; Uchendu, Uche S.; Ukwaja, Kingsley N.; Undurraga, Eduardo A.; Uzun, Selen Begum; Vallely, Andrew J.; van Gool, Coen H.; Vasankari, Tommi J.; Vavilala, Monica S.; Venketasubramanian, N.; Villalpando, Salvador; Violante, Francesco S.; Vlassov, Vasiliy Victorovich; Vos, Theo; Waller, Stephen; Wang, Haidong; Wang, Linhong; Wang, XiaoRong; Wang, Yanping; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Westerman, Ronny; Wilkinson, James D.; Woldeyohannes, Solomon Meseret; Wong, John Q.; Wordofa, Muluemebet Abera; Xu, Gelin; Yang, Yang C.; Yano, Yuichiro; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z.; Yu, Chuanhua; Jin, Kim Yun; Zaki, Maysaa El Sayed; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zhu, Jun; Zou, Xiao Nong; Lopez, Alan D.; Naghavi, Mohsen; Murray, Christopher J. L.; Lozano, Rafael

    2014-01-01

    Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes

  14. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

    NARCIS (Netherlands)

    N.J. Kassebaum (Nicholas J); A. Bertozzi-Villa (Amelia); M.S. Coggeshall (Megan S); K.A. Shackelford (Katya A); C. Steiner (Caitlyn); K.R. Heuton (Kyle R); D. Gonzalez-Medina (Diego); R. Barber (Rachel); T.T. Huynh (Thanh); D. Dicker (Daniel); B. Templin (Barry); T.M. Wolock (Timothy M); A.A. Ozgoren (Ayse Abbasoglu); F. Abd-Allah (Foad); S.F. Abera (Semaw Ferede); T. Achoki (Tom); A. Adelekan (Ademola); Z. Ademi (Zanfina); A.K. Adou (Arsène Kouablan); J.C. Adsuar (José C); E.E. Agardh (Emilie Elisabet); D. Akena (Dickens); D. Alasfoor (Deena); G. Alemu (Getnet ); R. Alfonso-Cristancho (Rafael); S. Alhabib (Samia); R. Ali (Raghib); M.J. Al Kahbouri (Mazin J); F. Alla (Francois); P.J. Allen (Peter J); M.A. AlMazroa (Mohammad A); U. Alsharif (Ubai); E. Alvarez (Elena); N. Alvis-Guzman (Nelson); A.A. Amankwaa (Adansi A); A.T. Amare (Azmeraw T); H. Amini (Hassan); K.A. Ammar; C.A.T. Antonio (Carl Abelardo T); P. Anwari (Palwasha); J. Ärnlöv (Johan); V.S.A. Arsenijevic (Valentina S Arsic); A. Artaman (Ali); M.M. Asad (Majed Masoud); R.J. Asghar (Rana J); R. Assadi (Reza); L.S. Atkins (Lydia S); A.F. Badawi (Alaa); K. Balakrishnan (Kannan); A. Basu (Anirban); S. Basu (Saonli); J. Beardsley (Justin); A.S. Bedi (Arjun Singh); T. Bekele (Tolesa); M.L. Bell (Michelle Lee); E. Bernabe (Eduardo); T.J. Beyene (Tariku Jibat); Z.A. Bhutta (Zulfiqar A); A. Bin Abdulhak (Aref); J.D. Blore (Jed D); B.B. Basara (Berrak Bora); D. Bose (Dipan); N. Breitborde (Nicholas); R. Cárdenas (Rosario); C.A. Castañeda-Orjuela (Carlos A); R.E. Castro (Ruben Estanislao); F. Catalá-López (Ferrán); A. Cavlin (Alanur); J.-C. Chang (Jung-Chen); J. Che (Jiahua); C.A. Christophi (Costas A); S.S. Chugh (Sumeet); E. Cirillo (Emilia); S.M. Colquhoun (Samantha M); L.T. Cooper Jr. (Leslie Trumbull); C. Cooper (Charles); I. da Costa Leite (Iuri); L. Dandona (Lalit); R. Dandona (Rakhi); A. Davis (Adrian); A. Dayama (Anand); F. Degenhardt; D. de Leo (Diego); B. Del Pozo-Cruz (Borja); K. Deribe (Kebede); M. Dessalegn (Muluken); G. Deveber (Gabrielle); S.D. Dharmaratne (Samath D); U. Dilmen (Uǧur); E.L. Ding (Eric); R.E. Dorrington (Rob E); J.M. Driscoll; S. Ermakov (Sergey); A. Esteghamati (Alireza); E.J.A. Faraon (Emerito Jose A); F. Farzadfar (Farshad); A.C. Felicio (Andre); S.-M. Fereshtehnejad (Seyed-Mohammad); G.M.F. de Lima (Graça Maria Ferreira); M.H. Forouzanfar (Mohammad H); E.B. França (Elisabeth B); L. Gaffikin (Lynne); K. Gambashidze (Ketevan); F.G. Gankpé (Fortuné Gbètoho); A.C. Garcia (Ana C); J.M. Geleijnse (Marianne); K.B. Gibney (Katherine B); M. Giroud (Maurice); E.L. Glaser (Elizabeth L); K. Goginashvili (Ketevan); P. Gona (Philimon); D. González-Castell (Dinorah); A. Goto (Akimoto); H.N. Gouda (Hebe N); H.C. Gugnani (Harish Chander); R. Gupta (Rajeev); R. Gupta (Rajeev); N. Hafezi-Nejad (Nima); R.R. Hamadeh (Randah Ribhi); M. Hammami (Mouhanad); G.J. Hankey (Graeme); H.L. Harb (Hilda L); R. Havmoeller (Rasmus); S.I. Hay (Simon); I.B.H. Pi (Ileana B Heredia); H.W. Hoek (Hans); H.D. Hosgood (H Dean); D.G. Hoy (Damian G); A. Husseini (Abdullatif); B.T. Idrisov (Bulat T); K. Innos (Kaire); M. Inoue (Manami); K.H. Jacobsen (Kathryn H); E. Jahangir (Eiman); S.H. Jee (Sun Ha); P.N. Jensen (Paul N); V. Jha (Vivekanand); G. Jiang (Guohong); K. Juel (Knud); E.K. Kabagambe (Edmond); H. Kan (Haidong); V. Karam (Vincent); F. Karch (Francois); C.K. Karema (Corine Kakizi); A. Kaul (Anil); N. Kawakami (Norito); K. Kazanjan (Konstantin); D.S. Kazi (Dhruv S); A.G. Kemp (Andrew G); A.P. Kengne (Andre Pascal); M. Kereselidze (Maia); Y.S. Khader (Yousef Saleh); S.E.A.H. Khalifa (Shams Eldin Ali Hassan); E.A. Khan (Ejaz Ahmed); Y.-H. Khang (Young-Ho); L. Knibbs (Luke); Y. Kokubo (Yoshihiro); S. Kosen (Soewarta); B.K. Defo (Barthelemy Kuate); C. Kulkarni (Chanda); V.S. Kulkarni (Veena S); G.A. Kumar (G Anil); K. Kumar (Kuldeep); R.B. Kumar (Ravi B); G.F. Kwan (Gene F); T. Lai (Taavi); R. Lalloo (Ratilal); H. Lam (Hilton); V.C. Lansingh (Van C); A. Larsson (Anders); J.-T. Lee (Jong-Tae); P.N. Leigh (Nigel); M. Leinsalu (Mall); R. Leung (Ricky); X. Li (Xiaohong); Y. Li (Yichong); Y. Li (Yongmei); J. Liang (Juan); X. Liang (Xiao); S.S. Lim (Stephen); H.-H. Lin (Hsien-Ho); S.E. Lipshultz (Steven); S. Liu (Simin); Y. Liu (Yang); B.K. Lloyd (Belinda K); S.J. London (Stephanie); P.A. Lotufo (Paulo A); J. Ma (Jixiang); S. Ma (Stefan); V.M.P. Machado (Vasco Manuel Pedro); N.K. Mainoo (Nana Kwaku); M. Majdan (Marek)

    2014-01-01

    textabstractBackground: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key

  15. Trends in maternal mortality in resident vs. migrant women in Shanghai, China, 2000-2009: a register-based analysis.

    Science.gov (United States)

    Du, Li; Qin, Min; Zhang, Lei; Xu, Houqin; Zhu, Liping

    2012-06-01

    Although Shanghai has good maternal health indicators, it also has a large in-migrating population, which has made control of maternal mortality a major challenge. This study analyzed maternal mortality and causes of death in pregnant women in Shanghai in the ten years from 2000 to 2009, comparing resident and migrant women. All live births were registered and every maternal death audited. The number of live births rose from 84,898 in 2000 to 187,335 in 2009. The number of migrants increased 4.6 times, while the proportion of live births to migrant women increased from 27% to 55%. There were 262 maternal deaths, 55 in Shanghai residents and 207 in migrant women (78.9% of the total). Most deaths in migrant women were due to illegal delivery. Three policy changes focusing on maternal health greatly reduced deaths: low-cost delivery services were established for migrant women in maternity hospitals, five obstetric emergency care and referral centres were created in general hospitals, and training for health professionals and health education for women were instituted. Maternal mortality in Shanghai decreased steadily from 2000 to 2009, reaching 10 per 100,000 live births in 2009. Among Shanghai permanent residents the ratio was below ten in most of those years, while among migrant women it declined sharply from 58 to 12 per 100,000 live births. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  16. Maternal mortality according to race/skin color in Mato Grosso do Sul, Brazil, from 2010 to 2015

    Directory of Open Access Journals (Sweden)

    Renata Palópoli Pícoli

    Full Text Available Abstract Objectives: to investigate the epidemiological profile, by race/skin color, of maternal deaths in the state of Mato Grosso do Sul, Brazil. Methods: the present epidemiological study of maternal death distribution by race/skin color was based on data extracted from Brazilian mortality and livebirth information systems from 2010 to 2015. The maternal mortality ratio and the specific maternal mortality ratio were calculated and analyzed according to obstetric variables. Results: the death risk for black (RR = 4.3, CI95%= 2.088.71 and indigenous women (RR = 3.7, CI95% 2.26.23 was approximately fourfold in comparison to the risk for white women. For direct causes of death, the state of Mato Grosso do Sul showed higher levels, 74.1%, as well as for most races/skin colors in the first triennium. The specific maternal mortality ratio was higher among black and indigenous women aged30 to 39 years old (416.7 and 651.8, respectively per 100,000 live births (p<0.05. Conclusions: higher maternal mortality ratio for indigenous and black women and the predominance of deaths related to direct obstetric causes among race/skin color categories reflect inadequate health care during pregnancy and puerperium.

  17. Historical perspective on induced abortion through the ages and its links with maternal mortality.

    Science.gov (United States)

    Drife, James Owen

    2010-08-01

    Abortion is mentioned in ancient medical texts but the effectiveness of the methods described is doubtful. Attitudes varied from apparent disapproval by Hippocrates to open approval in Ancient Rome. In mediaeval times abortion was practised by women in secret and this continued during the 19th and early 20th centuries. Despite being illegal in England induced abortion became more common in Victorian times as the population grew. At the same time the link between criminal abortion and maternal mortality became increasingly clear, and if a woman died after a procedure the abortionist (sometimes a midwife) could be sentenced to death. The law was more tolerant of abortions performed by registered doctors. In the 20th century pressure grew for its legalisation. At the time of the 1967 Abortion Act, abortion was the leading cause of maternal death in the UK but within fifteen years death from illegal abortion had been abolished. 2010 Elsevier Ltd. All rights reserved.

  18. The impact of economic recession on maternal and infant mortality: lessons from history

    Directory of Open Access Journals (Sweden)

    Fitzmaurice Ann

    2010-11-01

    Full Text Available Abstract Background The effect of the recent world recession on population health has featured heavily in recent international meetings. Maternal health is a particular concern given that many countries were already falling short of their MDG targets for 2015. Methods We utilise 20th century time series data from 14 high and middle income countries to investigate associations between previous economic recession and boom periods on maternal and infant outcomes (1936 to 2005. A first difference logarithmic model is used to investigate the association between short run fluctuations in GDP per capita (individual incomes and changes in health outcomes. Separate models are estimated for four separate time periods. Results The results suggest a modest but significant association between maternal and infant mortality and economic growth for early periods (1936 to 1965 but not more recent periods. Individual country data display markedly different patterns of response to economic changes. Japan and Canada were vulnerable to economic shocks in the post war period. In contrast, mortality rates in countries such as the UK and Italy and particularly the US appear little affected by economic fluctuations. Conclusions The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mechanisms that protect vulnerable populations from the effects of fluctuating national income.

  19. Maternal nutritional status & practices & perinatal, neonatal mortality in rural Andhra Pradesh, India.

    Science.gov (United States)

    Bamji, Mahtab S; V S Murthy, P V; Williams, Livia; Vardhana Rao, M Vishnu

    2008-01-01

    Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages. Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test. Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality. Significant association between signs

  20. Technology use, cesarean section rates, and perinatal mortality at Danish maternity wards

    DEFF Research Database (Denmark)

    Lidegaard, O; Jensen, L M; Weber, Tom

    1994-01-01

    Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... FHM had a 15% higher cesarean section rate (not planned) than units not using FHM (p ... a technology index was calculated for eight regions in Denmark, weighting the index of each unit in a region according to its number of deliveries. There was no association between the technology index in these eight regions in Denmark and their cesarean section rates. Use of FHM, technology index...

  1. Progress on the maternal mortality ratio reduction in Wuhan, China in 2001-2012.

    Directory of Open Access Journals (Sweden)

    Shaoping Yang

    Full Text Available BACKGROUND: Most maternal deaths occur in developing countries and most maternal deaths are avoidable. China has made a great effort to reduce MMR by three quarters to meet the fifth Millennium Development Goal (MDG5. METHODS: This retrospective study reviewed and analyzed maternal death data in Wuhan from 2001 to 2012. Joinpoint regression and multivariate Poisson regression was conducted using the log-linear model to measure the association of the number of maternal deaths with time, cause of death, where the death occurred, and cognitive factors including knowledge, attitude, resource, and management stratified. RESULTS: The MMR declined from 33.41 per 100,000 live births in 2001 to 10.63 per 100,000 live births in 2012, with a total decline of 68.18% and an average annual decline of 9.89%. From 2001-2012, the four major causes of maternal death were obstetric hemorrhage (35.16%, pregnancy complications (28.57%, amniotic fluid embolism (16.48% and gestational hypertension (8.79%. Multivariate Poisson regression showed on average the MMR decreased by.17% each year from 2001-2006 and stayed stagnant since 2007-2012. CONCLUSIONS: With the reduction in MMR in obstetric death (e.g. obstetric hemorrhage, there had been a remarkable reduction in MMR in Wuhan in 2001-2012, which may be due to (1 the improvement in the obstetric quality of perinatal care service on prevention and treatment of obstetric hemorrhage and emergency care skills, and (2 the improvement in the maternal health management and quality of prenatal care. Interventions to further reduce the MMR include several efforts such as the following: (1 designing community-based interventions, (2 providing subsidies to rural women and/hospitals for hospital delivery, (3 screening for pregnancy complications, and (4 establishing an emergency rescue system for critically ill pregnant women.

  2. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India.

    Science.gov (United States)

    Dasari, Papa

    2015-06-01

    To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care.

  3. Household structure, maternal characteristics and childhood mortality in rural sub-Saharan Africa.

    Science.gov (United States)

    Akinyemi, Joshua O; Chisumpa, Vesper H; Odimegwu, Clifford O

    2016-01-01

    The household dynamics of childhood mortality in rural areas of sub-Saharan Africa is less researched despite the fact that mortality rates are almost two times that of urban settings. This study aimed to investigate the influence of household structure on childhood mortality while controlling for household and maternal characteristics in rural sub-Saharan Africa. Eight countries with recent demographic and health survey data not earlier than the year 2010 were selected, two from each sub-region of sub-Saharan Africa. The outcome variables were risk of infant and child death while the main independent variables included sex of household head and household structure. Descriptive statistics were generated for all variables. Mortality rates disaggregated by sex of household head and household structure were estimated using the Kaplan-Meier method. Cox proportional hazard regression models were fitted to investigate the relationship between the outcome and explanatory variables in each country. The percentage of children living in female-headed households (FHHs) ranged from 5.2% in Burkina Faso to 49.1% in Namibia while those living in extended family households ranged from 27.4% in Rwanda to 59.9% in Namibia. Multivariate hazard regression showed that, in the majority of the countries, there was no significant relationship between living in FHHs and childhood mortality, but the direction and magnitude of effect varied across countries. A significant negative effect of FHHs on infant mortality was observed in Burkina Faso (HR=1.64, 95% confidence interval (CI): 1.09-2.48) and Zambia (HR=1.49, 95%CI: 1.02-2.17). Likewise, children in extended family households had a higher risk of child mortality in Burkina Faso (HR=1.33, 95%CI: 1.04-1.69) and Zambia (HR=1.59, 95%CI: 1.02-2.49). There was not much difference in the effect of FHHs between infancy (0-11 months) and childhood (12-59 months) in the other countries. The pooled adjusted hazard ratio (HR) showed that the risk

  4. Maternal morbidity and mortality in Pakistan - an overview of major contributors

    International Nuclear Information System (INIS)

    Khan, A.; Izhar, V.; Viqar, M. A.

    2017-01-01

    Objective: To assess the trend of the proportion of maternal mortality ratio (MMR) due to common direct causes that are the major contributors in Pakistan. Study Design: Descriptive method study. Place and Duration of Study: The study was conducted in Jun 2014. Material and Methods: Descriptive method study was conducted in June 2014. Data collected in different time periods from articles published between 01 Jan 2005 to 31 Dec 2012 in medical journals, proceedings of workshops/conferences as well as from newsletters of the National Committee of Maternal Health (NCMH) along with global burden of disease (GBD) 2013 to estimate MMR. Data were later tabulated accordingly in June 2014. Results: In the hospitals over 80% of the deaths are due to direct causes. Direct causes account for 78.1 percent of deaths, hemorrhage being the most common followed by sepsis, eclampsia, rupture of the uterus, and abortions. The contributors were greater in booked multi-gravid as of 20 to 40 years, para 3 to 5, under matric education and with less than Rs. 10,000 monthly income. Conclusion: Massive hemorrhage and uncontrolled hypertension are major contributors of maternal morbidity in Pakistan. (author)

  5. Composite measures of women's empowerment and their association with maternal mortality in low-income countries.

    Science.gov (United States)

    Lan, Chiao-Wen; Tavrow, Paula

    2017-11-08

    Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women's empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women's advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants. Using data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures - the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) - with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive. Two gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = -0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = -0.04, P = 0.04). No gender measure was significant. In African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women's motivation to deliver in a hospital setting. Improving gender equality and

  6. Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.

    Science.gov (United States)

    Chongsuvivatwong, Virasakdi; Bachtiar, Hafni; Chowdhury, Mahbub Elahi; Fernando, Sunil; Suwanrath, Chitkasaem; Kor-Anantakul, Ounjai; Tuan, Le Anh; Lim, Apiradee; Lumbiganon, Pisake; Manandhar, Bekha; Muchtar, Masrul; Nahar, Lutfan; Hieu, Nguyen Trong; Fang, Pan Xiao; Prasertcharoensuk, Witoon; Radnaabarzar, Erdenetungalag; Sibuea, Daulat; Than, Kyu Kyu; Tharnpaisan, Piangjit; Thach, Tran Son; Rowe, Patrick

    2010-02-01

    To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals. Hospital based prospective study at 12 centers of 9 countries. 12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P cesarean section. Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.

  7. Pregnancy termination in Matlab, Bangladesh: maternal mortality risks associated with menstrual regulation and abortion.

    Science.gov (United States)

    Rahman, Mizanur; DaVanzo, Julie; Razzaque, Abdur

    2014-09-01

    In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (known or suspected). However, little is known about changes over time in the use of these methods or their relative mortality risks. Data from the Demographic Surveillance System in Matlab, Bangladesh, on 110,152 pregnancy outcomes between 1989 and 2008 were used to assess changes in mortality risks associated with MR (and a small number of dilation and curettage procedures), abortion and live birth. Tabulation and logistic regression analyses were used to compare outcomes in two areas of Matlab--the comparison area, which receives standard government health and family planning services, and the Maternal and Child Health-Family Planning (MCH-FP) area, which receives enhanced health and family planning services. In Matlab as a whole, the proportion of pregnancies ending in MR increased from 1.9% in 1989-1999 to 4.2% in 2000-2008, while the proportion ending in abortion decreased from 1.6% to 1.1%. The odds of mortality from MR were 4.1 times those from live birth in 1989-1999, but were no longer elevated in 2000-2008. The odds of mortality from abortion were 12.0 and 4.9 times those of live birth in 1989-1999 and 2000-2008, respectively. Reduction in mortality risk was greater in the MCH-FP area than the comparison area (90% vs. 75%). MR is no longer associated with higher mortality risk than live birth in Bangladesh, but abortion is.

  8. [Coverage for birth care in Mexico and its interpretation within the context of maternal mortality].

    Science.gov (United States)

    Lazcano-Ponce, Eduardo; Schiavon, Raffaela; Uribe-Zúñiga, Patricia; Walker, Dilys; Suárez-López, Leticia; Luna-Gordillo, Rufino; Ulloa-Aguirre, Alfredo

    2013-01-01

    To evaluate health coverage for birth care in Mexico within the frame of maternal mortality reduction. Two information sources were used: 1) The comparison between the results yield by the Mexican National Health and Nutrition Surveys 2006 and 2012 (ENSANUT 2006 and 2012), and 2) the databases monitoring maternal deaths during 2012 (up to December 26), and live births (LB) in Mexico as estimated by the Mexican National Population Council (Conapo). The national coverage for birth care by medical units is nearly 94.4% at the national level, but in some federal entities such as Chiapas (60.5%), Nayarit (87.8%), Guerrero (91.2%), Durango (92.5%), Oaxaca (92.6%), and Puebla (93.4%), coverage remains below the national average. In women belonging to any social security system (eg. IMSS, IMSS Oportunidades, ISSSTE), coverage is almost 99%, whereas in those affiliated to the Mexican Popular Health Insurance (which depends directly from the Federal Ministry of Health), coverage reached 92.9%. In terms of Maternal Mortality Ratio (MMR), there are still large disparities among federal states in Mexico, with a national average of 47.0 per 100 000 LB (preliminary data for 2012, up to December 26). The MMR estimation has been updated using the most recent population projections. There is no correlation between the level of institutional birth care and the MMR in Mexico. It is thus necessary not only to guarantee universal birth care by health professionals, but also to provide obstetric care by qualified personnel in functional health services networks, to strengthen the quality of obstetric care, family planning programs, and to promote the implementation of new and innovative health policies that include intersectoral actions and human rights-based approaches targeted to reduce the enormous social inequity still prevailing in Mexico.

  9. Biocultural perspectives on maternal mortality and obstetrical death from the past to the present.

    Science.gov (United States)

    Stone, Pamela K

    2016-01-01

    Global efforts to improve maternal health are the fifth focus goal of the Millennium Development Goals adopted by the international community in 2000. While maternal mortality is an epidemic, and the death of a woman in childbirth is tragic, certain assumptions that frame the risk of death for reproductive aged women continue to hinge on the anthropological theory of the "obstetric dilemma." According to this theory, a cost of hominin selection to bipedalism is the reduction of the pelvic girdle; in tension with increasing encephalization, this reduction results in cephalopelvic disproportion, creating an assumed fragile relationship between a woman, her reproductive body, and the neonates she gives birth to. This theory, conceived in the 19th century, gained traction in the paleoanthropological literature in the mid-20th century. Supported by biomedical discourses, it was cited as the definitive reason for difficulties in human birth. Bioarchaeological research supported this narrative by utilizing demographic parameters that depict the death of young women from reproductive complications. But the roles of biomedical and cultural practices that place women at higher risk for morbidity and early mortality are often not considered. This review argues that reinforcing the obstetrical dilemma by framing reproductive complications as the direct result of evolutionary forces conceals the larger health disparities and risks that women face globally. The obstetrical dilemma theory shifts the focus away from other physiological and cultural components that have evolved in concert with bipedalism to ensure the safe delivery of mother and child. It also sets the stage for a framework of biological determinism and structural violence in which the reproductive aged female is a product of her pathologized reproductive body. But what puts reproductive aged women at risk for higher rates of morbidity and mortality goes far beyond the reproductive body. Moving beyond reproduction

  10. 76 FR 10908 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal...

    Science.gov (United States)

    2011-02-28

    ... HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal Vitamin D Status and Preterm Birth, DP11-002, Initial... and other committee management activities, for both the Centers for Disease Control and Prevention and...

  11. 75 FR 78999 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal...

    Science.gov (United States)

    2010-12-17

    ... HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Maternal Vitamin D Status and Preterm Birth, DP11-002, Initial... Centers for Disease Control and Prevention (CDC) announces the aforementioned meeting: Time and Date: 11 a...

  12. Maternal morbidity and mortality due to primary PPH-experience at ayub teaching hospital abbottabad

    International Nuclear Information System (INIS)

    Naz, H.; Sarwar, I.; Nisa, A.U.

    2008-01-01

    Postpartum Haemorrhage (PPH) remains a significant cause of maternal mortality and morbidity like hypovolemic shock, anaemia, multi organ failure, consumptive coagulopathy, disseminated intra vascular coagulation (DIC), blood transfusion related complications and hysterectomy leading to loss of childbearing potential. The present study was conducted to determine the frequency of PPH and the associated maternal morbidity at the Department of Gynaecology Unit B, Ayub Teaching Hospital Abbottabad. The study was carried out in the Department of Obstetrics and Gynaecology Unit B of the Ayub teaching Hospital Abbottabad from 18th April 2006 to 17 July 2006. The study population included all cases admitted with primary PPH during the study period. For calculation of frequencies, the total number of deliveries in the setting during the study period was used. All subjects underwent a complete obstetrical clinical workup comprising of history, general physical examination, abdominal and pelvic examination, relevant laboratory investigations. The maternal condition was assessed and managed according to established hospital protocols which included both pharmacological and surgical intervention. All maternal complications were noted and recorded on pre-designed proformas. Data was entered and analyzed by computer. A total of 50 cases of primary PPH were recorded during the study period. The frequency of PPH was calculated as 7.1%. The major cause of PPH was uterine atony found in 29 (58%) cases, followed by cervical, vaginal and perineal tears in 12 (24%) cases. Initially all patients were managed pharmacologically followed by surgical intervention. Subtotal (haemostatic) hysterectomy was performed in 10 (20%) cases. Maternal morbidity was detected in 31 (62%) of cases; the major morbidities were DIC in 3 (6%) cases. Acute renal failure in 3 (6%) patients and shock in 2 (9.9%) cases and anaemia in 20 (90.1%) cases. The study concludes that the frequency of primary PPH in this

  13. Causes of maternal and child mortality among Cambodian sex workers and their children: a cross sectional study.

    Science.gov (United States)

    Willis, Brian; Onda, Saki; Stoklosa, Hanni Marie

    2016-11-21

    To reach global and national goals for maternal and child mortality, countries must identify vulnerable populations, which includes sex workers and their children. The objective of this study was to identify and describe maternal deaths of female sex workers in Cambodia and causes of death among their children. A convenience sample of female sex workers were recruited by local NGOs that provide support to sex workers. We modified the maternal mortality section of the 2010 Cambodia Demographic and Health Survey and collected reports of all deaths of female sex workers. For each death we ask the 'sisterhood' methodology questions to identify maternal deaths. For child deaths we asked each mother who reported the death of a child about the cause of death. We also asked all participants about the cause of deaths of children of other female sex workers. We interviewed 271 female sex workers in the four largest Cambodian cities between May and September 2013. Participants reported 32 deaths of other female sex workers that met criteria for maternal death. The most common reported causes of maternal deaths were abortion (n = 13;40%) and HIV (n = 5;16%). Participants report deaths of 8 of their children and 50 deaths of children of other female sex workers. HIV was the reported cause of death for 13 (36%) children under age five. This is the first report of maternal deaths of sex workers in Cambodia or any other country. This modification of the sisterhood methodology has not been validated and did not allow us to calculate maternal mortality rates so the results are not generalizable, however these deaths may represent unrecognized maternal deaths in Cambodia. The results also indicate that children of sex workers in Cambodia are at risk of HIV and may not be accessing treatment. These issues require additional studies but in the meantime we must assure that sex workers in Cambodia and their children have access to quality health services.

  14. Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services.

    Science.gov (United States)

    Getahun, Haileyesus; Sculier, Delphine; Sismanidis, Charalambos; Grzemska, Malgorzata; Raviglione, Mario

    2012-05-15

    Tuberculosis affected an estimated 8.8 million people and caused 1.4 million deaths globally in 2010, including a half-million women and at least 64 000 children. It also results in nearly 10 million cumulative orphans due to parental deaths. Moreover, it causes 6%-15% of all maternal mortality, which increases to 15%-34% if only indirect causes are considered. Increasingly, more women with tuberculosis are notified than men in settings with a high prevalence of human immunodeficiency virus (HIV), and maternal tuberculosis increases the vertical transmission of HIV. Tuberculosis prevention, diagnosis, and treatment services should be included as key interventions in the integrated management of pregnancy and child health. Tuberculosis screening using a simple clinical algorithm that relies on the absence of current cough, fever, weight loss, and night sweats should be used to identify eligible pregnant women living with HIV for isoniazid preventive therapy or for further investigation for tuberculosis disease as part of services for prevention of vertical HIV transmission. While implementing these simple, low-cost, effective interventions as part of maternal, neonatal, and child health services, the unmet basic and operational tuberculosis research needs of children, pregnant, and breastfeeding women should be addressed. National policy makers, program managers, and international stakeholders (eg, United Nations bodies, donors, and implementers) working on maternal, neonatal, and child health, especially in HIV-prevalent settings, should give due attention and include tuberculosis prevention, diagnosis, and treatment services as part of their core functions and address the public health impacts of tuberculosis in their programs and services.

  15. Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

    Directory of Open Access Journals (Sweden)

    Khainza Betty

    2011-07-01

    Full Text Available Abstract Background Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda. Methods This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care. Results Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39, maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1. The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8, non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2, non use of oxytocics (OR 4.0, 95% CI 1.7-9.7, lack of essential drugs (OR 3.6, 95% CI 1.1-11.3 and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9 and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1. Conclusion The predictors of progression from severe maternal morbidity to mortalitywere: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS. There is need to improve on the

  16. Infant, maternal, and geographic factors influencing gastroschisis related mortality in Zimbabwe.

    Science.gov (United States)

    Apfeld, Jordan C; Wren, Sherry M; Macheka, Nyasha; Mbuwayesango, Bothwell A; Bruzoni, Matias; Sylvester, Karl G; Kastenberg, Zachary J

    2015-12-01

    Survival for infants with gastroschisis in developed countries has improved dramatically in recent decades with reported mortality rates of 4-7%. Conversely, mortality rates for gastroschisis in sub-Saharan Africa remain as great as 60% in contemporary series. This study describes the burden of gastroschisis at the major pediatric hospital in Zimbabwe with the goal of identifying modifiable factors influencing gastroschisis-related infant mortality. We performed a retrospective cohort study of all cases of gastroschisis admitted to Harare Children's Hospital in 2013. Univariate and multivariate analyses were performed to describe infant, maternal, and geographic factors influencing survival. A total of 5,585 neonatal unit admissions were identified including 95 (1.7%) infants born with gastroschisis. Gastroschisis-related mortality was 84% (n = 80). Of infants with gastroschisis, 96% (n = 91) were born outside Harare Hospital, 82% (n = 78) were born outside Harare Province, and 23% (n = 25) were home births. The unadjusted odds of survival for these neonates with gastroschisis were decreased for low birth weight infants (age; OR, 0.06; 95% CI, 0.01-0.50), and for those born to teenage mothers (age; OR, 0.05; 95% CI, 0.01-0.46). There was also a trend toward decreased odds of survival for home births (OR, 0.16; 95% CI, 0.02-1.34) and for those born outside Harare Province (OR, 0.35; 95% CI, 0.10-1.22). Gastroschisis-related infant mortality in Zimbabwe is associated with well-known risk factors, including low birth weight, prematurity, and teenage mothers. However, modifiable factors identified in this study signify potential opportunities for developing innovative approaches to perinatal care in such a resource-constrained environment. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries.

    Science.gov (United States)

    Raj, Anita; Boehmer, Ulrike

    2013-04-01

    This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

  18. The potential of medical abortion to reduce maternal mortality in Africa: what benefits for Tanzania and Ethiopia?

    Directory of Open Access Journals (Sweden)

    Rebecca F Baggaley

    2010-10-01

    Full Text Available Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative.By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term.Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia. Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates.This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.

  19. Overall and abortion-related maternal mortality rates in Uruguay over the past 25years and their association with policies and actions aimed at protecting women's rights.

    Science.gov (United States)

    Briozzo, Leonel; Gómez Ponce de León, Rodolfo; Tomasso, Giselle; Faúndes, Anibal

    2016-08-01

    To evaluate changes in maternal mortality rates in Uruguay over the past 25years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated. Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10years also coincides with a reduction in poverty and an improvement in the HDI. A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion. Copyright © 2016. Published by Elsevier Ireland Ltd.

  20. Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights.

    Science.gov (United States)

    Briozzo, Leonel; Gómez Ponce de León, Rodolfo; Tomasso, Giselle; Faúndes, Anibal

    2016-08-01

    To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated. Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10 years also coincides with a reduction in poverty and an improvement in the HDI. A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion. © 2016 The Authors. Published by International Federation of Gynecology and Obstetrics and John Wiley & Sons Ltd.

  1. Technology use, cesarean section rates, and perinatal mortality at Danish maternity wards

    DEFF Research Database (Denmark)

    Lidegaard, O; Jensen, L M; Weber, Tom

    1994-01-01

    FHM had a 15% higher cesarean section rate (not planned) than units not using FHM (p complicated deliveries to central units, which at the same time relatively often use FHM, is probably responsible for this association. Trying to encounter this selection bias......Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... a technology index was calculated for eight regions in Denmark, weighting the index of each unit in a region according to its number of deliveries. There was no association between the technology index in these eight regions in Denmark and their cesarean section rates. Use of FHM, technology index...

  2. Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

    Science.gov (United States)

    Arendt, Esther; Singh, Neha S; Campbell, Oona M R

    2018-01-01

    The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health. We used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (health system and families more, and are associated with worse health outcomes. We suggest that our findings be used to argue for policies targeting stunting in infant girls and potential catch-up growth in adolescence and early adulthood, aiming to increase their adult height and thus decrease their subsequent risk of experiencing caesarean section and adverse birth outcomes.

  3. Widowers' accounts of maternal mortality among women of low socioeconomic status in Nigeria.

    Science.gov (United States)

    Nwokocha, Ezebunwa Ethelbert

    2012-09-01

    The research is based on information collected on 50 deceased Nigerian women of low socioeconomic status in different locations of the country including Lagos, Ibadan, Kaduna, Zaria, Minna, Enugu, and Port-Harcourt among others. They had some common characteristics such as low levels of education, involvement in petty trading and were clients of a microfinance bank as small loan receivers. Primary data were generated mainly through verbal autopsy with widowers employing in-depth interviews and key informant interviews. In addition, unobtrusive observation was carried out in these locations to ascertain in some instances the distance between the deceased homes and health facilities patronised by the women. Secondary data were specific to death certificates of the deceased supplied by the widowers. Both ethnographic summaries and content analysis were employed in data analysis to account for contextual differences, especially in a multicultural society like Nigeria. The findings implicated several issues that are taken for granted at the micro-family and macro-society levels. It specifically revealed that small loans alone are not sufficient to empower poor women to make meaningful contributions to their own reproductive health in a patriarchal society like Nigeria. Results also indicated that cultural differences as well as rural-urban dichotomy were not proximate determinants of maternal behaviour; the latter rather finds expression in low socioeconomic status. Consequently, policy relevant recommendations that could contribute to significant maternal mortality reduction were proffered.

  4. Gaining Insight into the Prevention of Maternal Death Using Narrative Analysis: An Experience from Kerman, Iran

    Directory of Open Access Journals (Sweden)

    Rana Eftekhar-Vaghefi

    2013-11-01

    Full Text Available Reduction in maternal mortality requires an in-depth knowledge of the causes of death. This study was conducted to explore the circumstances and events leading to maternal mortality through a holistic approach. Using narrative text analysis, all documents related to maternal deaths occurred from 2007 to 2011 in Kerman province/Iran were reviewed thoroughly by an expert panel. A 93-item chart abstraction instrument was developed according to the expert panel and literature. The instrument consisted of demographic and pregnancy related variables, underlying and contributing causes of death, and type of delays regarding public health aspects, medical and system performance issues. A total of 64 maternal deaths were examined. One third of deaths occurred in women less than 18 or higher than 35 years. Nearly 95% of them lived in a low or mid socioeconomic status. In half of the cases, inappropriate or nonuse of contraceptives was seen. Delay in the provision of any adequate treatment after arrival at the health facility was seen in 59% of cases. The most common medical causes of death were preeclampsia/eclampsia (15.6%, postpartum hemorrhage (12.5% and deep phlebothrombosis (10.9%, respectively. Negligence was accounted for 95% of maternal deaths. To overcome the root causes of maternal death, more emphasis should be devoted to system failures and patient safety rather than the underlying causes of death and medical issues solely.

  5. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long-term mortality impact.

    Science.gov (United States)

    Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A

    2017-06-01

    There is limited evidence about the long-term effectiveness of integrated community-based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH-FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1- to 4-year mortality, or under-5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community-based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first-level hospital care. The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of

  6. Effect of early detection and treatment on malaria related maternal mortality on the north-western border of Thailand 1986-2010

    NARCIS (Netherlands)

    McGready, Rose; Boel, Machteld; Rijken, Marcus J.; Ashley, Elizabeth A.; Cho, Thein; Moo, Oh; Paw, Moo Koh; Pimanpanarak, Mupawjay; Hkirijareon, Lily; Carrara, Verena I.; Lwin, Khin Maung; Phyo, Aung Pyae; Turner, Claudia; Chu, Cindy S.; van Vugt, Michele; Price, Richard N.; Luxemburger, Christine; ter Kuile, Feiko O.; Tan, Saw Oo; Proux, Stephane; Singhasivanon, Pratap; White, Nicholas J.; Nosten, François H.

    2012-01-01

    Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on

  7. AN AUDIT OF MATERNAL DEATHS

    Directory of Open Access Journals (Sweden)

    Basavana Gowda

    2015-03-01

    Full Text Available OBJECTIVES: A study of maternal death conducted to evaluate various factors responsible for maternal deaths. To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly. To analyze the causes and epidemiological amounts maternal mortality e.g. age parity, socioeconomic status and literacy. In order to reduce maternal mortality and to implement safe motherhood program and complications of pregnancy and to find out safe motherhood program. METHODS: The data collected was a retrograde by a proforma containing particulars of the diseased, detailed history and relatives were interviewed for additional information. The data collected was analysed. RESULTS: Maternal mortality rate in our own institution is 200/ 100,000 live births. Among 30 maternal deaths, 56% deaths (17 were among low socio - economic status, groups 60% deaths among unbooked 53.5% deaths more along illiterates evidenced by direct and indirect deaths about 25% of deaths were preventable. CONCLUSION: Maternal death is a great tragedy in the family life. It is crusade to know not just the medical cause of the death but the circumstances what makes these continued tragic death even more unacceptable is that deaths are largely preventable

  8. Contribution of maternal age, medical and obstetric history to maternal and perinatal morbidity/mortality for women aged 35 or older.

    Science.gov (United States)

    Morris, Jonathan M; Totterdell, James; Bin, Yu Sun; Ford, Jane B; Roberts, Christine L

    2018-02-01

    As age is not modifiable, pregnancy risk information based on age alone is unhelpful for older women. To determine severe morbidity/mortality rates for women aged ≥35 years according to maternal profile based on parity, pre-existing medical conditions and prior pregnancy complications, and to assess the independent contribution of age. Population-based record-linkage study using NSW hospitalisation and birth records 2006-2012. Maternal and perinatal mortality/morbidity were assessed for non-anomalous singleton births to women aged ≥35 years. For 117 357 pregnancies among 99 375 women aged ≥35 years, the median age at delivery was 37 years (range 35-56 years), including: 35 652 (30.4%) multiparae without pre-existing medical or obstetric complications, 33,058 (28.2%) nulliparae without pre-existing medical conditions and 30 325 (25.8%) multiparae with prior pregnancy complications. Maternal and perinatal mortality/morbidity varied by maternal profile with ranges of 0.9-3.5% and 2.4-11.9%, respectively. For nulliparae, each five-year increase in age did not contribute significantly to maternal risk after controlling for medical conditions (adjustedodds ratio 1.08, 95% CI 0.93-1.25), but did confer perinatal risk (1.14; 1.05-1.25). For multiparae, each five-year increase in age beyond 35 years was independently associated with adverse maternal (1.23; 1.09-1.39) and perinatal outcomes (1.23; 1.09-1.39). For women aged ≥35 years, presence of medical conditions conferred a greater risk for morbidity/mortality than age itself. For multiparous women, the effects of medical and obstetric history were additive. The contribution of maternal age to adverse outcomes in pregnancies without significant medical and obstetric history is modest. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  9. An option for measuring maternal mortality in developing countries: a survey using community informants

    Directory of Open Access Journals (Sweden)

    Anggondowati Trisari

    2010-11-01

    Full Text Available Abstract Background The maternal mortality ratio (MMR remains high in most developing countries. Local, recent estimates of MMR are needed to motivate policymakers and evaluate interventions. But, estimating MMR, in the absence of vital registration systems, is difficult. This paper describes an efficient approach using village informant networks to capture maternal death cases (Maternal Deaths from Informants/Maternal Death Follow on Review or MADE-IN/MADE-FOR developed to address this gap, and examines its validity and efficiency. Methods MADE-IN used two village informant networks - heads of neighbourhood units (RTs and health volunteers (Kaders. Informants were invited to attend separate network meetings - through the village head (for the RT and through health centre for the kaders. Attached to the letter was a form with written instructions requesting informants list deaths of women of reproductive age (WRA in the village during the previous two years. At a 'listing meeting' the informants' understanding on the form was checked, informants could correct their forms, and then collectively agreed a consolidated list. MADE-FOR consisted of visits relatives of likely pregnancy related deaths (PRDs identified from MADE-IN, to confirm the PRD status and gather information about the cause of death. Capture-recapture (CRC analysis enabled estimation of coverage rates of the two networks, and of total PRDs. Results The RT network identified a higher proportion of PRDs than the kaders (estimated 0.85 vs. 0.71, but the latter was easier and cheaper to access. Assigned PRD status amongst identified WRA deaths was more accurate for the kader network, and seemingly for more recent deaths, and for deaths from rural areas. Assuming information on live births from an existing source to calculate the MMR, MADE-IN/MADE-FOR cost only $0.1 (US per women-year risk of exposure, substantially cheaper than alternatives. Conclusions This study shows that reliable

  10. Maternal Antiviral Immunoglobulin Accumulates in Neural Tissue of Neonates To Prevent HSV Neurological Disease

    Directory of Open Access Journals (Sweden)

    Yike Jiang

    2017-07-01

    Full Text Available While antibody responses to neurovirulent pathogens are critical for clearance, the extent to which antibodies access the nervous system to ameliorate infection is poorly understood. In this study on herpes simplex virus 1 (HSV-1, we demonstrate that HSV-specific antibodies are present during HSV-1 latency in the nervous systems of both mice and humans. We show that antibody-secreting cells entered the trigeminal ganglion (TG, a key site of HSV infection, and persisted long after the establishment of latent infection. We also demonstrate the ability of passively administered IgG to enter the TG independently of infection, showing that the naive TG is accessible to antibodies. The translational implication of this finding is that human fetal neural tissue could contain HSV-specific maternally derived antibodies. Exploring this possibility, we observed HSV-specific IgG in HSV DNA-negative human fetal TG, suggesting passive transfer of maternal immunity into the prenatal nervous system. To further investigate the role of maternal antibodies in the neonatal nervous system, we established a murine model to demonstrate that maternal IgG can access and persist in neonatal TG. This maternal antibody not only prevented disseminated infection but also completely protected the neonate from neurological disease and death following HSV challenge. Maternal antibodies therefore have a potent protective role in the neonatal nervous system against HSV infection. These findings strongly support the concept that prevention of prenatal and neonatal neurotropic infections can be achieved through maternal immunization.

  11. Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria.

    Science.gov (United States)

    Wall, L L

    1998-12-01

    Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.

  12. Mortalidade materna: 75 anos de observações em uma Maternidade Escola Maternal mortality: 75 years of observations in a teaching maternity hospital

    Directory of Open Access Journals (Sweden)

    Amaury Teixeira Leite Andrade

    2006-07-01

    Full Text Available OBJETIVO: avaliar as causas de todas as mortes maternas ocorridas no período de 1927 a 2001 entre 164.161 pacientes, internadas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora. MG. MÉTODOS: estudo retrospectivo das 144 mortes maternas que ocorreram na maternidade em 75 anos, com um total de 131.048 nascidos vivos, utilizando todos os prontuários de pacientes, avaliados pela história clínica e dados da certidão de óbito (não foram realizadas necropsias. Foram registrados a idade, paridade, tempo de gestação, complicações, momento e causas de morte, estabelecendo-se o índice de mortalidade materna (IMM hospitalar por cem mil nascidos vivos. Análise estatística pelo teste do chi2 e pela técnica de amortecimento exponencial (alfa =0,05. RESULTADOS: de 1927 a 1941 o IMM foi de 1544, entre 1942 e 1956 houve redução para 314 (pPURPOSE: to evaluate all maternal deaths that occurred between 1927 and 2001, among 164,161 patients admitted to the Maternidade Therezinha de Jesus, the obstetrical service of the "Universidade Federal de Juiz de Fora", Brazil. METHODS: a retrospective study of 144 maternal deaths that occurred in the maternity hospital in 75 years, with 131,048 live births in the same period of time, analyzing all patients's records regarding their clinical history and data from death certificates. Autopsies were not performed. Data obtained were age, parity, gestation length, complications, moment, and causes of death. The index of maternal mortality (IMM period 100 thousand live births was utilized. For statistical analysis the chi2 test and the exponential smoothing technique were used (alpha=0.05. RESULTS: IMM decreased from 1544 in the period 1927-1941 to 314 (p<0.001 between 1942 and 1956 and from 1957 to 1971 it was reduced to 76.4 per 100 thousand live births (p<0.001. Nevertheless, since 1972 there was no further significant improvement (IMM=46 in the last 15 years, p=0.139. Maternal mortality was

  13. Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country.

    Science.gov (United States)

    Buchmann, E J; Mnyani, C N; Frank, K A; Chersich, M F; McIntyre, J A

    2015-01-01

    To estimate maternal mortality ratio (MMR) and determine maternal death causes and trends in Greater Soweto, Johannesburg, South Africa. Cross-sectional study. Chris Hani Baragwanath Maternity Hospital (CHBMH) in Greater Soweto. Maternal deaths at CHBMH. Record review of maternal deaths from 1997 to 2012, using hospital death records, with denominator data from the district health information system and the hospital. Maternal mortality ratio per 100,000 live births, and causes of death classified as in the South African confidential enquiries. There were 479 deaths, with a peak MMR of 139 in 2004 and a decline to 86 in 2012. Of 332 women tested, 245 (74%) were HIV-infected. Nonpregnancy-related infection (40%) was the most frequent cause of death, followed by hypertension (16%) and obstetric haemorrhage (13%). HIV infection rates in these groups were 92%, 30% and 61%, respectively. Previous caesarean section was associated with obstetric haemorrhage death (odds ratio [OR] 3.2, 95% confidence interval [95% CI] 1.7-6.0), maternal age ≥35 years with hypertension death (OR 2.2, 95% CI 1.2-3.7) and antenatal anaemia with nonpregnancy-related infection death (OR 4.0, 95% CI 2.3-6.9), compared with other causes of death. There is evidence of a decline in MMR since HIV treatment for pregnant women was introduced in 2004. Previous caesarean section, advanced maternal age, and anaemia were associated with death from obstetric haemorrhage, hypertensive disorders of pregnancy and nonpregnancy-related infections, respectively. MMR may be further reduced with accelerated initiation of HIV treatment during pregnancy. © 2014 Royal College of Obstetricians and Gynaecologists.

  14. Impact of maternal diabetes mellitus on mortality and morbidity of preterm infants (24-33 weeks' gestation).

    Science.gov (United States)

    Bental, Yoram; Reichman, Brian; Shiff, Yakov; Weisbrod, Meir; Boyko, Valentina; Lerner-Geva, Liat; Mimouni, Francis B

    2011-10-01

    We hypothesized that maternal diabetes mellitus (DM) increases the risk for mortality, respiratory distress syndrome (RDS), and major complications of prematurity. Analysis of prospectively collected (1995-2007) Israel National Very Low Birth Weight Infant Database. Maternal DM was recorded as pregestational or gestational. Multivariable logistic regression analysis was used to assess the independent effect of maternal DM status on infant mortality, RDS, and other complications of prematurity. Infants of mothers with pregestational (n = 120) and gestational (n = 825) DM were similar, and their data were pooled for analyses. Mothers with DM were more likely to have received a complete course of prenatal steroids than control mothers. Infants of diabetic mothers (IDM) had a slightly higher gestational age and birthweight than non-IDM's. Distribution of birthweight percentiles and the mean birthweight z scores were similar. Apgar scores were statistically higher in the IDM group. There were no significant differences between the 2 groups in terms of delivery room mortality, RDS, and other major complications of prematurity. Total mortality and bronchopulmonary dysplasia rates were significantly higher in the nondiabetic group. The adjusted odds ratios for mortality, RDS, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and patent ductus arteriosus were not significantly increased in the IDM group. With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM.

  15. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    Directory of Open Access Journals (Sweden)

    Aradeon SB

    2016-03-01

    Full Text Available Susan B Aradeon,1 Henry V Doctor2 1Freelance International Consultant (Social and Behavioral Change Communication, Aventura, FL, USA; 2Department of Information, Evidence and Research, Regional Office for the Eastern Mediterranean, World Health Organization, Nasr City, Cairo, Egypt Abstract: The Sustainable Development Goal (SDG maternal mortality target risks being underachieved like its Millennium Development Goal (MDG predecessor. The MDG skilled birth attendant (SBA strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and

  16. Analysis of inequality in maternal and child health outcomes and mortality from 2000 to 2013 in China.

    Science.gov (United States)

    Li, Yanting; Zhang, Yimin; Fang, Shuai; Liu, Shanshan; Liu, Xinyu; Li, Ming; Liang, Hong; Fu, Hua

    2017-04-20

    Inequality in maternal and child health seriously hinders the overall improvement of health, which is a concern in both the United Nations Sustainable Development Goals (SDGs) and Healthy China 2030. However, research on the equality of maternal and child health is scarce. This study longitudinally assessed the equality trends in China's maternal and child health outcomes from 2000 to 2013 based on place of residence and gender to improve the fairness of domestic maternal and child health. Data on China's maternal and child health monitoring reports were collected from 2000 to 2013. Horizontal and vertical monitoring were performed on the following maternal and child health outcome indicators: incidence of birth defects (IBD), maternal mortality rate (MMR), under 5 mortality rate (U5MR) and neonatal mortality rate (NMR). The newly developed HD*Calc software by the World Health Organization (WHO) was employed as a tool for the health inequality assessment. The between group variance (BGV) and the Theil index (T) were used to measure disparity between different population groups, and the Slope index was used to analyse the BGV and T trends. The disparity in the MMR, U5MR and NMR for the different places of residence (urban and rural) improved over time. The BGV (Slope BGV = -32.24) and T (Slope T = -7.87) of MMR declined the fastest. The gender differences in the U5MR (Slope BGV = -0.06, Slope T = -0.21) and the NMR (Slope BGV = -0.01, Slope T = 0.23) were relatively stable, but the IBD disparity still showed an upward trend in both the place of residence and gender strata. A decline in urban-rural differences in the cause of maternal death was found for obstetric bleeding (Slope BGV = -14.61, Slope T = -20.84). Improvements were seen in the urban-rural disparity in premature birth and being underweight (PBU) in children under 5 years of age. Although diarrhoea and pneumonia decreased in the U5MR, no obvious gender-based trend in the causes of death was observed. We

  17. Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.

    Directory of Open Access Journals (Sweden)

    David M Bishai

    Full Text Available From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change.This paper decomposes the progress made by 146 low- and middle-income countries (LMICs in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data.The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector.Overall, countries improved maternal and child health (MCH from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

  18. Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.

    Science.gov (United States)

    Bishai, David M; Cohen, Robert; Alfonso, Y Natalia; Adam, Taghreed; Kuruvilla, Shyama; Schweitzer, Julian

    2016-01-01

    From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

  19. Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub-Saharan Africa.

    Science.gov (United States)

    Akinyemi, Joshua O; Adedini, Sunday A; Wandera, Stephen O; Odimegwu, Clifford O

    2016-12-01

    To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub-Saharan Africa. Pooled weighted data on 143 602 under-five children in the most recent demographic and health surveys for 15 sub-Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0-11 months) and child (age 12-59 months) mortality. Socio-economic and other confounding variables were included as controls. The distribution of the main explanatory variable in households was as follows: smoking + solid fuel - 4.6%; smoking + non-solid fuel - 0.22%; no smoking + solid fuel - 86.9%; and no smoking + non-solid fuel - 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29-2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28-3.08). Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under-five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel. © 2016 John Wiley & Sons Ltd.

  20. Mortality among children under the age of one: analysis of cases after discharge from maternity *

    Directory of Open Access Journals (Sweden)

    Elieni Paula dos Santos

    2016-06-01

    Full Text Available Abstract OBJECTIVE To analyze infant death after discharge from maternity in the time period between 2000 and 2013. METHOD A cross-sectional retrospective quantitative study in a municipality northward in the state of Paraná. Data were analyzed using the SPSS®, and were subjected to Chi-square test, logistical regression, 95% confidence interval, and a significance level of p <0.05. RESULTS Two hundred forty-nine children were born, discharged from maternity and subsequently died; 10.1% in the neonatal period and 89.9% in the post-neonatal period. Pregnancy follow-up, birth, and child monitoring took place mainly in the public health system. There was a statistically significant association between the infant component and place of delivery (p =0.002; RR=1.143; IC95%=1.064-1.229, and a lower number of childcare medical visits (p =0.001; RR=1.294; IC95%=1.039-1.613. The causes of death in the neonatal period were perinatal conditions (40%; external causes (32%; and congenital malformations (20%. In the post-neonatal period, congenital malformations (29.9%, external causes (24.1%; and infectious-parasitic diseases (11.2% were the causes of death. CONCLUSION Virtually all children were born in conditions of good vitality that were worsened due to potentially preventable diseases that led to death.

  1. The influence of the social and cultural environment on maternal mortality in Nigeria: Evidence from the 2013 demographic and health survey.

    Directory of Open Access Journals (Sweden)

    Oluwatosin Ariyo

    Full Text Available Reducing maternal mortality remains a priority for global health. One in five maternal deaths, globally, are from Nigeria.This study aimed to assess the sociocultural correlates of maternal mortality in Nigeria.We conducted a retrospective analysis of nationally representative data from the 2013 Nigeria Demographic and Health Survey. The analysis was based on responses from the core women's questionnaire. Maternal mortality was categorized as 'yes' for any death while pregnant, during delivery or two months after delivery (as reported by the sibling, and 'no' for deaths of other or unknown causes. Multilevel logistic regression analysis was conducted to test for association between maternal mortality and predictor variables of sociocultural status (educational attainment, community women's education, region, type of residence, religion, and women's empowerment.Region, Religion, and the level of community women's education were independently associated with maternal mortality. Women in the North West were more than twice as likely to report maternal mortality (OR: 2.14; 95% CI: 1.42-3.23 compared to those in the North Central region. Muslim women were 52% more likely to report maternal deaths (OR: 1.52; 95% CI: 1.10-2.11 compared to Christian women. Respondents living in communities where a significant proportion of women have at least secondary schooling were 33% less likely to report that their sisters died of pregnancy-related causes (OR: 0.67; 95% CI: 0.48-0.95.Efforts to reduce maternal mortality should implement tailored programs that address barriers to health-seeking behavior influenced by cultural beliefs and attitudes, and low educational attainment. Strategies to improve women's agency should be at the core of these programs; they are essential for reducing maternal mortality and achieving sustainable development goals towards gender equality. Future studies should develop empirically evaluated measures which assess, and further

  2. Maternal intimate partner violence victimization and under-five children mortality in Western Ethiopia: a case-control study.

    Science.gov (United States)

    Garoma, Sileshi; Fantahun, Mesganaw; Worku, Alemayehu

    2012-12-01

    This study aimed to compare the association between maternal intimate partner violence and under-five mortality. Matched case-control study was conducted from May to June 2011. A sample of 286 cases and 572 controls were randomly selected from East Wollega Zone, West Ethiopia. Among cases, 72.7% ever experienced controlling behaviors when compared to 62.4% for controls. All forms of maternal intimate partner violence were experienced by 61.9% of cases and 50.9% of controls. Controlling behavior in marriage and experiences of all forms of intimate partner violence during lifetime were more than four [adjusted odds ratio (AOR) 4.27, 95% confidence interval (CI) 0.97-18.89), and two (AOR = 2.55, 95% CI 1.66-3.92) times as likely to be associated with under-five mortality. Maternal intimate partner violence victimization is strongly associated with under-five mortality. Involving men in maternal and child health programs could be one strategy to address the issue of intimate partner violence against women.

  3. Causes of maternal and child mortality among Cambodian sex workers and their children: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Brian Willis

    2016-11-01

    Full Text Available Abstract Background To reach global and national goals for maternal and child mortality, countries must identify vulnerable populations, which includes sex workers and their children. The objective of this study was to identify and describe maternal deaths of female sex workers in Cambodia and causes of death among their children. Methods A convenience sample of female sex workers were recruited by local NGOs that provide support to sex workers. We modified the maternal mortality section of the 2010 Cambodia Demographic and Health Survey and collected reports of all deaths of female sex workers. For each death we ask the ‘sisterhood’ methodology questions to identify maternal deaths. For child deaths we asked each mother who reported the death of a child about the cause of death. We also asked all participants about the cause of deaths of children of other female sex workers. Results We interviewed 271 female sex workers in the four largest Cambodian cities between May and September 2013. Participants reported 32 deaths of other female sex workers that met criteria for maternal death. The most common reported causes of maternal deaths were abortion (n = 13;40% and HIV (n = 5;16%. Participants report deaths of 8 of their children and 50 deaths of children of other female sex workers. HIV was the reported cause of death for 13 (36% children under age five. Conclusion This is the first report of maternal deaths of sex workers in Cambodia or any other country. This modification of the sisterhood methodology has not been validated and did not allow us to calculate maternal mortality rates so the results are not generalizable, however these deaths may represent unrecognized maternal deaths in Cambodia. The results also indicate that children of sex workers in Cambodia are at risk of HIV and may not be accessing treatment. These issues require additional studies but in the meantime we must assure that sex workers in Cambodia and their

  4. Income and Preventable Mortality: The Case of Youth Traffic Fatalities

    OpenAIRE

    Donald Freeman

    2012-01-01

    The income-health gradient is a well-established finding in public health. This paper explores the gradient between income and different types of mortality: mortality that can be ameliorated via specific public policy measures, namely traffic fatalities, and mortality that is due to more “natural” causes, such as infectious disease. Using U.S. state-level data, growth in traffic mortality for 15-19 year-olds is shown to be more sensitive to initial levels of median income than growth in non-i...

  5. Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan

    International Nuclear Information System (INIS)

    Shah, N.; Hossain, N.; Khan, N.H.

    2011-01-01

    Objective: To study the mortality and morbidity of unsafe abortion in a University Teaching Hospital. Methods: A cross-sectional, descriptive study was conducted in Department of Obstetrics and Gynaecology, Unit III, Dow Medical College and Civil Hospital Karachi from January 2005 to December 2009. Data regarding the socio demographic characteristics, reasons and methods of abortion, nature of provider, complications and treatment were collected for 43 women, who were admitted with complications of unsafe abortion, and an analysis was done. Results: The frequency of unsafe abortion was 1.35% and the case fatality rate was 34.9%. Most of the women belonged to a very poor socioeconomic group (22/43; 51.2%) and were illiterate (27/43; 62.8%). Unsafe abortion followed an induced abortion in 29 women and other miscarriages in 14 women. The majority of women who had an induced abortion were married (19/29, 65.5%). A completed family was the main reason for induced abortion (14/29; 48.2%) followed by being unmarried (8/29, 27.5%) and domestic violence in 5/29 cases (17.2%). Instruments were the commonest method used for unsafe abortion (26/43;68.4%).The most frequent complication was septicaemia (34; 79%) followed by uterine perforation with or without bowel perforation (13, 30.2%) and haemorrhage (9; 20.9%). Majority of induced abortions were performed by untrained providers (22/26; 84.6%) compared to only 3/14 cases (21.4%) of other miscarriages (p=0.0001). Conclusion: The high maternal mortality and morbidity of unsafe abortion in our study highlights the need for improving contraceptive and safe abortion services in Pakistan. (author)

  6. Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan.

    Science.gov (United States)

    Shah, Nusrat; Hossain, Nazli; Noonari, Mukhtiar; Khan, Nusrat Hassan

    2011-06-01

    To study the mortality and morbidity of unsafe abortion in a University Teaching Hospital. A cross-sectional, descriptive study was conducted in Department of Obstetrics and Gynaecology, Unit III, Dow Medical College and Civil Hospital Karachi from January 2005 to December 2009. Data regarding the sociodemographic characteristics, reasons and methods of abortion, nature of provider, complications and treatment were collected for 43 women, who were admitted with complications of unsafe abortion, and an analysis was done. The frequency of unsafe abortion was 1.35% and the case fatality rate was 34.9%. Most of the women belonged to a very poor socioeconomic group (22/43; 51.2%) and were illiterate (27/43; 62.8%). Unsafe abortion followed an induced abortion in 29 women and other miscarriages in 14 women. The majority of women who had an induced abortion were married (19/29, 65.5%). A completed family was the main reason for induced abortion (14/29; 48.2%) followed by being unmarried (8/29, 27.5%) and domestic violence in 5/29 cases (17.2%). Instruments were the commonest method used for unsafe abortion (26/43; 68.4%).The most frequent complication was septicaemia (34; 79%) followed by uterine perforation with or without bowel perforation (13, 30.2%) and haemorrhage (9; 20.9%). Majority of induced abortions were performed by untrained providers (22/26; 84.6%) compared to only 3/14 cases (21.4%) of other miscarriages (p = 0.0001). The high maternal mortality and morbidity of unsafe abortion in our study highlights the need for improving contraceptive and safe abortion services in Pakistan.

  7. Vitamin D supplementation for prevention of mortality in adults

    DEFF Research Database (Denmark)

    Bjelakovic, Goran; Gluud, Lise Lotte; Nikolova, Dimitrinka

    2014-01-01

    Available evidence on the effects of vitamin D on mortality has been inconclusive. In a recent systematic review, we found evidence that vitamin D3 may decrease mortality in mostly elderly women. The present systematic review updates and reassesses the benefits and harms of vitamin D...

  8. Prevention of congenital cytomegalovirus complications by maternal and neonatal treatments: a systematic review.

    Science.gov (United States)

    Hamilton, Stuart T; van Zuylen, Wendy; Shand, Antonia; Scott, Gillian M; Naing, Zin; Hall, Beverley; Craig, Maria E; Rawlinson, William D

    2014-11-01

    Human cytomegalovirus is the leading non-genetic cause of congenital malformation in developed countries. Congenital CMV may result in fetal and neonatal death or development of serious clinical sequelae. In this review, we identified evidence-based interventions for prevention of congenital CMV at the primary level (prevention of maternal infection), secondary level (risk reduction of fetal infection and disease) and tertiary level (risk reduction of infected neonates being affected by CMV). A systematic review of existing literature revealed 24 eligible studies that met the inclusion criteria. Prevention of maternal infection using hygiene and behavioural interventions reduced maternal seroconversion rates during pregnancy. However, evidence suggested maternal adherence to education on preventative behaviours was a limiting factor. Treatment of maternal CMV infection with hyperimmune globulin (HIG) showed some evidence for efficacy in prevention of fetal infection and fetal/neonatal morbidity with a reasonable safety profile. However, more robust clinical evidence is required before HIG therapy can be routinely recommended. Limited evidence also existed for the safety and efficacy of established CMV antivirals (valaciclovir, ganciclovir and valganciclovir) to treat neonatal consequences of CMV infection, but toxicity and lack of randomised clinical trial data remain major issues. In the absence of a licensed CMV vaccine or robust clinical evidence for anti-CMV therapeutics, patient education and behavioural interventions that emphasise adherence remain the best preventative strategies for congenital CMV. There is a strong need for further data on the use of HIG and other antivirals in pregnancy, as well as the development of less toxic, novel, antiviral agents. Copyright © 2014 John Wiley & Sons, Ltd.

  9. Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Kimiyo Kikuchi

    Full Text Available Continuum of care has the potential to improve maternal, newborn, and child health (MNCH by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood and space dimensions (from community-family care to clinical care. However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers' uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%. Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%.Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the

  10. An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India

    Directory of Open Access Journals (Sweden)

    Marie Ng

    2014-12-01

    Full Text Available Background: The Indian Janani Suraksha Yojana (JSY program is a demand-side program in which the state pays women a cash incentive to deliver in an institution, with the aim of reducing maternal mortality. The JSY has had 54 million beneficiaries since inception 7 years ago. Although a number of studies have demonstrated the effect of JSY on coverage, few have examined the direct impact of the program on maternal mortality. Objective: To study the impact of JSY on maternal mortality in Madhya Pradesh (MP, one of India's largest provinces. Design: By synthesizing data from various sources, district-level maternal mortality ratios (MMR from 2005 to 2010 were estimated using a Bayesian spatio-temporal model. Based on these, a mixed effects multilevel regression model was applied to assess the impact of JSY. Specifically, the association between JSY intensity, as reflected by 1 proportion of JSY-supported institutional deliveries, 2 total annual JSY expenditure, and 3 MMR, was examined. Results: The proportion of all institutional deliveries increased from 23.9% in 2005 to 55.9% in 2010 province-wide. The proportion of JSY-supported institutional deliveries rose from 14% (2005 to 80% (2010. MMR declines in the districts varied from 2 to 35% over this period. Despite the marked increase in JSY-supported delivery, our multilevel models did not detect a significant association between JSY-supported delivery proportions and changes in MMR in the districts. The results from the analysis examining the association between MMR and JSY expenditure are similar. Conclusions: Our analysis was unable to detect an association between maternal mortality reduction and the JSY in MP. The high proportion of institutional delivery under the program does not seem to have converted to lower mortality outcomes. The lack of significant impact could be related to supply-side constraints. Demand-side programs like JSY will have a limited effect if the supply side is unable

  11. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    Science.gov (United States)

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.

  12. Conservative fluid management prevents age-associated ventilator induced mortality.

    Science.gov (United States)

    Herbert, Joseph A; Valentine, Michael S; Saravanan, Nivi; Schneck, Matthew B; Pidaparti, Ramana; Fowler, Alpha A; Reynolds, Angela M; Heise, Rebecca L

    2016-08-01

    Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hospital mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. 2month old and 20month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4h with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. At 4h, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1h in advanced age HVT subjects. In 4h ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in

  13. Global, regional, and national levels of maternal mortality, 1990-2015 : A systematic analysis for the Global Burden of Disease Study 2015

    NARCIS (Netherlands)

    Kassebaum, Nicholas J.; Barber, Ryan M.; Bhutta, Zulfiqar A.; Dandona, Lalit; Gething, Peter W.; Hay, Simon I.; Kinfu, Yohannes; Larson, Heidi J.; Liang, Xiaofeng; Lim, Stephen S.; Lopez, Alan D.; Lozano, Rafael; Mensah, George A.; Mokdad, Ali H.; Naghavi, Mohsen; Pinho, Christine; Salomon, Joshua A.; Steiner, Caitlyn; Vos, Theo; Wang, Haidong; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbas, Kaja M.; Abd-Allah, Foad; Abdallat, Mahmud A.; Abdulle, Abdishakur M.; Abera, Semaw Ferede; Aboyans, Victor; Abubakar, Ibrahim; Abu-Rmeileh, Niveen M. E.; Achoki, Tom; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adelekan, Ademola Lukman; Adou, Arsene Kouablan; Afanvi, Kossivi Agbelenko; Agarwal, Arnav; Kiadaliri, Aliasghar Ahmad; Ajala, Oluremi N.; Akinyemiju, Tomi F.; Akseer, Nadia; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore K. M.; Alasfoor, Deena; Aldhahri, Saleh Fahed; Aldridge, Robert William; Alhabib, Samia; Ali, Raghib; Alkerwi, Ala'a; Alla, Francois; Al-Raddadi, Rajaa; Alsharif, Ubai; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Amberbir, Alemayehu; Amegah, Adeladza Kofi; Ammar, Walid; Amrock, Stephen Marc; Andersen, Hjalte H.; Anderson, Gregory M.; Antoine, Rose Mayerline; Antonio, Carl Abelardo T.; Aregay, Atsede Fantahun; Arnlov, Johan; Arora, Megha; Arsenijevic, Valentina S. Arsic; Al Artaman, Ali; Asayesh, Hamid; Atique, Suleman; Avokpaho, Euripide Frinel G. Arthur; Awasthi, Ashish; Quintanilla, Beatriz Paulina Ayala; Azzopardi, Peter; Bacha, Umar; Badawi, Alaa; Bahit, Maria C.; Balakrishnan, Kalpana; Banerjee, Amitava; Barac, Aleksandra; Barker-Collo, Suzanne L.; Barnighausen, Till; Basu, Sanjay; Bayou, Tigist Assefa; Bayou, Yibeltal Tebekaw; Bazargan-Hejazi, Shahrzad; Beardsley, Justin; Bedi, NeerajHaidong Wang; Bekele, Tolesa; Bell, Michelle L.; Bennett, Derrick A.; Bensenor, Isabela M.; Berhane, Adugnaw; Bernabe, Eduardo; Betsu, Balem Demtsu; Beyene, Addisu Shunu; Biadgilign, Sibhatu; Bikbov, Boris; Bin Abdulhak, Aref A.; Biroscak, Brian J.; Biryukov, Stan; Bisanzio, Donal; Bjertness, Espen; Blore, Jed D.; Brainin, Michael; Brazinova, Alexandra; Breitborde, Nicholas J. K.; Brugha, Traolach S.; Butt, Zahid A.; Campos-Nonato, Ismael Ricardo; Campuzano, Julio Cesar; Cardenas, Rosario; Carrero, Juan Jesus; Carter, Austin; Casey, Daniel C.; Castaneda-Oquela, Carlos A.; Castro, Ruben Estanislao; Catala-Lopez, Ferran; Cavalleri, Fiorella; Chang, Hsing-Yi; Chang, Jung -Chen; Chavan, Laxmikant; Chibueze, Chioma Ezinne; Chisumpa, Vesper Hichilombwe; Choi, Jee-Young Jasmine; Chowdhury, Rajiv; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G.; Cirillo, Massimo; Coates, Matthew M.; Coggeshall, Megan; Colistro, Valentina; Colquhoun, Samantha M.; Cooper, Cyrus; Cooper, Leslie Trumbull; Cortinovis, Monica; Dahiru, Tukur; Damasceno, Albertino; Danawi, Hadi; Dandona, Rakhi; Das Neves, Jose; De Leo, Diego; Dellavalle, Robert P.; Deribe, Kebede; Deribew, Amare; Jarlais, Don C. Des; Dharmaratne, Samath D.; Dicker, Daniel J.; Ding, Eric L.; Dossou, Edem; Dubey, Manisha; Ebel, Beth E.; Ellingsen, Christian Lycke; Elyazar, Iqbal; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshrati, Babak; Esteghamati, Alireza; Faraon, Emerito Jose Aquino; Farid, Talha A.; Farinha, Carla Sofia E. Sa; Faro, Andre; Farvid, Maryam S.; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fernandes, Joao C.; Fischer, Florian; Fitchett, Joseph R. A.; Fleming, Tom; Gt, Nataliya Fo; Franca, Elisabeth Barboza; Franklin, Richard C.; Fraser, Maya S.; Friedman, Joseph; Pullman, Nancy; Furst, Thomas; Futran, Neal D.; Gambashidze, Ketevan; Gamkrelidze, Amiran; Gebre, Teshome; Gebrehiwot, Tsegaye Tewelde; Gebremedhin, Amanuel Tesfay; Gebremedhin, Mengistu; Gebru, Alemseged Aregay; Geleijnse, Johanna M.; Gibney, Katherine B.; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Glaser, Elizabeth; Goenka, Shifalika; Gomez-Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Goto, Atsushi; Graetz, Nicholas; Gugnani, Harish Chander; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gupta, Vipin; Hafezi-Nejad, Nima; Hailu, Alemayehu Desalegne; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hamidi, Samer; Hancock, Jamie; Handal, Alexis J.; Hankey, Graeme J.; Harb, Hilda L.; Harikrishnan, Sivadasanpillai; Harun, Kimani M.; Havmoeller, Rasmus; Hoek, Hans W.; Horino, Masako; Horita, Nobuyuki; Hosgood, H. Dean; Hoy, Damian G.; Htet, Aung Soe; Hu, Guoqing; Huang, Hsiang; Huang, John J.; Huybrechts, Inge; Huynh, Chantal; Iannarone, Marissa; Iburg, Kim Moesgaard; Idrisov, Bulat T.; Iyer, Veena J.; Jacobsen, Kathryn H.; Jahanmehr, Nader; Jakovljevic, Mihajlo B.; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jee, Sun Ha; Jeemon, Panniyammakal; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jibat, Tariku; Jonas, Jost B.; Kabir, Zubair; Kamal, Ritul; Kan, Haidong; Karch, Andre; Karletsos, Dimitris; Kasaeian, Amir; Kaul, Anil; Kawakami, Norito; Kayibanda, Jeanne Francoise; Kazanjan, Konstantin; Kazi, Dhruv S.; Keiyoro, Peter Njenga; Kemmer, Laura; Kemp, Andrew Haddon; Kengne, Andre Pascal; Keren, Andre; Kereselidze, Maia; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khang, Young-Ho; Khonelidze, Irma; Khosravi, Ardeshir; Khubchandani, Jagdish; Kim, Yun Jin; Kivipelto, Miia; Knibbs, Luke D.; Kokubo, Yoshihiro; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Krishnaswami, Sanjay; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kudom, Andreas A.; Kulikoff, Xie Rachel; Kulkarni, Chanda; Kumar, G. Anil; Kutz, Michael J.; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lam, Hilton; Lamadrid-Figueroa, Hector; Lan, Qing; Larsson, Anders; Laryea, Dennis Odai; Leigh, James; Leung, Ricky; Li, Yichong; Li, Yongmei; Lipshultz, Steven E.; Liu, Patrick Y.; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K.; Lotufo, Paulo A.; Lunevicius, Raimundas; Ma, Stefan; El Razek, Hassan Magdy Abd; El Razek, Mohammed Magdy Abd; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Mapoma, Chabila C.; Marcenes, Wagner; Margolis, David Joel; Marquez, Neal; Masiye, Felix; Marzan, Melvin Barrientos; Mason-Jones, Amanda J.; Mazorodze, Tasara T.; Meaney, Peter A.; Mehari, Alem; Mehndiratta, Man Mohan; Mena-Rodriguez, Fabiola; Mekonnen, Alemayehu B.; Melaku, Yohannes Adama; Memish, Ziad A.; Mendoza, Walter; Meretoja, Atte; Meretoja, Tuomo J.; Mhimbira, Francis Apolinary; Miller, Ted R.; Mills, Edward J.; Mirarefin, Mojde; Misganaw, Awoke; Ibrahim, Norlinah Mohamed; Mohammad, Karzan Abdulmuhsin; Mohammadi, Alireza; Mohammed, Shafiu; Mola, Glen Liddell D.; Monasta, Lorenzo; Monis, Jonathan De la Cruz; Hernandez, Julio Cesar Montanez; Montero, Pablo; Montico, Marcella; Mooney, Meghan D.; Moore, Ami R.; Moradi-Lakeh, Maziar; Morawska, Lidia; Mori, Rintaro; Mueller, Ulrich; Murthy, Gudlavalleti Venkata Satyanarayana; Murthy, Srinivas; Nachega, Jean B.; Naheed, Aliya; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Nash, Denis; Neupane, Subas; Newton, John N.; Ng, Marie; Ngalesoni, Frida Namnyak; Nguhiu, Peter; Nguyen, Grant; Le Nguyen, Quyen; Nisar, Muhammad Imran; Nomura, Marika; Norheim, Ole F.; Norman, Rosana E.; Nyakarahuka, Luke; Obermeyer, Carla Makhlouf; Ogbo, Felix Akpojene; Oh, In-Hwan; Ojelabi, Foluke Adetola; Olivares, Pedro R.; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Opio, John Nelson; Oren, Eyal; Ota, Erika; Oyekale, Abayomi Samuel; Pa, Mahesh; Pain, Amanda; Papantoniou, Nikolaos; Park, Eun-Kee; Park, Hye-Youn; Caicedo, Angel J. Paternina; Patten, Scott B.; Paul, Vinod K.; Pereira, David M.; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Pillay, Julian David; Pishgar, Farhad; Polinder, Suzanne; Pope, Daniel; Pourmalek, Farshad; Qorbani, Mostafa; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Ram, Usha; Ranabhat, Chhabi Lal; Rangaswamy, Thara; Rao, Paturi Vishnupriya; Refaat, Amany H.; Remuzzi, Giuseppe; Violante, Francesco S.

    2016-01-01

    Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify

  14. Interventions to prevent adverse fetal programming due to maternal obesity during pregnancy.

    Science.gov (United States)

    Nathanielsz, Peter W; Ford, Stephen P; Long, Nathan M; Vega, Claudia C; Reyes-Castro, Luis A; Zambrano, Elena

    2013-10-01

    Maternal obesity is a global epidemic affecting both developed and developing countries. Human and animal studies indicate that maternal obesity adversely programs the development of offspring, predisposing them to chronic diseases later in life. Several mechanisms act together to produce these adverse health effects. There is a consequent need for effective interventions that can be used in the management of human pregnancy to prevent these outcomes. The present review analyzes the dietary and exercise intervention studies performed to date in both altricial and precocial animals, rats and sheep, with the aim of preventing adverse offspring outcomes. The results of these interventions present exciting opportunities to prevent, at least in part, adverse metabolic and other outcomes in obese mothers and their offspring. © 2013 International Life Sciences Institute.

  15. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

    OpenAIRE

    Raj, Anita; Saggurti, Niranjan; Winter, Michael; Labonte, Alan; Decker, Michele R; Balaiah, Donta; Silverman, Jay G

    2010-01-01

    Objective: To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design: Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting: India. Population: Women aged 15-49 years (n=124 385); data collected ...

  16. Prevention of maternal cytomegalovirus infection: current status and future prospects

    Directory of Open Access Journals (Sweden)

    Jessica L Nyholm

    2010-02-01

    Full Text Available Jessica L Nyholm1, Mark R Schleiss21Department of Obstetrics, Gynecology, and Women’s Health, and 2Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USAAbstract: Human cytomegalovirus (CMV infection is the most common cause of perinatal viral infection in the developed world, resulting in approximately 40,000 congenitally infected infants in the United States each year. Congenital CMV infection can produce varying degrees of neurodevelopmental disabilities. The significant impact of congenital CMV has led the Institute of Medicine to rank development of a CMV vaccine as a top priority. Vaccine development has been ongoing; however no licensed CMV vaccine is currently available. Treatment of pregnant women with CMV hyperimmune globulin has shown promising results, but has not been studied in randomized controlled trials. Education on methods to prevent CMV transmission, particularly among young women of child-bearing age, should continue until a CMV vaccine becomes available. The epidemiology, clinical manifestations, prevention strategies, and treatment of CMV infections are reviewed.Keywords: cytomegalovirus, CMV vaccines, congenital CMV, CMV infection, immunoglobulin

  17. The antibiotic transformation of Danish obstetrics. The hidden links between the decline in perinatal mortality and maternal mortality in the mid-twentieth century

    DEFF Research Database (Denmark)

    Løkke, Anne

    2012-01-01

    maternal mortality due to puerperal fever. Restricting this strategy to the pathological deliveries was important because invasive interventions were still much more risky for mother and fetus than a vaginal delivery, attended by a skilled midwife for all potential normal births. Le grand déclin...... aux accouchements pathologiques prend toute son importance dès lors qu’on rappelle les risques considérablement plus élevés pour la mère et le foetus des opérations ouvertes par opposition aux accouchements par voie basse, pratiqués par une sagefemme adroite dans la majorité des naissances sans...

  18. Addressing the human resources crisis: a case study of Cambodia's efforts to reduce maternal mortality (1980-2012).

    Science.gov (United States)

    Fujita, Noriko; Abe, Kimiko; Rotem, Arie; Tung, Rathavy; Keat, Phuong; Robins, Ann; Zwi, Anthony B

    2013-05-14

    To identify factors that have contributed to the systematic development of the Cambodian human resources for health (HRH) system with a focus on midwifery services in response to high maternal mortality in fragile resource-constrained countries. Qualitative case study. Review of the published and grey literature and in-depth interviews with key informants and stakeholders using an HRH system conceptual framework developed by the authors ('House Model'; Fujita et al, 2011). Interviews focused on the perceptions of respondents regarding their contributions to strengthening midwifery services and the other external influences which may have influenced the HRH system and reduction in the maternal mortality ratio (MMR). Three rounds of interviews were conducted with senior and mid-level managers of the Ministries of Health (MoH) and Education, educational institutes and development partners. A total of 49 interviewees, who were identified through a snowball sampling technique. Scaling up the availability of 24 h maternal health services at all health centres contributing to MMR reduction. The incremental development of the Cambodian HRH system since 2005 focused on the production, deployment and retention of midwives in rural areas as part of a systematic strategy to reduce maternal mortality. The improved availability and access to midwifery services contributed to significant MMR reduction. Other contributing factors included improved mechanisms for decision-making and implementation; political commitment backed up with necessary resources; leadership from the top along with a growing capacity of mid-level managers; increased MoH capacity to plan and coordinate; and supportive development partners in the context of a conducive external environment. Lessons from this case study point to the importance of a systemic and comprehensive approach to health and HRH system strengthening and of ongoing capacity enhancement and leadership development to ensure effective

  19. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    Science.gov (United States)

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  20. PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana.

    Science.gov (United States)

    Moyer, Cheryl A; Aborigo, Raymond A; Kaselitz, Elizabeth B; Gupta, Mira L; Oduro, Abraham; Williams, John

    2016-03-09

    While Ghana is a leader in some health indicators among West African nations, it still struggles with high maternal and neonatal morbidity and mortality rates, especially in the northern areas. The clinical causes of mortality and morbidity are relatively well understood in Ghana, but little is known about the impact of social and cultural factors on maternal and neonatal outcomes. Less still is understood about how such factors may vary by geographic location, and how such variability may inform locally-tailored solutions. Preventing Maternal And Neonatal Deaths (PREMAND) is a three-year, three-phase project that takes place in four districts in the Upper East, Upper West, and Northern Regions of Ghana. PREMAND will prospectively identify all maternal and neonatal deaths and 'near-misses', or those mothers and babies who survive a life threatening complication, in the project districts. Each event will be followed by either a social autopsy (in the case of deaths) or a sociocultural audit (in the case of near-misses). Geospatial technology will be used to visualize the variability in outcomes as well as the social, cultural, and clinical predictors of those outcomes. Data from PREMAND will be used to generate maps for local leaders, community members and Government of Ghana to identify priority areas for intervention. PREMAND is an effort of the Navrongo Health Research Centre and the University of Michigan Medical School. PREMAND uses an innovative, multifaceted approach to better understand and address neonatal and maternal morbidity and mortality in northern Ghana. It will provide unprecedented access to information on the social and cultural factors that contribute to deaths and near-misses in the project regions, and will allow such causal factors to be situated geographically. PREMAND will create the opportunity for local, regional, and national stakeholders to see how these events cluster, and place them relative to traditional healer compounds, health

  1. Mortality Implications of Appropriate Implantable Cardioverter Defibrillator Therapy in Secondary Prevention Patients: Contrasting Mortality in Primary Prevention Patients From a Prospective Population-Based Registry.

    Science.gov (United States)

    Almehmadi, Fahad; Porta-Sánchez, Andreu; Ha, Andrew C T; Fischer, Hadas D; Wang, Xuesong; Austin, Peter C; Lee, Douglas S; Nanthakumar, Kumaraswamy

    2017-08-19

    We sought to examine the mortality impact of appropriate implantable cardioverter defibrillator (ICD) therapy between patients who received ICD for primary versus secondary prevention purposes. From a prospective, population-based registry, we identified 7020 patients who underwent de novo ICD implantation between February 2007 and May 2012 in Ontario, Canada. The primary outcome was all-cause mortality. We used multivariable Cox proportional hazard modeling to adjust for differences in baseline characteristics and analyzed the mortality impact of first appropriate ICD therapy (shock and antitachycardia pacing [ATP]) as a time-varying covariate. There were 1929 (27.5%) patients who received ICDs for secondary prevention purposes. The median follow-up period was 5.02 years. Compared with those with secondary prevention ICDs, patients with primary prevention ICDs had more medical comorbidities, and lower ejection fraction. Patients who experienced appropriate ICD shock or ATP had greater risk of death compared with those who did not, irrespective of implant indication. In the primary prevention group, the adjusted hazard ratios of death for appropriate shock and ATP were 2.00 (95% CI: 1.72-2.33) and 1.73 (95% CI: 1.52-1.97), respectively. In the secondary prevention group, the adjusted hazard ratios of death for appropriate ICD shock and ATP were 1.46 (95% CI: 1.20-1.77) and 1.38 (95% CI: 1.16-1.64), respectively. Despite having a more favorable clinical profile, occurrence of appropriate ICD shock or ATP in patients with secondary prevention ICDs was associated with similar magnitudes of mortality risk as those with primary prevention ICDs. A heightened degree of care is warranted for all patients who experience appropriate ICD shock or ATP therapy. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  2. Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries

    Directory of Open Access Journals (Sweden)

    Muldoon Katherine A

    2011-10-01

    Full Text Available Abstract Objective Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. Methods We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR, child mortality rate (CMR, and maternal mortality rate (MMR using 13 explanatory variables as outlined by the World Health Organization. Results Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91, higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93, and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80. Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62 were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94, having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66, and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92. Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00 were found to be a significant risk factor for MMR. Conclusion Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities.

  3. Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries.

    Science.gov (United States)

    Muldoon, Katherine A; Galway, Lindsay P; Nakajima, Maya; Kanters, Steve; Hogg, Robert S; Bendavid, Eran; Mills, Edward J

    2011-10-24

    Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR), child mortality rate (CMR), and maternal mortality rate (MMR) using 13 explanatory variables as outlined by the World Health Organization. Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91), higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93), and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80). Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62) were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94), having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66), and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92). Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00) were found to be a significant risk factor for MMR. Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities.

  4. Space-time patterns in maternal and mother mortality in a rural South African population with high HIV prevalence (2000–2014: results from a population-based cohort

    Directory of Open Access Journals (Sweden)

    B. Tlou

    2017-06-01

    Full Text Available Abstract Background International organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective. Methods Population-based mortality data from 2000 to 2014 for women aged 15–49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and ‘Mother death’; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time. Results The overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a

  5. Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies

    Directory of Open Access Journals (Sweden)

    Desta Teklay

    2007-02-01

    Full Text Available Abstract Background Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5, thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine

  6. Effects of welfare and maternal work on recommended preventive care utilization among low-income children.

    Science.gov (United States)

    Holl, Jane L; Oh, Elissa H; Yoo, Joan; Amsden, Laura B; Sohn, Min-Woong

    2012-12-01

    We examined how maternal work and welfare receipt are associated with children receiving recommended pediatric preventive care services. We identified American Academy of Pediatrics-recommended preventive care visits from medical records of children in the 1999-2004 Illinois Families Study: Child Well-Being. We used Illinois administrative data to identify whether mothers received welfare or worked during the period the visit was recommended, and we analyzed the child visit data using random-intercept logistic regressions that adjusted for child, maternal, and visit-specific characteristics. The 485 children (95%) meeting inclusion criteria made 41% of their recommended visits. Children were 60% more likely (adjusted odds ratios [AOR` = 1.60; 95% confidence interval [CI] = 1.27, 2.01) to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely (AOR = 0.75; 95% CI = 0.60, 0.94) to make preventive care visits during periods when mothers received welfare and worked compared with welfare only periods. The Temporary Assistance for Needy Families maternal work requirement may be a barrier to receiving recommended preventive pediatric health care.

  7. Birth size in the most recent pregnancy and maternal mortality in premenopausal breast cancer by tumor characteristics.

    Science.gov (United States)

    Hajiebrahimi, Mohammadhossein; Cnattingius, Sven; Lambe, Mats; Hsieh, Chung-Cheng; Ahlgren, Johan; Adolfsson, Jan; Bahmanyar, Shahram

    2014-06-01

    The main aim of this study was to investigate possible associations between measures of offspring size at birth in the most recent pregnancy before premenopausal breast cancer diagnosis and the risks of maternal breast cancer mortality, taking tumor characteristics into account. We also aimed to investigate if these associations are modified by age at childbirth, time since childbirth, parity, and age at diagnosis. We followed 6,019 women from their date of premenopausal breast cancer (diagnosed from 1992 to 2008) until emigration, death or December 31st, 2009, whichever occurred first. We used Cox proportional hazard regression models, adjusted for parity, age at diagnosis, and education level, to estimate associations between women pregnancy, cancer characteristics and offspring birth characteristics, and mothers' mortality risk. In stratified analyses, mortality risks were estimated by tumor stage, ER or PR status. There was no association between offspring birth weight (HR = 1.00, 95 % CI 0.99-1.01, when used as a continuous variable), birth weight for gestational age or ponderal index, and premenopausal breast cancer mortality. Similarly, in analyses stratified by tumor stage, receptor status, and time difference between last pregnancy and date of diagnosis, we found no associations between birth size and breast cancer mortality. Our findings suggest that the hypothesis that "premenopausal breast cancer mortality is associated with offspring birth characteristics in the most recent pregnancy before the diagnosis" may not be valid. In addition, these associations are not modified by tumor characteristics.

  8. Maternal complication prevention: evidence from a case-control study in southwest Nigeria

    Directory of Open Access Journals (Sweden)

    Kayode O. Osungbade

    2014-01-01

    Full Text Available Background: The importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes.Aim: This study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention.Setting: The study was carried out in a postnatal ward in a secondary health facility.Methods: This was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases was done, and one booked pregnant woman (control was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05.Results: Booked women had a lower median length of labour (10 hours compared to unbooked women (13 hours. More women in the booked control group (139; 35.1% than in the unbooked case group (96; 23.6% reported at least one type of morbidity during the index pregnancy (p = 0.0004. Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery.Conclusion: Strengthening antenatal and secondary healthcare services as short- and mediumterm measures might be cost-effective as a preventive strategy in complications of pregnancy,whilst socio-economic dimensions of health are accorded priority in the long term.

  9. Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Robert F. Pass

    2018-03-01

    Full Text Available Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection.

  10. Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

    Directory of Open Access Journals (Sweden)

    Madhivanan Purnima

    2009-02-01

    Full Text Available Abstract Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.

  11. Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

    Science.gov (United States)

    Krupp, Karl; Madhivanan, Purnima

    2009-02-27

    Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services - interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India--Gujarat and Tamil Nadu--have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.

  12. Maternal Trypanosoma cruzi infection, pregnancy outcome, morbidity, and mortality of congenitally infected and non-infected newborns in Bolivia.

    Science.gov (United States)

    Torrico, Faustino; Alonso-Vega, Cristina; Suarez, Eduardo; Rodriguez, Patricia; Torrico, Mary-Cruz; Dramaix, Michèle; Truyens, Carine; Carlier, Yves

    2004-02-01

    This work compares the results of two epidemiologic and clinical surveys on the consequences of maternal chronic Trypanosoma cruzi infection. They were conducted in 1992-1994 and 1999-2001 in the same maternity clinic in Bolivia, a country highly endemic for infection with this parasite. In both surveys, the materno-fetal transmission of parasites occurred in 5-6% of the infected mothers. Maternal chronic T. cruzi infection had no effect on pregnancy outcome and health of newborns when there was no materno-fetal transmission of parasites. Comparisons between the older and the more recent surveys highlighted significant reductions in frequencies of symptomatic cases (from 54% to 45%), Apgar scores infected babies. Neonatal mortality related to congenital Chagas disease also decreased from 13% to 2% in the interval between both studies. These results suggest that the decrease in poverty that has occurred in Bolivia between both surveys might have contributed to reduce the morbidity and mortality, but not the transmission rate of T. cruzi congenital infection, which remains a serious public health problem in this country.

  13. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force.

    Science.gov (United States)

    Henderson, Jillian T; Whitlock, Evelyn P; O'Connor, Elizabeth; Senger, Caitlyn A; Thompson, Jamie H; Rowland, Maya G

    2014-05-20

    Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. To systematically review benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia. MEDLINE, Database of Abstracts of Reviews of Effects, PubMed, and Cochrane Central Register of Controlled Trials (January 2006 to June 2013); previous systematic reviews, clinical trial registries, and surveillance searches for large studies (June 2013 to February 2014). Randomized, controlled trials (RCTs) to assess benefits among women at high preeclampsia risk and RCTs or large cohort studies of harms among women at any risk level. English-language studies of fair or good quality were included. Dual quality assessment and abstraction of studies. Two large, multisite RCTs and 13 smaller RCTs of high-risk women (8 good-quality) were included, in addition to 6 RCTs and 2 observational studies of average-risk women to assess harms (7 good-quality). Depending on baseline risk, aspirin use was associated with absolute risk reductions of 2% to 5% for preeclampsia (relative risk [RR], 0.76 [95% CI, 0.62 to 0.95]), 1% to 5% for intrauterine growth restriction (RR, 0.80 [CI, 0.65 to 0.99]), and 2% to 4% for preterm birth (RR, 0.86 [CI, 0.76 to 0.98]). No significant perinatal or maternal harms were identified, but rare harms could not be ruled out. Evidence on long-term outcomes was sparse, but 18-month follow-up from the largest trial found no developmental harms. Benefits may have been overestimated due to small-study effects. Predictive intervals were not statistically significant. Future studies could shift findings toward the null. Daily low-dose aspirin beginning as early as the second trimester prevented clinically important health outcomes. No harms were identified, but long-term evidence was limited.

  14. Comparative fetal mortality in maternal virus diseases. A prospective study on rubella, measles, mumps, chicken pox and hepatitis.

    Science.gov (United States)

    Siegel, M; Fuerst, H T; Peress, N S

    1966-04-07

    Comparative data on fetal and neonatal deaths following maternal mumps, rubella, hepatitis, chicken pox and measles were obtained in a prospective study in New York City from 1957 to 1964, inclusive. The evidence pointed to an increase in early fetal death rate after rubella and mumps and an increase in perinatal mortality after rubella and hepatitis. A significant increase in these rates was not demonstrable for chicken pox and measles in the selected population studied and under the conditions of the present study. The lethal effects of maternal virus diseases were demonstrable in cases of mumps and rubella occurring in the early weeks of gestation and in cases of hepatitis occurring in the late weeks of pregnancy. Fetal death was attributable to severity of maternal disease in hepatitis and to early infection of the fetus in rubella. Other factors related to gonadal infection and to placental and hormonal changes early in pregnancy may be influential in the lethal effect of mumps. Maternal and fetal death occurred in single cases of chicken-pox pneumonia and hepatitis.

  15. Activism: working to reduce maternal mortality through civil society and health professional alliances in sub-Saharan Africa.

    Science.gov (United States)

    Ray, Sunanda; Madzimbamuto, Farai; Fonn, Sharon

    2012-06-01

    Partnerships between civil society groups campaigning for reproductive and human rights, health professionals and others could contribute more to the strengthening of health systems needed to bring about declines in maternal deaths in Africa. The success of the HIV treatment literacy model developed by the Treatment Action Campaign in South Africa provides useful lessons for activism on maternal mortality, especially the combination of a right-to-health approach with learning and capacity building, community networking, popular mobilisation and legal action. This paper provides examples of these from South Africa, Botswana, Kenya and Uganda. Confidential enquiries into maternal deaths can be powerful instruments for change if pressure to act on their recommendations is brought to bear. Shadow reports presented during UN human rights country assessments can be used in a similar way. Public protests and demonstrations over avoidable deaths have succeeded in drawing attention to under-resourced services, shortages of supplies, including blood for transfusion, poor morale among staff, and lack of training and supervision. Activists could play a bigger role in holding health services, governments, and policy-makers accountable for poor maternity services, developing user-friendly information materials for women and their families, and motivating appropriate human resources strategies. Training and support for patients' groups, in how to use health facility complaints procedures is also a valuable strategy. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  16. La contribución de la violencia a la mortalidad materna en Morelos, México The contribution of violence to maternal mortality in Morelos, Mexico

    Directory of Open Access Journals (Sweden)

    Lourdes Campero

    2006-01-01

    METHODS: The study was carried out in the state of Morelos, based on the review of all death certificates (394 of reproductive aged women (12-49 years who died during 2001. Based on a list of diagnostic criteria we eliminated 167 certificates that were neither violent deaths nor maternal deaths. The remaining 227 certificates were further evaluated through verbal autopsy and/or review of medical charts. RESULTS: Fifty-one violent deaths were found. Eighteen maternal deaths were officially reported in 2001, however, our study identified 23 direct maternal deaths and four violent deaths during pregnancy and the post-partum period. We found that this reproductive event was the direct trigger for the homicide or suicide of these four women, and only one of these cases was documented officially. CONCLUSIONS: Violent deaths related to pregnancy should be included in official maternal mortality statistics as indirect causes of maternal deaths. This would allow for a greater and more accurate understanding of violent maternal deaths and guide appropriate prevention and care policies, programs and services. Verbal autopsy is a useful technique for identifying cases of violent maternal deaths.

  17. Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

    Directory of Open Access Journals (Sweden)

    Esther Arendt

    Full Text Available The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health.We used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (<145.0cm, Short (145.0-149.9cm, Short-average (150.0-154.9cm, Average (155.0-159.9cm, Average-tall (160.0-169.9cm and Tall (≥170.0cm. Multivariate logistic regression was used to assess the contribution of maternal stature to the odds ratio of caesarean section delivery, adjusting for other exposures, such as age at index birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index

  18. Maternal Antioxidant Supplementation Prevents Adiposity in the Offspring of Western Diet?Fed Rats

    OpenAIRE

    Sen, Sarbattama; Simmons, Rebecca A.

    2010-01-01

    OBJECTIVE Obesity in pregnancy significantly increases the risk of the offspring developing obesity after birth. The aims of this study were to test the hypothesis that maternal obesity increases oxidative stress during fetal development, and to determine whether administration of an antioxidant supplement to pregnant Western diet-fed rats would prevent the development of adiposity in the offspring. RESEARCH DESIGN AND METHODS Female Sprague Dawley rats were started on the designated diet at ...

  19. Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

    OpenAIRE

    Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

    2012-01-01

    Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients tr...

  20. Maternal mortality as a Millennium Development Goal of the United Nations: a systematic assessment and analysis of available data in threshold countries using Indonesia as example.

    Science.gov (United States)

    Reinke, Evelyn; Supriyatiningsih; Haier, Jörg

    2017-06-01

    In 2015 the proposed period ended for achieving the Millennium Development Goals (MDG) of the United Nations targeting to lower maternal mortality worldwide by ~ 75%. 99% of these cases appear in developing and threshold countries; but reports mostly rely on incomplete or unrepresentative data. Using Indonesia as example, currently available data sets for maternal mortality were systematically reviewed. Besides analysis of international and national data resources, a systematic review was carried out according to Cochrane methodology to identify all data and assessments regarding maternal mortality. Overall, primary data on maternal mortality differed significantly and were hardly comparable. For 1990 results varied between 253/100 000 and 446/100 000. In 2013 data appeared more conclusive (140-199/100 000). An annual reduction rate (ARR) of -2.8% can be calculated. Reported data quality of maternal mortality in Indonesia is very limited regarding comprehensive availability and methodology. This limitation appears to be of general importance for the targeted countries of the MDG. Primary data are rare, not uniformly obtained and not evaluated by comparable methods resulting in very limited comparability. Continuous small data set registration should have high priority for analysis of maternal health activities.

  1. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study.

    Science.gov (United States)

    Grandi, Carlos; Tapia, Jose L; Cardoso, Viviane C

    2015-01-01

    To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). This was a cohort study with retrospective data collection (2001-2010, n=11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p=0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  2. Melatonin Therapy Prevents Programmed Hypertension and Nitric Oxide Deficiency in Offspring Exposed to Maternal Caloric Restriction

    Directory of Open Access Journals (Sweden)

    You-Lin Tain

    2014-01-01

    Full Text Available Nitric oxide (NO deficiency is involved in the development of hypertension, a condition that can originate early in life. We examined whether NO deficiency contributed to programmed hypertension in offspring from mothers with calorie-restricted diets and whether melatonin therapy prevented this process. We examined 3-month-old male rat offspring from four maternal groups: untreated controls, 50% calorie-restricted (CR rats, controls treated with melatonin (0.01% in drinking water, and CR rats treated with melatonin (CR + M. The effect of melatonin on nephrogenesis was analyzed using next-generation sequencing. The CR group developed hypertension associated with elevated plasma asymmetric dimethylarginine (ADMA, a nitric oxide synthase inhibitor, decreased L-arginine, decreased L-arginine-to-ADMA ratio (AAR, and decreased renal NO production. Maternal melatonin treatment prevented these effects. Melatonin prevented CR-induced renin and prorenin receptor expression. Renal angiotensin-converting enzyme 2 protein levels in the M and CR + M groups were also significantly increased by melatonin therapy. Maternal melatonin therapy had long-term epigenetic effects on global gene expression in the kidneys of offspring. Conclusively, we attributed these protective effects of melatonin on CR-induced programmed hypertension to the reduction of plasma ADMA, restoration of plasma AAR, increase of renal NO level, alteration of renin-angiotensin system, and epigenetic changes in numerous genes.

  3. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

    Science.gov (United States)

    Nandi, Arijit; Hajizadeh, Mohammad; Harper, Sam; Koski, Alissa; Strumpf, Erin C; Heymann, Jody

    2016-03-01

    Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.

  4. Maternal health and human rights

    African Journals Online (AJOL)

    Abstract. In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality.

  5. Maternal morbidity and mortality among indigenous people in Bangladesh : a study of the Mru community

    OpenAIRE

    Islam, Md. Rakibul

    2010-01-01

    Maternal health of indigenous people is poorer than the non-indigenous people across the world which is also true in the Bangladesh context. However, little research has been done among indigenous people in Bangladesh. As a result, the present study was conducted among the Mru indigenous people to comprehend their maternal health status and the factors associated with it. The study was carried out in three upazilas (administrative sub-districts) namely Alikadam, Lama and Thanchi of the Bandar...

  6. Maternal and neonatal survival and mortality in the Upper West Region of Ghana.

    Science.gov (United States)

    Issah, Kofi; Nang-Beifubah, Alexis; Opoku, Chris F

    2011-06-01

    To describe the health facility-based factors affecting maternal/neonatal health and the outcomes of maternal death notifications and audits in the Upper West Region of Ghana. Maternal death notifications and audits were conducted at 6 hospitals and in communities in the Upper West Region of Ghana in 2009. Furthermore, a kangaroo mother care strategy was implemented at 5 health facilities in the region to improve neonatal survival. The results of these implementations were recorded between July and December 2009. Forty-seven maternal deaths were reported and audited, with 46.5% occurring within 24 hours after admission. Twenty-three deaths were linked to delays in receiving care and non-adherence to treatment protocols. Of 155 midwives expected to provide skilled care, 129 (83.2%) were between 46 and 59 years of age. The kangaroo mother care strategy resulted in 622 (89.5%) of 695 targeted infants surviving. At the end of 2009, only 30% of the recommendations of audit committees had been implemented. Maternal death notifications and audits are useful tools for improving quality of care and outcomes. With almost half of maternal deaths occurring within 24 hours of admission, emergency care in the Upper West Region of Ghana must be improved. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. [Maternal death: unequal risks].

    Science.gov (United States)

    Defossez, A C; Fassin, D

    1989-01-01

    rates include political, geographic, and economic mechanisms of exclusion which affect the vast majority of the population in developing countries. Political power is concentrated in the hands of relatively small groups whose decisions about such expenditures as health care are usually more favorable to the privileged. A consequence of the very unequal regional development in most Third World countries is that health, educational, and most other resources are concentrated in large cities and perhaps 1 or 2 strategic regions, leaving most of the population underserved. The low social position of women leaves them doubly vulnerable. The social factors adding to risks of maternal mortality should be considered in programs of prevention if the causes and not just the consequences are to be addressed.

  8. Mortalidade materna na perspectiva do familiar Mortalidad materna en la perspectiva del familiar Maternal mortality on the family members' perspective

    Directory of Open Access Journals (Sweden)

    Flávia Azevedo Gomes

    2006-03-01

    materna en la institución de salud. Las visitas domiciliarias confirmaron que existen factores coadyuvantes que influyeron en la ocurrencia de las muertes maternas.Maternal mortality is one of the health and social development indicators for countries. It is a tragedy for the family, as the death of a mother deprives the child of breastfeeding and maternal contact and also due to the fact that women maintain family unity. This study is aimed at understanding the meaning of death for the family members of women who have died. The population was formed by 10 family members of 7 women who died as a result of maternal problems in the municipality of Ribeirão Preto. The authors visited their homes and collected data through interviews. For analyzing the data the authors used thematic analysis. Three thematic categories were found: the meaning of maternal mortality; living maternal mortality in the family; and living maternal mortality in the health services. The visit confirmed that there are secondary factors that influenced in the occurrence of maternal deaths.

  9. Hypospadias and maternal exposure to atrazine via drinking water in the National Birth Defects Prevention study.

    Science.gov (United States)

    Winston, Jennifer J; Emch, Michael; Meyer, Robert E; Langlois, Peter; Weyer, Peter; Mosley, Bridget; Olshan, Andrew F; Band, Lawrence E; Luben, Thomas J

    2016-07-15

    Hypospadias is a relatively common birth defect affecting the male urinary tract. It has been suggested that exposure to endocrine disrupting chemicals might increase the risk of hypospadias by interrupting normal urethral development. Using data from the National Birth Defects Prevention Study, a population-based case-control study, we considered the role of maternal exposure to atrazine, a widely used herbicide and potential endocrine disruptor, via drinking water in the etiology of 2nd and 3rd degree hypospadias. We used data on 343 hypospadias cases and 1,422 male controls in North Carolina, Arkansas, Iowa, and Texas from 1998-2005. Using catchment level stream and groundwater contaminant models from the US Geological Survey, we estimated atrazine concentrations in public water supplies and in private wells. We assigned case and control mothers to public water supplies based on geocoded maternal address during the critical window of exposure for hypospadias (i.e., gestational weeks 6-16). Using maternal questionnaire data about water consumption and drinking water, we estimated a surrogate for total maternal consumption of atrazine via drinking water. We then included additional maternal covariates, including age, race/ethnicity, parity, and plurality, in logistic regression analyses to consider an association between atrazine and hypospadias. When controlling for maternal characteristics, any association between hypospadias and daily maternal atrazine exposure during the critical window of genitourinary development was found to be weak or null (odds ratio for atrazine in drinking water = 1. 00, 95 % CI = 0.97 to 1.03 per 0.04 μg/day increase; odds ratio for maternal consumption = 1.02, 95 % CI = 0.99 to 1.05; per 0.05 μg/day increase). While the association that we observed was weak, our results suggest that additional research into a possible association between atrazine and hypospadias occurrence, using a more sensitive exposure metric

  10. Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services.

    Science.gov (United States)

    Ryan-Fogarty, Yvonne; Becker, Genevieve; Moles, Richard; O'Regan, Bernadette

    2017-03-01

    Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. A CLINICAL STUDY OF MATERNAL DEATHS DUE TO PPH

    Directory of Open Access Journals (Sweden)

    Basavana Gowda

    2015-03-01

    Full Text Available OBJECTIVES: A study of maternal death conducted to evaluate various factors responsible for maternal deaths. To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly. To analyze the causes and epidemiological amounts maternal mortality e.g. age parity, socioeconomic status and literacy. In order to reduce maternal mortality and to implement safe motherhood program and complications of pregnancy and to find out safe motherhood program. METHODS: The data collected was a retrograde by a proforma containing particulars of the diseased, detailed history and relatives were interviewed for additional information. The data collected was analysed. RESULTS: Maternal mortality rate in our own institution is 200/ 100,000 live births. Among 30 maternal deaths, 56% deaths (17 were among low socio - economic status, groups 60% deaths among unbooked 53.5% deaths more along illiterates evidenced by direct and indirect deaths about 25% of deaths were preventable. CONCLUSION: Maternal mortality is a global problem, facing every country in the world. Target specific interventions are needed for specific population. Fifth millennium development goal (MDG is to reduce maternal mortality by 75% by the year 2015, worthwhile investment for every case provider, results that investing on mothers

  12. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss

    Directory of Open Access Journals (Sweden)

    Pattinson Robert C

    2004-08-01

    Full Text Available Abstract Aim To determine the prevalence of severe acute maternal morbidity (SAMM worldwide (near miss. Method Systematic review of all available data. The methodology followed a pre-defined protocol, an extensive search strategy of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Data were extracted using data extraction instrument which collects additional information on the quality of reporting including definitions and identification of cases. Data were entered into a specially constructed database and tabulated using SAS statistical management and analysis software. Results A total of 30 studies are included in the systematic review. Designs are mainly cross-sectional and 24 were conducted in hospital settings, mostly teaching hospitals. Fourteen studies report on a defined SAMM condition while the remainder use a response to an event such as admission to intensive care unit as a proxy for SAMM. Criteria for identification of cases vary widely across studies. Prevalences vary between 0.80% – 8.23% in studies that use disease-specific criteria while the range is 0.38% – 1.09% in the group that use organ-system based criteria and included unselected group of women. Rates are within the range of 0.01% and 2.99% in studies using management-based criteria. It is not possible to pool data together to provide summary estimates or comparisons between different settings due to variations in case-identification criteria. Nevertheless, there seems to be an inverse trend in prevalence with development status of a country. Conclusion There is a clear need to set uniform criteria to classify patients as SAMM. This standardisation could be made for similar settings separately. An organ-system dysfunction/failure approach is the most epidemiologically sound as it is least open to bias, and thus could permit developing summary estimates.

  13. Understanding the determinants of the complex interplay between cost-effectiveness and equitable impact in maternal and child mortality reduction.

    Science.gov (United States)

    Chopra, Mickey; Campbell, Harry; Rudan, Igor

    2012-06-01

    One of the most unexpected outcomes arising from the efforts towards maternal and child mortality reduction is that all too often the objective success has been coupled with increased inequity in the population. The aim of this study is to analyze the determinants of the complex interplay between cost-effectiveness and equity and suggest strategies that will promote an impact on mortality that reduce population child health inequities. We developed a conceptual framework that exposes the nature of the links between the five key determinants that need to be taken into account when planning equitable impact. These determinants are: (i) efficiency of intervention scale-up (requires knowledge of differential increase in cost of intervention scale-up by equity strata in the population); (ii) effectiveness of intervention (requires understanding of differential effectiveness of interventions by equity strata in the population); (iii) the impact on mortality (requires knowledge of differential mortality levels by equity strata, and understanding the differences in cause composition of overall mortality in different equity strata); (iv) cost-effectiveness (compares the initial cost and the resulting impact on mortality); (v) equity structure of the population. The framework is presented visually as a four-quadrant graph. We use the proposed framework to demonstrate why the relationship between cost-effectiveness and equitable impact of an intervention cannot be intuitively predicted or easily planned. The relationships between the five determinants are complex, often nonlinear, context-specific and intervention-specific. We demonstrate that there will be instances when an equity-promoting approach, ie, trying to reach for the poorest and excluded in the population with health interventions, will also be the most cost-effective approach. However, there will be cases in which this will be entirely unfeasible, and where equity-neutral or even inequity-promoting approaches may

  14. Mortalidade materna por eclâmpsia Eclampsia as a cause of maternal mortality

    Directory of Open Access Journals (Sweden)

    Joe Luiz Vieira Garcia Novo

    2010-06-01

    Full Text Available OBJETIVO: analisar fatores associados à mortalidade materna causada por eclâmpsia. MÉTODOS: estudo de coorte retrospectivo revisando-se prontuários médicos dos partos assistidos no Conjunto Hospitalar de Sorocaba (janeiro/1995 a dezembro/2005. Variáveis pesquisadas: ano do parto, características sócio-demográficas maternas, antecedentes familiares, pessoais e obstétricos, características da gestação, parto, puerpério, atendimento realizado, evolução e condições de alta. A análise estatística incluiu teste exato de Fisher, correlação de Pearson, e regressão múltipla de Poisson. RESULTADOS: registraram-se 35.973 partos, 179 casos de eclâmpsia, 52 com sérias complicações, 23 com maior permanência no tratamento intensivo e 8 evoluíram para óbito. A proporção de eclâmpsia decresceu no período (0,90% para 0,37%; r= - 0,746; p=0,008, mas mantendo a proporção de casos com sérias complicações (0,25% para 0,17%, r= - 0,45; p=0,162. A proporção de óbitos foi maior entre pacientes não brancas (RR=9,10; IC95%=1,83-45,23; p=0,007 e menor entre as tratadas com sulfato de magnésio (RR=0,08; IC95%=0,02-0,35; p= 0,001. CONCLUSÕES: reduziu-se a proporção de eclâmpsia entre os partos assistidos no Conjunto Hospitalar de Sorocaba, porém, a eclâmpsia continua sendo importante causa de óbito materno na região. Este estudo revela que é fundamental o aperfeiçoamento das medidas de diagnóstico precoce e tratamento da pré-eclâmpsia e eclâmpsia pela rede de atenção à saúde.OBJECTIVE: to assess the factors associated with maternal mortality resulting from eclampsia. METHODS: a retrospective cohort study reviewing the medical records of deliveries carried out at the Sorocaba Hospital Compound (between January 1995 and December 2005. The variables included were: year of delivery, social and demographic characteristics of mother, personal, family and obstetric history, characteristics of the pregnancy, delivery and

  15. [Analysis of maternal mortality during three periods at Hospital de Ginecología y Obstetricia del Centro Médico Nacional de Occidente].

    Science.gov (United States)

    Angulo Vázquez, José; Cortés Sanabria, Laura; Torres Gómez, Luís Guillermo; Aguayo Alcaraz, Guadalupe; Hernández Higareda, Salvador; Avalos Nuño, Joel

    2007-07-01

    Most of deceases due to pregnancy, delivery, puerperium and them attention are avoidable with current medicine resources. To analyze some basic elements of epidemiologic behavior of a hospital environment maternal mortality in a third level hospital during a period of 21 years. Analytical cross-sectional study, 222 maternal deaths registered at Hospital de Ginecologia y Obstetricia, Centro Medico Nacional de Occidente del Instituto Mexicano del Seguro Social, were included, during the period 1985-2005. Deaths were analyzed in three periods of 7 years each one. The analysis of results was made based on descriptive statistic. chi2 was used for comparison between periods. Maternal death ratio was 73 per 100,000 live births during the 21 years. Maternal mortality was lower in the group of women under 20 years and increase agreed maternal age. Frequency of direct obstetric deaths decreased when comparing the 3 periods. The main causes of maternal death were preeclampsia/eclampsia and obstetric hemorrhage, which were responsible for almost 50% of maternal deaths. There was no significant difference to anticipation by comparing periods, between 28 and 37% of deaths were foreseen. 98% of deaths occurred at Intensive Care Units. Direct and indirect maternal deaths show very similar values in the third period, which translates in an improvement in anticipation. It must be reinforce the simple and opportune information to the patient with regard to warning signs and the permanent medical training must be a priority at the 3 medical levels.

  16. Maternal mortality due to hemorrhage in Brazil Mortalidad materna en Brasil debida a hemorragia Mortalidade materna por hemorragia no Brasil

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes de Souza

    2013-06-01

    Full Text Available OBJECTIVE: to analyze the rates of maternal mortality due to hemorrhage identified in Brazil from 1997 to 2009. Methods: the time series and population data from the Brazilian Health Ministry, Mortality Information System and Live Birth Information System were examined. From the Mortality Information System, we initially selected all reported deaths of women between 10 and 49 years old, which occurred from January 1, 1997 to December 31, 2009 in Brazil, recorded as a "maternal death". RESULTS: during the research period, 22,281 maternal deaths were identified, among which 3,179 were due to hemorrhage, accounting for 14.26% of the total deaths. The highest rates of maternal mortality were found in the North and Northeast areas of Brazil. CONCLUSIONS: the Brazilian scenario shows regional inequalities regarding maternal mortality. It presents hemorrhaging as a symptom and not as a cause of death. OBJETIVO: analizar las tasas de mortalidad materna debida a hemorragia, identificadas en Brasil durante el periodo de 1997 a 2009. MÉTODOS: fueron examinados los datos de series temporales y de población del Ministerio de la Salud de Brasil, del Sistema de Información de Mortalidad y del Sistema de Información de Nacidos Vivos. Del Sistema de Información de Mortalidad, inicialmente seleccionamos todos los informes sobre muerte de mujeres con edad entre 10 y 49 años, que ocurrieron entre el 01 de enero de 1997 y el 31 de diciembre de 2009, en Brasil, clasificadas como "muertes maternas". RESULTADOS: durante el periodo de investigación, fueron identificadas 22.281 muertes maternas, entre las cuales 3.179 se debieron a hemorragia, siendo responsables por 14,26% del total de muertes. La tasa más alta de mortalidad materna fue encontrada en las regiones Norte y Noreste de Brasil. CONCLUSIONES: el escenario brasileño muestra desigualdades regionales en lo que se refiere a mortalidad materna; este presenta la hemorragia como un síntoma y no como la

  17. Effects of maternal micronutrient supplementation on fetal loss and under-2-years child mortality

    DEFF Research Database (Denmark)

    Andersen, Gregers Stig; Friis, Henrik; Michaelsen, Kim Fleischer

    2010-01-01

    A number of trials on maternal multi-micronutrient supplementation (MMS) have found a benefical effect on birth weight, but few have demonstrated a beneficial effect on infant survival. We examined the effect of two different preparations of antenatal MMS on fetal loss and under-2-years child...

  18. Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality

    DEFF Research Database (Denmark)

    Smith, Emily R; Shankar, Anuraj H; Wu, Lee S-F

    2017-01-01

    BACKGROUND: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, h...

  19. Effects of maternal micronutrient supplementation on fetal loss and under-2-years child mortality

    DEFF Research Database (Denmark)

    Andersen, Gregers Stig; Friis, Henrik; Michaelsen, Kim F.

    2010-01-01

    A number of trials on maternal multi-micronutrient supplementation (MMS) have found a benefical effect on birth weight, but few have demonstrated a beneficial effect on infant survival. We examined the effect of two different preparations of antenatal MMS on fetal loss and under-2-years child mor...

  20. Gender inequality : Behind maternal mortality in Nias Island, North Sumatra, Indonesia: Towards a gender audit

    NARCIS (Netherlands)

    Zaluchu, F.

    2018-01-01

    Singling out Nias Island in North Sumatra Indonesia as the research location, this research attempts to analyze local aspects pertaining to gender inequality in the context of maternal health in Indonesia. This research aims to portray the presence of gender inequality in Nias, and how it affects

  1. Maternal mortality in south-South Nigeria: Are we getting it right ...

    African Journals Online (AJOL)

    All deaths were due to direct obstetric causes with 66.7% resulting from Primary post partum haemorrhage, while 16.7% were due to severe Pre-eclampsia/ Eclampsia and puerperal sepsis respectively. Conclusion: The MMR observed in the study was 391 per 100,000 births. All maternal deaths were due to direct obstetric ...

  2. Maternal reading skills and child mortality in Nigeria: a reassessment of why education matters.

    Science.gov (United States)

    Smith-Greenaway, Emily

    2013-10-01

    Mother's formal schooling-even at the primary level-is associated with lower risk of child mortality, although the reasons why remain unclear. This study examines whether mother's reading skills help to explain the association in Nigeria. Using data from the Demographic and Health Survey, the analysis demonstrates that women's reading skills increase linearly with years of primary school; however, many women with several years of formal school are unable to read at all. The results further show that mother's reading skills help to explain the relationship between mother's formal schooling and child mortality, and that mother's reading skills are highly associated with child mortality. The study highlights the need for more data on literacy and for more research on whether and how mother's reading skills lower child mortality in other contexts.

  3. Catalase prevents maternal diabetes-induced perinatal programming via the Nrf2-HO-1 defense system.

    Science.gov (United States)

    Chang, Shiao-Ying; Chen, Yun-Wen; Zhao, Xin-Ping; Chenier, Isabelle; Tran, Stella; Sauvé, Alexandre; Ingelfinger, Julie R; Zhang, Shao-Ling

    2012-10-01

    We investigated whether overexpression of catalase (CAT) in renal proximal tubular cells (RPTCs) could prevent the programming of hypertension and kidney disease in the offspring of dams with maternal diabetes. Male offspring of nondiabetic and diabetic dams from two transgenic (Tg) lines (Hoxb7-green fluorescent protein [GFP]-Tg [controls] and Hoxb7/CAT-GFP-Tg, which overexpress CAT in RPTCs) were studied from the prenatal period into adulthood. Nephrogenesis, systolic blood pressure, renal hyperfiltration, kidney injury, and reactive oxygen species (ROS) generation were assessed. Gene expression of transforming growth factor-β1 (TGF-β1), nuclear factor erythroid 2p45-related factor-2 (Nrf2), and heme oxygenase-1 (HO-1) was tested in both in vitro and in vivo studies. Renal dysmorphogenesis was observed in offspring of Hoxb7-GFP-Tg dams with severe maternal diabetes; the affected male offspring displayed higher renal ROS generation and developed hypertension and renal hyperfiltration as well as renal injury with heightened TGF-β1 expression in adulthood. These changes were ameliorated in male offspring of diabetic Hoxb7/CAT-GFP-Tg dams via the Nrf2-HO-1 defense system. CAT promoted Nrf2 nuclear translocation and HO-1 gene expression, seen in both in vitro and in vivo studies. In conclusion, CAT overexpression in the RPTCs ameliorated maternal diabetes-induced perinatal programming, mediated, at least in part, by triggering the Nrf2-HO-1 defense system.

  4. Pediatric Obesity: It’s Time for Prevention Before Conception Can Maternal Obesity Program Pediatric Obesity?

    Directory of Open Access Journals (Sweden)

    Zach Ferraro

    2008-01-01

    Full Text Available Global increases in obesity have led public health experts to declare this disease a pandemic. Although prevalent in all ages, the dire consequences associated with maternal obesity have a pronounced impact on the long-term health of their children as a result of the intergenerational effects of developmental programming. Previously, fetal under-nutrition has been linked to the predisposition to pediatric obesity explained by the adiposity rebound and ‘catch-up’ growth that occurs when a child born to a nutrient deprived mother is exposed to the obesogenic environment of present day. Given the recent increase in maternal overweight/obesity (OW/OB our attention has shifted from nutrient restriction to overabundance and excess during pregnancy. Consideration must now be given to interventions that could mitigate pregravid body mass index (BMI, attenuate gestational weight gain (GWG and reduce postpartum weight retention (PPWR in an attempt to prevent the downstream signaling of pediatric obesity and halt the intergenerational cycle of weight related disease currently plaguing our world. Thus, this paper will briefly review current research that best highlights the proposed mechanisms responsible for the development of child OW/OB and related sequalae (e.g. type II diabetes (T2D and cardiovascular disease (CVD resulting from maternal obesity.

  5. Pediatric Obesity: It's Time for Prevention before Conception Can Maternal Obesity Program Pediatric Obesity?

    Directory of Open Access Journals (Sweden)

    Zach Ferraro

    2008-01-01

    Full Text Available Global increases in obesity have led public health experts to declare this disease a pandemic. Although prevalent in all ages, the dire consequences associated with maternal obesity have a pronounced impact on the long-term health of their children as a result of the intergenerational effects of developmental programming. Previously, fetal under-nutrition has been linked to the predisposition to pediatric obesity explained by the adiposity rebound and ‘catch-up’ growth that occurs when a child born to a nutrient deprived mother is exposed to the obesogenic environment of present day. Given the recent increase in maternal overweight/obesity (OW/OB our attention has shifted from nutrient restriction to overabundance and excess during pregnancy. Consideration must now be given to interventions that could mitigate pregravid body mass index (BMI, attenuate gestational weight gain (GWG and reduce postpartum weight retention (PPWR in an attempt to prevent the downstream signaling of pediatric obesity and halt the intergenerational cycle of weight related disease currently plaguing our world. Thus, this paper will briefly review current research that best highlights the proposed mechanisms responsible for the development of child OW/OB and related sequalae (e.g. type II diabetes (T2D and cardiovascular disease (CVD resulting from maternal obesity.

  6. Maternal factors contributing to under-five mortality at birth order 1 to 5 in India: a comprehensive multivariate study.

    Science.gov (United States)

    Singh, Rajvir; Tripathi, Vrijesh

    2013-01-01

    The objective of the study is to assess maternal factors contributing to under-five mortality at birth order 1 to 5 in India. Data for this study was derived from the children's record of the 2007 India National Family Health Survey, which is a nationally representative cross-sectional household survey. Data is segregated according to birth order 1 to 5 to assess mother's occupation, Mother's education, child's gender, Mother's age, place of residence, wealth index, mother's anaemia level, prenatal care, assistance at delivery , antenatal care, place of delivery and other maternal factors contributing to under-five mortality. Out of total 51555 births, analysis is restricted to 16567 children of first birth order, 14409 of second birth order, 8318 of third birth order, 5021 of fourth birth order and 3034 of fifth birth order covering 92% of the total births taken place 0-59 months prior to survey. Mother's average age in years for birth orders 1 to 5 are 23.7, 25.8, 27.4, 29 and 31 years, respectively. Most mothers whose children died are Hindu, with no formal education, severely anaemic and working in the agricultural sector. In multivariate logistic models, maternal education, wealth index and breastfeeding are protective factors across all birth orders. In birth order model 1 and 2, mother's occupation is a significant risk factor. In birth order models 2 to 5, previous birth interval of lesser than 24 months is a risk factor. Child's gender is a risk factor in birth order 1 and 5. Information regarding complications in pregnancy and prenatal care act as protective factors in birth order 1, place of delivery and immunization in birth order 2, and child size at birth in birth order 4. Prediction models demonstrate high discrimination that indicates that our models fit the data. The study has policy implications such as enhancing the Information, Education and Communication network for mothers, especially at higher birth orders, in order to reduce under

  7. The Centers for Disease Control and Prevention's maternal health response to 2009 H1N1 influenza.

    Science.gov (United States)

    Mosby, Laura G; Ellington, Sascha R; Forhan, Sara E; Yeung, Lorraine F; Perez, Mirna; Shah, Melisa M; MacFarlane, Kitty; Laird, Susan K; House, Lawrence D; Jamieson, Denise J

    2011-06-01

    We describe the efforts of the Maternal Health Team, which was formed to address the needs of pregnant and breastfeeding women during the Centers for Disease Control and Prevention's (CDC's) 2009 pandemic influenza A (2009 H1N1) emergency response. We examined the team's activities, constructed a timeline of key pandemic events, and analyzed the Maternal Health 2009 H1N1 inquiry database. During the pandemic response, 9 guidance documents that addressed the needs of pregnant and breastfeeding women and their providers were developed by the Maternal Health Team. The Team received 4661 maternal health-related inquiries that came primarily from the public (75.5%) and were vaccine related (69.3%). Peak inquiry volume coincided with peak hospitalizations (October-November 2009). The Maternal Health 2009 H1N1 inquiry database proved useful to identify information needs of the public and health care providers during the pandemic. Copyright © 2011 Mosby, Inc. All rights reserved.

  8. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample.

    Science.gov (United States)

    Raj, Anita; Saggurti, Niranjan; Winter, Michael; Labonte, Alan; Decker, Michele R; Balaiah, Donta; Silverman, Jay G

    2010-01-21

    To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers). In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age child (1-5 years) mortality; low birth weight (child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India.

  9. Financial incentives to influence maternal mortality in a low-income setting: making available 'money to transport' - experiences from Amarpatan, India.

    Science.gov (United States)

    De Costa, Ayesha; Patil, Rajkumar; Kushwah, Surgiv Singh; Diwan, Vinod Kumar

    2009-03-18

    Only 40.7% women in India deliver in an institution; leaving many vulnerable to maternal morbidity and mortality (India has 22% of global maternal deaths). While limited accessibility to functioning institutions may account in part, a common reason why women deliver at home is poverty. A lack of readily available financial resources for families to draw upon at the time of labor to transport the mother to an institution, is often observed. This paper reports a yearlong collaborative intervention (between the University and Department of Health) to study if providing readily available and easily accessible funds for emergency transportation would reduce maternal deaths in a rural, low income, and high maternal mortality setting in central India. It aimed to obviate a deterrent to emergency obstetric care; the non-availability of resources with mothers when most needed. Issues in implementation are also discussed. Maternal deaths were actively identified in block Amarpatan (0.2 million population) over a 2-year period. The project, with participation from local government and other groups, trained 482 local health care providers (public and private) to provide antenatal care. Emergency transport money (in cash) was placed with one provider in each village. Maternal mortality in the adjacent block (Maihar) was followed (as a 'control' block). Maternal deaths in Amarpatan decreased during the project year relative to the previous year, or in the control block the same year. Issues in implementation of the cash incentive scheme are discussed. Although the intervention reduced maternal deaths in this low-income setting, chronic poverty and malnutrition are underlying structural problems that need to be addressed.

  10. Maternal methyl donors supplementation during lactation prevents the hyperhomocysteinemia induced by a high-fat-sucrose intake by dams.

    Science.gov (United States)

    Cordero, Paul; Milagro, Fermin I; Campion, Javier; Martinez, J Alfredo

    2013-12-16

    Maternal perinatal nutrition may program offspring metabolic features. Epigenetic regulation is one of the candidate mechanisms that may be affected by maternal dietary methyl donors intake as potential controllers of plasma homocysteine levels. Thirty-two Wistar pregnant rats were randomly assigned into four dietary groups during lactation: control, control supplemented with methyl donors, high-fat-sucrose and high-fat-sucrose supplemented with methyl donors. Physiological outcomes in the offspring were measured, including hepatic mRNA expression and global DNA methylation after weaning. The newborns whose mothers were fed the obesogenic diet were heavier longer and with a higher adiposity and intrahepatic fat content. Interestingly, increased levels of plasma homocysteine induced by the maternal high-fat-sucrose dietary intake were prevented in both sexes by maternal methyl donors supplementation. Total hepatic DNA methylation decreased in females due to maternal methyl donors administration, while Dnmt3a hepatic mRNA levels decreased accompanying the high-fat-sucrose consumption. Furthermore, a negative association between Dnmt3a liver mRNA levels and plasma homocysteine concentrations was found. Maternal high-fat-sucrose diet during lactation could program offspring obesity features, while methyl donors supplementation prevented the onset of high hyperhomocysteinemia. Maternal dietary intake also affected hepatic DNA methylation metabolism, which could be linked with the regulation of the methionine-homocysteine cycle.

  11. Maternal endometrial oedema may increase perinatal mortality of cloned and transgenic piglets

    DEFF Research Database (Denmark)

    Schmidt, Mette; Winter, K.D.; Dantzer, Vibeke

    2011-01-01

    The perinatal mortality of cloned animals is a well-known problem. In the present retrospective study, we report on mortality of cloned transgenic or non-transgenic piglets produced as part of several investigations. Large White (LW) sows (n = 105) received hand-made cloned LW or minipig...... endometrial oedema in sows pregnant with cloned and transgenic piglets, as well as in empty recipients, at term. The growth of certain organs in some of the cloned piglets was reduced and the rate of stillborn piglets was greater in cloned and transgenic piglets delivered vaginally, possibly because of oedema...

  12. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.

    NARCIS (Netherlands)

    Melsen, W.G.; Rovers, M.M.; Koeman, M.; Bonten, M.J.

    2011-01-01

    OBJECTIVE: : To assess the attributable mortality of ventilator-associated pneumonia using results from randomized controlled trials on ventilator-associated pneumonia prevention. DATA SOURCES: : A systematic search was performed in PubMed, Embase, Web of Science, and Cochrane Library from their

  13. Antiviral therapy for prevention of hepatocellular carcinoma and mortality in chronic hepatitis B

    DEFF Research Database (Denmark)

    Thiele, Maja; Gluud, Lise Lotte; Dahl, Emilie K

    2013-01-01

    The effect of antiviral therapy on clinical outcomes in chronic hepatitis B virus (HBV) is not established. We aimed to assess the effects of interferon and/or nucleos(t)ide analogues versus placebo or no intervention on prevention of hepatocellular carcinoma (HCC) and mortality in chronic HBV....

  14. Associations between maternal experiences of intimate partner violence and child nutrition and mortality: findings from Demographic and Health Surveys in Egypt, Honduras, Kenya, Malawi and Rwanda.

    Science.gov (United States)

    Rico, Emily; Fenn, Bridget; Abramsky, Tanya; Watts, Charlotte

    2011-04-01

    If effective interventions are to be used to address child mortality and malnutrition, then it is important that we understand the different pathways operating within the framework of child health. More attention needs to be given to understanding the contribution of social influences such as intimate partner violence (IPV). To investigate the relationship between maternal exposure to IPV and child mortality and malnutrition using data from five developing countries. Population data from Egypt, Honduras, Kenya, Malawi and Rwanda were analysed. Logistic regression analysis was used to generate odds ratios of the associations between several categories of maternal exposure to IPV since the age of 15 and three child outcomes: under-2-year-old (U2) mortality and moderate and severe stunting (Honduras) to 46.2% (Kenya). For child stunting, prevalence ranged from 25.4% (Egypt) to 58.0% (Malawi) and for U2 mortality from 3.6% (Honduras) to 15.2% (Rwanda). In Kenya, maternal exposure to IPV was associated with higher U2 mortality (adjusted odds ratio (OR)=1.42, 95% CI 1.18 to 1.71) and child stunting (adjusted OR=1.36, 95% CI 1.16 to 1.61). In Malawi and Honduras, marginal associations were observed between IPV and severe stunting and U2 mortality, respectively, with strength of associations varying by type of violence. The relationship between IPV and U2 mortality and stunting in Kenya, Honduras and Malawi suggests that, in these countries, IPV plays a role in child malnutrition and mortality. This contributes to a growing body of evidence that broader public health benefits may be incurred if efforts to address IPV are incorporated into a wider range of maternal and child health programmes; however, the authors highlight the need for more research that can establish temporality, use data collected on the basis of the study's objectives, and further explore the causal framework of this relationship using more advanced statistical analysis.

  15. Alcohol intake and mortality among survivors of colorectal cancer: The Cancer Prevention Study II Nutrition Cohort.

    Science.gov (United States)

    Yang, Baiyu; Gapstur, Susan M; Newton, Christina C; Jacobs, Eric J; Campbell, Peter T

    2017-06-01

    Alcohol consumption is associated with a higher risk of colorectal cancer, but to the authors' knowledge its influence on survival after a diagnosis of colorectal cancer is unclear. The authors investigated associations between prediagnosis and postdiagnosis alcohol intake with mortality among survivors of colorectal cancer. The authors identified 2458 men and women who were diagnosed with invasive, nonmetastatic colorectal cancer between 1992 (enrollment into the Cancer Prevention Study II Nutrition Cohort) and 2011. Alcohol consumption was self-reported at baseline and updated in 1997, 1999, 2003, and 2007. Postdiagnosis alcohol data were available for 1599 participants. Of the 2458 participants diagnosed with colorectal cancer, 1156 died during follow-up through 2012. Prediagnosis and postdiagnosis alcohol consumption were not found to be associated with all-cause mortality, except for an association between prediagnosis consumption of mortality (relative risk [RR], 0.86; 95% confidence interval [95% CI], 0.74-1.00) compared with never drinking. Alcohol use was generally not associated with colorectal cancer-specific mortality, although there was some suggestion of increased colorectal cancer-specific mortality with postdiagnosis drinking (RR, 1.27 [95% CI, 0.87-1.86] for current drinking of mortality among individuals with nonmetastatic colorectal cancer. The association between postdiagnosis drinking and colorectal cancer-specific mortality should be examined in larger studies of individuals diagnosed with nonmetastatic colorectal cancer. Cancer 2017;123:2006-2013. © 2017 American Cancer Society. © 2017 American Cancer Society.

  16. SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan.

    Science.gov (United States)

    Ahmadi, Qudratullah; Danesh, Homayoon; Makharashvili, Vasil; Mishkin, Kathryn; Mupfukura, Lovemore; Teed, Hillary; Huff-Rousselle, Maggie

    2016-07-01

    This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  17. Maternal obesity and neonatal mortality according to subtypes of preterm birth

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard; Vaeth, Michael; Bech, Bodil H

    2007-01-01

    .6, CI 1.0-2.4, respectively). For preterm infants (n=3,934, 136 deaths), neonatal mortality in infants born after preterm premature rupture of membranes (PROM) was significantly increased if they were born to an overweight or obese mother (adjusted hazard ratios 3.5, CI 1.4-8.7, and 5.7, CI 2...

  18. An analysis of three levels of scaled-up coverage for 28 interventions to avert stillbirths and maternal, newborn and child mortality in 27 countries in Latin America and the Caribbean with the Lives Saved Tool (LiST).

    Science.gov (United States)

    Arnesen, Lauren; O'Connell, Thomas; Brumana, Luisa; Durán, Pablo

    2016-07-22

    Action to avert maternal and child mortality was propelled by the Millennium Development Goals (MDGs) in 2000. The Latin American and Caribbean (LAC) region has shown promise in achieving the MDGs in many countries, but preventable maternal, neonatal and child mortality persist. Furthermore, preventable stillbirths are occurring in large numbers in the region. While an effective set of maternal, newborn and child health (MNCH) interventions have been identified, they have not been brought to scale across LAC. Baseline data for select MNCH interventions for 27 LAC countries that are included in the Lives Saved Tool (LiST) were verified and updated with survey data. Three LiST projections were built for each country: baseline, MDG-focused, and All Included, each scaling up a progressively larger set of interventions for 2015 - 2030. Impact was assessed for 2015 - 2035, comparing annual and total lives saved, as projected by LiST. Across the 27 countries 235,532 stillbirths, and 752,588 neonatal, 959,393 under-five, and 60,858 maternal deaths would be averted between 2015 and 2035 by implementing the All-Included intervention package, representing 67 %, 616 %, 807 % and 101 % more lives saved, respectively, than with the MDG-focused interventions. 25 % neonatal deaths averted with the All-Included intervention package would be due to asphyxia, 42 % from prematurity and 24 % from sepsis. Our modelling suggests a 337 % increase in the number of lives saved, which would have enormous impacts on population health. Further research could help clarify the impacts of a comprehensive scale-up of the full range of essential MNCH interventions we have modelled.

  19. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

    DEFF Research Database (Denmark)

    Moesgaard Iburg, Kim

    2016-01-01

    Summary Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to qu...... performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation....

  20. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

    NARCIS (Netherlands)

    Kassebaum, N.J.; Barber, R.M.; Bhutta, Zulfiqar; Dandona, L.; Gething, Peter W.; Hay, S.I.; Kinfu, Yohannes; Larson, H.J.; Xiao, Liang; Lim, S.S.; Geleijnse, J.M.

    2016-01-01

    Background

    In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to

  1. Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania.

    Science.gov (United States)

    Mehta, Saurabh; Hunter, David J; Mugusi, Ferdinand M; Spiegelman, Donna; Manji, Karim P; Giovannucci, Edward L; Hertzmark, Ellen; Msamanga, Gernard I; Fawzi, Wafaie W

    2009-10-01

    Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and child mortality. A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality. The association of these outcomes with maternal vitamin D status at enrollment was examined in an observational analysis. No association was observed between maternal vitamin D status and adverse pregnancy outcomes, including low birth weight and preterm birth. In multivariate models, a low maternal vitamin D level (vitamin D level had a 61% higher risk of dying during follow-up (95% CI, 25%-107%). If found to be efficacious in randomized trials, vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children, particularly in resource-limited settings.

  2. Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

    Science.gov (United States)

    Alexander, Dayna S; Alfonso, Moya L; Cao, Chunhua; Wright, Alesha R

    2017-07-01

    Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children's positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers' support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers' support for prevention initiatives. Methods A convenience sample of maternal caregivers (N = 129, ages 22-65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers' support for prevention strategies. Results Caregivers' perceptions of childhood obesity risk factors were moderate (M = 3.4; SD = 0.64), as were their perceptions of obesity-related health complications (M = 3.3; SD = 0.75); however, they perceived a high level of support for prevention strategies (M = 4.2; SD = 0.74). In the regression model, only health complications were significantly associated with caregiver support (β = 0.348; p Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.

  3. The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project.

    Science.gov (United States)

    Ellard, David; Simkiss, Doug; Quenby, Siobhan; Davies, David; Kandala, Ngianga-bakwin; Kamwendo, Francis; Mhango, Chisale; O'Hare, Joseph Paul

    2012-10-25

    Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3-4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in

  4. Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to reducing maternal mortality in Ethiopia

    Science.gov (United States)

    2013-01-01

    Background Most maternal deaths take place during labour and within a few weeks after delivery. The availability and utilization of emergency obstetric care facilities is a key factor in reducing maternal mortality; however, there is limited evidence about how these institutions perform and how many people use emergency obstetric care facilities in rural Ethiopia. We aimed to assess the availability, quality, and utilization of emergency obstetric care services in the Gamo Gofa Zone of south-west Ethiopia. Methods We conducted a retrospective review of three hospitals and 63 health centres in Gamo Gofa. Using a retrospective review, we recorded obstetric services, documents, cards, and registration books of mothers treated and served in the Gamo Gofa Zone health facilities between July 2009 and June 2010. Results There were three basic and two comprehensive emergency obstetric care qualifying facilities for the 1,740,885 people living in Gamo Gofa. The proportion of births attended by skilled attendants in the health facilities was 6.6% of expected births, though the variation was large. Districts with a higher proportion of midwives per capita, hospitals and health centres capable of doing emergency caesarean sections had higher institutional delivery rates. There were 521 caesarean sections (0.8% of 64,413 expected deliveries and 12.3% of 4,231 facility deliveries). We recorded 79 (1.9%) maternal deaths out of 4,231 deliveries and pregnancy-related admissions at institutions, most often because of post-partum haemorrhage (42%), obstructed labour (15%) and puerperal sepsis (15%). Remote districts far from the capital of the Zone had a lower proportion of institutional deliveries (4% of deliveries, much higher than the average 1.9%). Conclusion Based on a population of 1.7 million people, there should be 14 basic and four comprehensive emergency obstetric care (EmOC) facilities in the Zone. Our study found that only three basic and two comprehensive EmOC service

  5. Maternal autoimmune disease and birth defects in the National Birth Defects Prevention Study.

    Science.gov (United States)

    Howley, Meredith M; Browne, Marilyn L; Van Zutphen, Alissa R; Richardson, Sandra D; Blossom, Sarah J; Broussard, Cheryl S; Carmichael, Suzan L; Druschel, Charlotte M

    2016-11-01

    Little is known about the association between maternal autoimmune disease or its treatment and the risk of birth defects. We examined these associations using data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. Analyses included 25,116 case and 9897 unaffected control infants with estimated delivery dates between 1997 and 2009. Information on autoimmune disease, medication use, and other pregnancy exposures was collected by means of telephone interview. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for birth defects with five or more exposed cases; crude ORs and exact 95% CIs were estimated for birth defects with three to four exposed cases. Autoimmune disease was reported by 373 mothers (279 case and 94 control mothers). The majority of birth defects evaluated were not associated with autoimmune disease; however, a statistically significant association between maternal autoimmune disease and encephalocele was observed (OR, 4.64; 95% CI, 1.95-11.04). Eighty-two mothers with autoimmune disease used an immune modifying/suppressing medication during pregnancy; this was associated with encephalocele (OR, 7.26; 95% CI, 1.37-24.61) and atrial septal defects (OR, 3.01; 95% CI, 1.16-7.80). Our findings suggest maternal autoimmune disease and treatment are not associated with the majority of birth defects, but may be associated with some defects, particularly encephalocele. Given the low prevalence of individual autoimmune diseases and the rare use of specific medications, we were unable to examine associations of specific autoimmune diseases and medications with birth defects. Other studies are needed to confirm these findings. Birth Defects Research (Part A) 106:950-962, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. 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).

    Science.gov (United States)

    Houle, Brian; Clark, Samuel J; Kahn, Kathleen; Tollman, Stephen; Yamin, Alicia

    2015-05-06

    Maternal 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. We 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. Children 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). This 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.

  7. The intrauterine metabolic environment modulates the gene expression pattern in fetal rat islets: prevention by maternal taurine supplementation.

    Science.gov (United States)

    Reusens, B; Sparre, T; Kalbe, L; Bouckenooghe, T; Theys, N; Kruhøffer, M; Orntoft, T F; Nerup, J; Remacle, C

    2008-05-01

    Events during fetal life may in critical time windows programme tissue development leading to organ dysfunction with potentially harmful consequences in adulthood such as diabetes. In rats, the beta cell mass of progeny from dams fed with a low-protein (LP) diet during gestation is decreased at birth and metabolic perturbation lasts through adulthood even though a normal diet is given after birth or after weaning. Maternal and fetal plasma taurine levels are suboptimal. Maternal taurine supplementation prevents these induced abnormalities. In this study, we aimed to reveal changes in gene expression in fetal islets affected by the LP diet and how taurine may prevent these changes. Pregnant Wistar rats were fed an LP diet (8% [wt/wt] protein) supplemented or not with taurine in the drinking water or a control diet (20% [wt/wt] protein). At 21.5 days of gestation, fetal pancreases were removed, digested and cultured for 7 days. Neoformed islets were collected and transcriptome analysis was performed. Maternal LP diet significantly changed the expression of more than 10% of the genes. Tricarboxylic acid cycle and ATP production were highly targeted, but so too were cell proliferation and defence. Maternal taurine supplementation normalised the expression of all altered genes. Development of the beta cells and particularly their respiration is modulated by the intrauterine environment, which may epigenetically modify expression of the genome and programme the beta cell towards a pre-diabetic phenotype. This mis-programming by maternal LP diet was prevented by early taurine intervention.

  8. The impact of eliminating within-country inequality in health coverage on maternal and child mortality: a Lives Saved Tool analysis

    Directory of Open Access Journals (Sweden)

    Adrienne Clermont

    2017-11-01

    Full Text Available Abstract Background Inequality in healthcare across population groups in low-income countries is a growing topic of interest in global health. The Lives Saved Tool (LiST, which uses health intervention coverage to model maternal, neonatal, and child health outcomes such as mortality rates, can be used to analyze the impact of within-country inequality. Methods Data from nationally representative household surveys (98 surveys conducted between 1998 and 2014, disaggregated by wealth quintile, were used to create a LiST analysis that models the impact of scaling up health intervention coverage for the entire country from the national average to the rate of the top wealth quintile (richest 20% of the population. Interventions for which household survey data are available were used as proxies for other interventions that are not measured in surveys, based on co-delivery of intervention packages. Results For the 98 countries included in the analysis, 24–32% of child deaths (including 34–47% of neonatal deaths and 16–19% of post-neonatal deaths could be prevented by scaling up national coverage of key health interventions to the level of the top wealth quintile. On average, the interventions with most unequal coverage rates across wealth quintiles were those related to childbirth in health facilities and to water and sanitation infrastructure; the most equally distributed were those delivered through community-based mass campaigns, such as vaccines, vitamin A supplementation, and bednet distribution. Conclusions LiST is a powerful tool for exploring the policy and programmatic implications of within-country inequality in low-income, high-mortality-burden countries. An “Equity Tool” app has been developed within the software to make this type of analysis easily accessible to users.

  9. Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013.

    Directory of Open Access Journals (Sweden)

    Hector Lamadrid-Figueroa

    Full Text Available Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision. Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR, the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM and the Birth Information Subsystem (SINAC of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01. A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition.

  10. Prevention of lymphocyte apoptosis in septic mice with cancer increases mortality.

    Science.gov (United States)

    Fox, Amy C; Breed, Elise R; Liang, Zhe; Clark, Andrew T; Zee-Cheng, Brendan R; Chang, Katherine C; Dominguez, Jessica A; Jung, Enjae; Dunne, W Michael; Burd, Eileen M; Farris, Alton B; Linehan, David C; Coopersmith, Craig M

    2011-08-15

    Lymphocyte apoptosis is thought to have a major role in the pathophysiology of sepsis. However, there is a disconnect between animal models of sepsis and patients with the disease, because the former use subjects that were healthy prior to the onset of infection while most patients have underlying comorbidities. The purpose of this study was to determine whether lymphocyte apoptosis prevention is effective in preventing mortality in septic mice with preexisting cancer. Mice with lymphocyte Bcl-2 overexpression (Bcl-2-Ig) and wild type (WT) mice were injected with a transplantable pancreatic adenocarcinoma cell line. Three weeks later, after development of palpable tumors, all animals received an intratracheal injection of Pseudomonas aeruginosa. Despite having decreased sepsis-induced T and B lymphocyte apoptosis, Bcl-2-Ig mice had markedly increased mortality compared with WT mice following P. aeruginosa pneumonia (85 versus 44% 7-d mortality; p = 0.004). The worsened survival in Bcl-2-Ig mice was associated with increases in Th1 cytokines TNF-α and IFN-γ in bronchoalveolar lavage fluid and decreased production of the Th2 cytokine IL-10 in stimulated splenocytes. There were no differences in tumor size or pulmonary pathology between Bcl-2-Ig and WT mice. To verify that the mortality difference was not specific to Bcl-2 overexpression, similar experiments were performed in Bim(-/-) mice. Septic Bim(-/-) mice with cancer also had increased mortality compared with septic WT mice with cancer. These data demonstrate that, despite overwhelming evidence that prevention of lymphocyte apoptosis is beneficial in septic hosts without comorbidities, the same strategy worsens survival in mice with cancer that are given pneumonia.

  11. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases

    DEFF Research Database (Denmark)

    Bjelakovic, Goran; Nikolova, Dimitrinka; Gluud, Lise Lotte

    2012-01-01

    and secondary prevention randomised clinical trials on antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. DATA COLLECTION AND ANALYSIS: Three authors extracted data. Random-effects and fixed-effect model meta-analyses were conducted. Risk......BACKGROUND: Our systematic review has demonstrated that antioxidant supplements may increase mortality. We have now updated this review. OBJECTIVES: To assess the beneficial and harmful effects of antioxidant supplements for prevention of mortality in adults. SEARCH METHODS: We searched...... years). The mean proportion of women was 46%. Of the 78 trials, 46 used the parallel-group design, 30 the factorial design, and 2 the cross-over design. All antioxidants were administered orally, either alone or in combination with vitamins, minerals, or other interventions. The duration...

  12. Child marriage and maternal health risks among young mothers in Gombi, Adamawa State, Nigeria: implications for mortality, entitlements and freedoms.

    Science.gov (United States)

    Adedokun, Olaide; Adeyemi, Oluwagbemiga; Dauda, Cholli

    2016-12-01

    Efforts toward liberation of the girl-child from the shackles of early marriage have continued to be resisted through tradition, culture and religion in some parts of Nigeria. This study therefore examines the maternal health implications of early marriage on young mothers in the study area. Multistage sampling technique was employed to obtained data from 200 young mothers aged 15-24 years who married before aged 16 years. The study reveals that more than 60% had only primary education while more than 70% had experienced complications before or after childbirth. Age at first marriage, current age, level of education and household decision-making significantly influence (Pmarriage in the study area should include mass and compulsory education of girls, provision of other options to early marriage and childbearing and involvement of fathers in preventing and ending the practice.

  13. Effect of early detection and treatment on malaria related maternal mortality on the north-western border of Thailand 1986-2010.

    Science.gov (United States)

    McGready, Rose; Boel, Machteld; Rijken, Marcus J; Ashley, Elizabeth A; Cho, Thein; Moo, Oh; Paw, Moo Koh; Pimanpanarak, Mupawjay; Hkirijareon, Lily; Carrara, Verena I; Lwin, Khin Maung; Phyo, Aung Pyae; Turner, Claudia; Chu, Cindy S; van Vugt, Michele; Price, Richard N; Luxemburger, Christine; ter Kuile, Feiko O; Tan, Saw Oo; Proux, Stephane; Singhasivanon, Pratap; White, Nicholas J; Nosten, François H

    2012-01-01

    Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand. All medical records from women who attended the Shoklo Malaria Research Unit antenatal clinics from 12(th) May 1986 to 31(st) December 2010 were reviewed, and maternal death records were analyzed for causality. There were 71 pregnancy-related deaths recorded amongst 50,981 women who attended antenatal care at least once. Three were suicide and excluded from the analysis as incidental deaths. The estimated maternal mortality ratio (MMR) overall was 184 (95%CI 150-230) per 100,000 live births. In camps for displaced persons there has been a six-fold decline in the MMR from 499 (95%CI 200-780) in 1986-90 to 79 (40-170) in 2006-10, pborder.

  14. The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities.

    Science.gov (United States)

    Ronzio, C R; Pamuk, E; Squires, G D

    2004-03-01

    To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities. Cross sectional ecological study. All cause death rates and death rates attributable to preventable or immediate causes for people under age 75. PREDICTOR MEASURES: Income inequality, city spending, and social factors. All central cities in the US with population equal to or greater than 100 000. Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads. Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.

  15. Maternity waiting homes: A panacea for maternal/neonatal ...

    African Journals Online (AJOL)

    Maternity waiting homes were introduced in Eritrea in 2007 as a strategy to mitigate against the attendant high maternal mortality rates in hard to reach regions. Objective: To assess pregnancy outcomes verified through maternal mortality and perinatal mortality rates since the introduction of maternity waiting homes in some ...

  16. Maternal mortality in the last triennium of the Millennium Development Goal Era at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

    Science.gov (United States)

    Awowole, Ibraheem Olayemi; Badejoko, Olusegun Olalekan; Kuti, Oluwafemi; Ijarotimi, Omotade Adebimpe; Sowemimo, Oluwaseun Oludotun; Ogunduyile, Ifeoluwa Emmanuel

    2018-02-01

    The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was 'Extremely High'. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels. This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy

  17. Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland.

    Science.gov (United States)

    Uggla, Caroline; Mace, Ruth

    2015-09-03

    Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology-that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level-will be associated with a higher risk of preventable death. We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables. We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men. Both behaviours that might lead to 'risky' death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours. © The Author(s) 2015. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.

  18. Preventing Early Child Maltreatment: Implications from a Longitudinal Study of Maternal Abuse History, Substance Use Problems, and Offspring Victimization

    Science.gov (United States)

    Appleyard, Karen; Berlin, Lisa J.; Rosanbalm, Katherine D.; Dodge, Kenneth A.

    2013-01-01

    In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers’ childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab]=.07, 95% CI [.02, .14]; effect size=.26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab]=.05, 95% CI [.01, .11]; effect size =.19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment. PMID:21240556

  19. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Gilmore, Brynne; McAuliffe, Eilish

    2013-09-13

    Community Health Workers are widely utilised in low- and middle-income countries and may be an important tool in reducing maternal and child mortality; however, evidence is lacking on their effectiveness for specific types of programmes, specifically programmes of a preventive nature. This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries. A search strategy was developed according to the Evidence for Policy and Practice Information and Co-ordinating Centre's (EPPI-Centre) guidelines and systematic searching of the following databases occurred between June 8-11th, 2012: CINAHL, Embase, Ovid Nursing Database, PubMed, Scopus, Web of Science and POPLINE. Google, Google Scholar and WHO search engines, as well as relevant systematic reviews and reference lists from included articles were also searched. Inclusion criteria were: i) Target beneficiaries should be pregnant or recently pregnant women and/or children under-5 and/or caregivers of children under-5; ii) Interventions were required to be preventive and delivered by Community Health Workers at the household level. No exclusion criteria were stipulated for comparisons/controls or outcomes. Study characteristics of included articles were extracted using a data sheet and a peer tested quality assessment. A narrative synthesis of included studies was compiled with articles being coded descriptively to synthesise results and draw conclusions. A total of 10,281 studies were initially identified and through the screening process a total of 17 articles detailing 19 studies were included in the review. Studies came from ten different countries and consisted of randomized controlled trials, cluster randomized controlled trials, before and after, case control and cross sectional studies. Overall quality of evidence was found to be moderate. Five main preventive intervention

  20. Syphilis during pregnancy: a preventable threat to maternal-fetal health.

    Science.gov (United States)

    Rac, Martha W F; Revell, Paula A; Eppes, Catherine S

    2017-04-01

    Syphilis remains the most common congenital infection worldwide and has tremendous consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory. Women testing positive for syphilis should undergo a history and physical exam as well as testing for other sexually transmitted infections, including HIV. Serofast syphilis can occur in patients with previous adequate treatment but persistent low nontreponemal titers (Syphilis can infect the fetus in all stages of the disease regardless of trimester and can sometimes be detected with ultrasound >20 weeks. The most common findings include hepatomegaly and placentomegaly, but also elevated peak systolic velocity in the middle cerebral artery (indicative of fetal anemia), ascites, and hydrops fetalis. Pregnancies with ultrasound abnormalities are at higher risk of compromise during syphilotherapy as well as fetal treatment failure. Thus, we recommend a pretreatment ultrasound in viable pregnancies when feasible. The only recommended treatment during pregnancy is benzathine penicillin G and it should be administered according to maternal stage of infection per Centers for Disease Control and Prevention guidelines. Women with a penicillin allergy should be desensitized and then treated with penicillin appropriate for their stage of syphilis. The Jarisch-Herxheimer reaction occurs in up to 44% of gravidas and can cause contractions, fetal heart rate abnormalities, and even stillbirth in the most severely affected pregnancies. We recommend all viable pregnancies receive the first

  1. Nexus of Health and Development: Modelling Crude Birth Rate and Maternal Mortality Ratio Using Nighttime Satellite Images

    Directory of Open Access Journals (Sweden)

    Koel Roychowdhury

    2014-05-01

    Full Text Available Health and development are intricately related. Although India has made significant progress in the last few decades in the health sector and overall growth in GDP, there are still large regional differences in both health and development. The main objective of this paper is to develop techniques for the prediction of health indicators for all the districts of India and examine the correlations between health and development. The level of electrification and district domestic product (DDP are considered as two fundamental indicators of development in this research. These data, along with health metrics and the information from two nighttime satellite images, were used to propose the models. These successfully predicted the health indicators with less than a 7%–10% error. The chosen health metrics, such as crude birth rate (CBR and maternal mortality rate (MMR, were mapped for the whole country at the district level. These metrics showed very strong correlation with development indicators (correlation coefficients ranging from 0.92 to 0.99 at the 99% confidence interval. This is the first attempt to use Visible Infrared Imaging Radiometer Suite (VIIRS (satellite imagery in a socio-economic study. This paper endorses the observation that areas with a higher DDP and level of electrification have overall better health conditions.

  2. Making EmOC a reality--CARE's experiences in areas of high maternal mortality in Africa.

    Science.gov (United States)

    Kayongo, M; Rubardt, M; Butera, J; Abdullah, M; Mboninyibuka, D; Madili, M

    2006-03-01

    This paper describes the package of interventions undertaken by the CARE/AMDD program collaboration to increase the availability and quality of emergency obstetric care for 3 high maternal mortality countries in Africa. Project implementation over 4 years focused on enhancing the capacity of 10 district hospitals in 3 countries - Tanzania, Rwanda and Ethiopia. Interventions were designed to create functional health facilities with trained and competent staff, working in an enabling environment supporting EmOC service delivery. By keeping a clear focus on EmOC, the project achieved modest improvements in services, even in the face of the considerable constraints of rural district hospitals. Availability and utilization of EmOC increased in Tanzania; the met need for EmOC increased slightly from 14% in year 1 to 19% in year 4, while in Rwanda it increased from 16% to 25% over 4 years. Case fatality rates (CFR) declined by 30-50% in all 3 countries. While still well below UN recommendations, in all 3 countries there was also a progressive increase in the cesarean section rates, a life saving obstetric intervention. The increases in met need and decreases in case fatality suggest that project interventions improved the quality and use of EmOC, a critical component for saving women's lives.

  3. Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access.

    Science.gov (United States)

    Ali, M; Hotta, M; Kuroiwa, C; Ushijima, H

    2005-10-01

    To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistan's Punjab and Northwest Frontier Province (NWFP) provinces. Cross-sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n=19); were randomly selected; all public health facilities providing EmOC services (n=170) were included. The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab. Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality.

  4. Effectiveness of National Weather Service heat alerts in preventing mortality in 20 US cities.

    Science.gov (United States)

    Weinberger, Kate R; Zanobetti, Antonella; Schwartz, Joel; Wellenius, Gregory A

    2018-04-09

    Extreme heat is a well-documented public health threat. The US National Weather Service (NWS) issues heat advisories and warnings (collectively, "heat alerts") in advance of forecast extreme heat events. The effectiveness of these alerts in preventing deaths remains largely unknown. To quantify the change in mortality rates associated with heat alerts in 20 US cities between 2001 and 2006. Because NWS heat alerts are issued based on forecast weather and these forecasts are imperfect, in any given location there exists a set of days of similar observed heat index in which heat alerts have been issued for some days but not others. We used a case-crossover design and conditional logistic regression to compare mortality rates on days with versus without heat alerts among such eligible days, adjusting for maximum daily heat index and temporal factors. We combined city-specific estimates into a summary measure using standard random-effects meta-analytic techniques. Overall, NWS heat alerts were not associated with lower mortality rates (percent change in rate: -0.5% [95% CI: -2.8, 1.9]). In Philadelphia, heat alerts were associated with a 4.4% (95% CI: -8.3, -0.3) lower mortality rate or an estimated 45.1 (95% empirical CI: 3.1, 84.1) deaths averted per year if this association is assumed to be causal. No statistically significant beneficial association was observed in other individual cities. Our results suggest that between 2001 and 2006, NWS heat alerts were not associated with lower mortality in most cities studied, potentially missing a valuable opportunity to avert a substantial number of heat-related deaths. These results highlight the need to better link alerts to effective communication and intervention strategies to reduce heat-related mortality. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

    Directory of Open Access Journals (Sweden)

    Parker Jacqui A

    2012-06-01

    Full Text Available Abstract Background Anaemia, in particular due to iron deficiency, is common in pregnancy with associated negative outcomes for mother and infant. However, there is evidence of significant variation in management. The objectives of this review of systematic reviews were to analyse and summarise the evidence base, identify gaps in the evidence and develop a research agenda for this important component of maternity care. Methods Multiple databases were searched, including MEDLINE, EMBASE and The Cochrane Library. All systematic reviews relating to interventions to prevent and treat anaemia in the antenatal and postnatal period were eligible. Two reviewers independently assessed data inclusion, extraction and quality of methodology. Results 27 reviews were included, all reporting on the prevention and treatment of anaemia in the antenatal (n = 24 and postnatal periods (n = 3. Using AMSTAR as the assessment tool for methodological quality, only 12 of the 27 were rated as high quality reviews. The greatest number of reviews covered antenatal nutritional supplementation for the prevention of anaemia (n = 19. Iron supplementation was the most extensively researched, but with ongoing uncertainty about optimal dose and regimen. Few identified reviews addressed anaemia management post-partum or correlations between laboratory and clinical outcomes, and no reviews reported on clinical symptoms of anaemia. Conclusions The review highlights evidence gaps including the management of anaemia in the postnatal period, screening for anaemia, and optimal interventions for treatment. Research priorities include developing standardised approaches to reporting of laboratory outcomes, and information on clinical outcomes relevant to the experiences of pregnant women.

  6. Deep brain stimulation during early adolescence prevents microglial alterations in a model of maternal immune activation.

    Science.gov (United States)

    Hadar, Ravit; Dong, Le; Del-Valle-Anton, Lucia; Guneykaya, Dilansu; Voget, Mareike; Edemann-Callesen, Henriette; Schweibold, Regina; Djodari-Irani, Anais; Goetz, Thomas; Ewing, Samuel; Kettenmann, Helmut; Wolf, Susanne A; Winter, Christine

    2017-07-01

    In recent years schizophrenia has been recognized as a neurodevelopmental disorder likely involving a perinatal insult progressively affecting brain development. The poly I:C maternal immune activation (MIA) rodent model is considered as a neurodevelopmental model of schizophrenia. Using this model we and others demonstrated the association between neuroinflammation in the form of altered microglia and a schizophrenia-like endophenotype. Therapeutic intervention using the anti-inflammatory drug minocycline affected altered microglia activation and was successful in the adult offspring. However, less is known about the effect of preventive therapeutic strategies on microglia properties. Previously we found that deep brain stimulation of the medial prefrontal cortex applied pre-symptomatically to adolescence MIA rats prevented the manifestation of behavioral and structural deficits in adult rats. We here studied the effects of deep brain stimulation during adolescence on microglia properties in adulthood. We found that in the hippocampus and nucleus accumbens, but not in the medial prefrontal cortex, microglial density and soma size were increased in MIA rats. Pro-inflammatory cytokine mRNA was unchanged in all brain areas before and after implantation and stimulation. Stimulation of either the medial prefrontal cortex or the nucleus accumbens normalized microglia density and soma size in main projection areas including the hippocampus and in the area around the electrode implantation. We conclude that in parallel to an alleviation of the symptoms in the rat MIA model, deep brain stimulation has the potential to prevent the neuroinflammatory component in this disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

    Directory of Open Access Journals (Sweden)

    Salime Hadad

    2002-12-01

    Full Text Available This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia, seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.

  8. Could introducing vacuum delivery into the education curriculum of community midwives in Yemen improve maternal and neonatal mortality and morbidity outcomes?

    Science.gov (United States)

    Kizler, Rose; Hollins Martin, Caroline J

    2013-03-01

    At present in Yemen the neonatal mortality rate stands at 12%. A contributing factor is that when abnormalities arise during labour in rural areas, there is an absence of trained medical staff to manage complications. Consequently, childbearing women are expected to travel long distances to hospitals to receive Essential Obstetric Care (EOC). This paper presents a debate over whether vacuum delivery should be introduced into the education curriculum of community midwifery courses in Yemen. It is proposed that this fundamental change to both the educational system and the community midwives role could facilitate a reduction in maternal and neonatal mortality and morbidity figures in Yemen. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Reducción de la mortalidad materna en Chile de 1990 a 2000 The reduction in maternal mortality in Chile, 1990­2000

    Directory of Open Access Journals (Sweden)

    Enrique Donoso Siña

    2004-05-01

    Mortalidad Materna en las Américas, habiendo logrado un descenso de más de 50% de dicha mortalidad en el período 1990­2000. Tal reducción se debe principalmente al descenso de la mortalidad materna por hipertensión arterial, aborto y sepsis puerperal.OBJECTIVE: To determine if Chile achieved the objective of reducing maternal mortality by 50% between 1990 and 2000, in line with the provisions of the Regional Plan of Action for the Reduction of Maternal Mortality in the Americas, which the governments of the Americas approved in 1990 at the 23rd Pan American Sanitary Conference. METHODS: A descriptive, observational study was designed, making it possible to analyze the trend in maternal mortality in Chile from 1990 through 2000. The variables that were evaluated were the maternal mortality ratio, the causes of death, and the age of the mothers who died. The causes of death were classified according to the ninth revision of the International Classification of Diseases (ICD-9, and the raw data were obtained from the yearbooks of the National Institute of Statistics of Chile. The changes in the variables were estimated according to the percentage of cumulative change, and trends were analyzed with the Pearson correlation coefficient. RESULTS: The study found a 60.3% reduction in maternal mortality from 1990 to 2000. The lowest maternal mortality ratio, 18.7 per 100 000 live births, occurred in the year 2000. The five leading causes of maternal mortality were hypertension, miscarriage, other current conditions in the mother, puerperal sepsis, and postpartum hemorrhage. There was a significant downward trend in maternal mortality due to hypertension (r = ­0.712; P = 0.014, abortion (r = ­0.810; P = 0.003, and puerperal sepsis (r = ­0.718; P = 0.013, but there were no statistically significant changes in mortality from other current conditions in the mother or from postpartum hemorrhage. The highest level of maternal mortality was found in women who were 40 years of age or

  10. Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index.

    Science.gov (United States)

    Choe, Seung-Ah; Cho, Sung-Il; Kim, Hongsoo

    2017-09-01

    Reducing maternal mortality has been a crucial part of the global development agenda. According to modernisation theory, the effect of gender equality on maternal health may differ depending on a country's economic development status. We explored the correlation between the Global Gender Gap Index (GGI) provided by the World Economic Forum and the maternal mortality ratio (MMR) obtained from the World Development Indicators database of the World Bank. The relationships between each score in the GGI, including its four sub-indices (measuring gender gaps in economic participation, educational attainment, health and survival, and political empowerment), and the MMR were analysed. When the countries were stratified by gross national income per capita, the low and lower-middle-income countries had lower scores in the GGI, and lower scores in the economic participation, educational attainment, and political empowerment sub-indices than the high-income group. Among the four sub-indices, the educational attainment sub-index showed a significant inverse correlation with the MMR in low and lower-middle-income countries when controlling for the proportion of skilled birth attendance and public share of health expenditure. This finding suggests that strategic efforts to reduce the gender gap in educational attainment could lead to improvements in maternal health in low and lower-middle-income countries.

  11. A replication of the Uruguayan model in the province of Buenos Aires, Argentina, as a public policy for reducing abortion-related maternal mortality.

    Science.gov (United States)

    Matía, Marisa G; Trumper, Eugenia C; Fures, Nery Orlando; Orchuela, Jimena

    2016-08-01

    To describe the application of the risk and harm reduction model at primary care level to decrease the mortality due to unsafe abortion in the Province of Buenos Aires, Argentina, and evaluate the results. The services offered at primary health units to women undergoing abortion are described-first, only risk reduction and later, legal termination of the pregnancy-including their evolution between 2010 and 2015. The changes in abortion-related maternal mortality are also evaluated. The χ(2) test was used to evaluate the differences in the percentage of abortion-related deaths out of the total number of maternal deaths. Primary care services increased progressively, both for risk reduction and for legal termination of pregnancy, which was carried out successfully, including manual vacuum aspiration, by general physicians and midwives. The proportion of abortion-related maternal deaths with respect to total maternal deaths fell by two-thirds between 2010 and 2014 (P<0.001). The Uruguayan risk reduction model was successfully applied in primary care in the Province of Buenos Aires. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. Prevention of Preeclampsia

    Directory of Open Access Journals (Sweden)

    Sammya Bezerra Maia e Holanda Moura

    2012-01-01

    Full Text Available Preeclampsia (PE affects around 2–5% of pregnant women. It is a major cause of maternal and perinatal morbidity and mortality. In an attempt to prevent preeclampsia, many strategies based on antenatal care, change in lifestyle, nutritional supplementation, and drugs have been studied. The aim of this paper is to review recent evidence about primary and secondary prevention of preeclampsia.

  13. Prevention of Preeclampsia

    OpenAIRE

    Bezerra Maia e Holanda Moura, Sammya; Marques Lopes, Laudelino; Murthi, Padma; da Silva Costa, Fabricio

    2012-01-01

    Preeclampsia (PE) affects around 2–5% of pregnant women. It is a major cause of maternal and perinatal morbidity and mortality. In an attempt to prevent preeclampsia, many strategies based on antenatal care, change in lifestyle, nutritional supplementation, and drugs have been studied. The aim of this paper is to review recent evidence about primary and secondary prevention of preeclampsia.

  14. Behind the Slow Road to Progress: Addressing Myriad Causes of the Persistence of Relatively High Maternal Mortality in Brebes Regency after the Post EMAS Program

    Science.gov (United States)

    Kusumo Habsari, Sri; Sofiah, Sofiah; Sumardiyono, Sumardiyono

    2018-02-01

    The purpose of this article is to discuss the restricting factors which hinder the Brebes regency’s goal of reducing maternal and new born mortality, especially in the aspects of communication strategy which has been applied by the local district government. The location of the research was Bulakamba sub-district which has applied the system of “desa siaga madya" (mid-size alert village) but unfortunately has the highest maternal mortality in Brebes regency. Through analyzing data which have been collected by making observation, doing interviews, conducting focus group discussion and studying documents using an interactive data analysis technique, the results show that there are some complex obstacles which hinder the success of the program. Although the local government has attempted to produce health regulations as an intervention, to improve the quality of the health services and to develop special communication strategy, the rate of maternal mortality is still relatively high in this sub-district. However, the cultural change as the impact of modernization and cultural mobility, especially in the coastal area of the regency could not be blamed as one of the myriad causes of the persistence. It still needs a special address from the government to intervene, especially to prepare the society to face the modern life with all of its complexities.

  15. Maternal PUFA omega-3 supplementation prevents hyperoxia-induced pulmonary hypertension in the offspring.

    Science.gov (United States)

    Zhong, Ying; Catheline, Daniel; Houeijeh, Ali; Sharma, Dyuti; Du, Li-Zhong; Besengez, Capucine; Deruelle, Philippe; Legrand, Philippe; Storme, Laurent

    2018-03-29

    Pulmonary hypertension (PH) and right ventricular hypertrophy (RVH) affect 16-25% of premature infants with bronchopulmonary dysplasia (BPD), contributing significantly to perinatal morbidity and mortality. Polyunsaturated fatty acids ω-3 (PUFA ω-3) can improve vascular remodeling, angiogenesis, and inflammation under pathophysiological conditions. However, the effects of PUFA ω-3 supplementation in BPD-associated PH are unknown. The present study aimed to evaluate the effects of PUFA ω-3 on pulmonary vascular remodeling, angiogenesis, and inflammatory response in a hyperoxia-induced rat model of PH. From embryonic day 15, pregnant Spague-Dawley rats were supplemented daily with PUFA ω-3, PUFA ω-6, or normal saline (0.2 ml/day). After birth, pups were pooled, assigned as 12 per litter, and randomly to either in air or continuous oxygen exposure (FiO2 = 85%) for 20 days, then sacrificed for pulmonary hemodynamic and morphometric analysis. We found that PUFA ω-3 supplementation improved survival, decreased right ventricular systolic pressure and RVH caused by hyperoxia, and significantly improved alveolarization, vascular remodeling, and vascular density. PUFA ω-3 supplementation produced a higher level of total ω-3 in lung tissue and breast milk, and was found reversing the reduced levels of VEGFA, VEGFR-2, ANGPT-1, TIE-2, eNOS, and NO concentrations in lung tissue, and the increased ANGPT-2 levels in hyperoxia-exposed rats. The beneficial effects of PUFA ω-3 in improving lung injuries were also associated with an inhibition of leukocyte infiltration, and reduced expression of proinflammatory cytokines IL-1β, IL-6 and TNF-α. These data indicated that maternal PUFA ω-3 supplementation strategies could effectively protect against infant PH induced by hyperoxia.

  16. Maternal antioxidant supplementation prevents adiposity in the offspring of Western diet-fed rats.

    Science.gov (United States)

    Sen, Sarbattama; Simmons, Rebecca A

    2010-12-01

    Obesity in pregnancy significantly increases the risk of the offspring developing obesity after birth. The aims of this study were to test the hypothesis that maternal obesity increases oxidative stress during fetal development, and to determine whether administration of an antioxidant supplement to pregnant Western diet-fed rats would prevent the development of adiposity in the offspring. Female Sprague Dawley rats were started on the designated diet at 4 weeks of age. Four groups of animals were studied: control chow (control); control + antioxidants (control+Aox); Western diet (Western); and Western diet + antioxidants (Western+Aox). The rats were mated at 12 to 14 weeks of age, and all pups were weaned onto control diet. Offspring from dams fed the Western diet had significantly increased adiposity as early as 2 weeks of age as well as impaired glucose tolerance compared with offspring of dams fed a control diet. Inflammation and oxidative stress were increased in preimplantation embryos, fetuses, and newborns of Western diet-fed rats. Gene expression of proadipogenic and lipogenic genes was altered in fat tissue of rats at 2 weeks and 2 months of age. The addition of an antioxidant supplement decreased adiposity and normalized glucose tolerance. CONCLUSIONS; Inflammation and oxidative stress appear to play a key role in the development of increased adiposity in the offspring of Western diet-fed pregnant dams. Restoration of the antioxidant balance during pregnancy in the Western diet-fed dam is associated with decreased adiposity in offspring.

  17. Aquatic Activities During Pregnancy Prevent Excessive Maternal Weight Gain and Preserve Birth Weight: A Randomized Clinical Trial.

    Science.gov (United States)

    Bacchi, Mariano; Mottola, Michelle F; Perales, Maria; Refoyo, Ignacio; Barakat, Ruben

    2018-03-01

    The aim of the present study was to examine the influence of a supervised and regular program of aquatic activities throughout gestation on maternal weight gain and birth weight. A randomized clinical trial. Instituto de Obstetricia, Ginecología y Fertilidad Ghisoni (Buenos Aires, Argentina). One hundred eleven pregnant women were analyzed (31.6 ± 3.8 years). All women had uncomplicated and singleton pregnancies; 49 were allocated to the exercise group (EG) and 62 to the control group (CG). The intervention program consisted of 3 weekly sessions of aerobic and resistance aquatic activities from weeks 10 to 12 until weeks 38 to 39 of gestation. Maternal weight gain, birth weight, and other maternal and fetal outcomes were obtained by hospital records. Student unpaired t test and χ 2 test were used; P values ≤.05 indicated statistical significance. Cohen's d was used to determinate the effect size. There was a higher percentage of women with excessive maternal weight gain in the CG (45.2%; n = 28) than in the EG (24.5%; n = 12; odds ratio = 0.39; 95% confidence interval: 0.17-0.89; P = .02). Birth weight and other pregnancy outcomes showed no differences between groups. Three weekly sessions of water activities throughout pregnancy prevents excessive maternal weight gain and preserves birth weight. The clinicaltrial.gov identifier: NCT 02602106.

  18. Airway tissue plasminogen activator prevents acute mortality due to lethal sulfur mustard inhalation.

    Science.gov (United States)

    Veress, Livia A; Anderson, Dana R; Hendry-Hofer, Tara B; Houin, Paul R; Rioux, Jacqueline S; Garlick, Rhonda B; Loader, Joan E; Paradiso, Danielle C; Smith, Russell W; Rancourt, Raymond C; Holmes, Wesley W; White, Carl W

    2015-01-01

    Sulfur mustard (SM) is a chemical weapon stockpiled today in volatile regions of the world. SM inhalation causes a life-threatening airway injury characterized by airway obstruction from fibrin casts, which can lead to respiratory failure and death. Mortality in those requiring intubation is more than 80%. No therapy exists to prevent mortality after SM exposure. Our previous work using the less toxic analog of SM, 2-chloroethyl ethyl sulfide, identified tissue plasminogen activator (tPA) an effective rescue therapy for airway cast obstruction (Veress, L. A., Hendry-Hofer, T. B., Loader, J. E., Rioux, J. S., Garlick, R. B., and White, C. W. (2013). Tissue plasminogen activator prevents mortality from sulfur mustard analog-induced airway obstruction. Am. J. Respir. Cell Mol. Biol. 48, 439-447). It is not known if exposure to neat SM vapor, the primary agent used in chemical warfare, will also cause death due to airway casts, and if tPA could be used to improve outcome. Adult rats were exposed to SM, and when oxygen saturation reached less than 85% (median: 6.5 h), intratracheal tPA or placebo was given under isoflurane anesthesia every 4 h for 48 h. Oxygen saturation, clinical distress, and arterial blood gases were assessed. Microdissection was done to assess airway obstruction by casts. Intratracheal tPA treatment eliminated mortality (0% at 48 h) and greatly improved morbidity after lethal SM inhalation (100% death in controls). tPA normalized SM-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress. Moreover, tPA treatment resulted in greatly diminished airway casts, preventing respiratory failure from airway obstruction. tPA given via airway more than 6 h after exposure prevented death from lethal SM inhalation, and normalized oxygenation and ventilation defects, thereby rescuing from respiratory distress and failure. Intra-airway tPA should be considered as a life-saving rescue therapy after a significant SM

  19. Association between coverage of maternal and child health interventions, and under-5 mortality: a repeated cross-sectional analysis of 35 sub-Saharan African countries.

    Science.gov (United States)

    Corsi, Daniel J; Subramanian, S V

    2014-01-01

    Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this paper, we investigate the role of coverage of maternal and child health (MNCH) interventions in contributing to declines in child mortality in sub-Saharan Africa. Data are from 81 Demographic and Health Surveys from 35 sub-Saharan African countries. Using ecological time-series and child-level regression models, we estimated the effect of MNCH interventions (summarized by the percent composite coverage index, or CCI) on child mortality with in the first 5 years of life net of temporal trends and covariates at the household, maternal, and child levels. At the ecologic level, a unit increase in standardized CCI was associated with a reduction in under-5 child mortality rate (U5MR) of 29.0 per 1,000 (95% CI: -43.2, -14.7) after adjustment for survey period effects and country-level per capita gross domestic product (pcGDP). At the child level, a unit increase in standardized CCI was associated with an odds ratio of 0.86 for child mortality (95% CI: 0.82-0.90) after adjustment for survey period effect, country-level pcGDP, and a set of household-, maternal-, and child-level covariates. MNCH interventions are important in reducing U5MR, while the effects of economic growth in sub-Saharan Africa remain weak and inconsistent. Improved coverage of proven life-saving interventions will likely contribute to further reductions in U5MR in sub-Saharan Africa.

  20. Association between coverage of maternal and child health interventions, and under-5 mortality: a repeated cross-sectional analysis of 35 sub-Saharan African countries

    Directory of Open Access Journals (Sweden)

    Daniel J. Corsi

    2014-09-01

    Full Text Available Background: Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this paper, we investigate the role of coverage of maternal and child health (MNCH interventions in contributing to declines in child mortality in sub-Saharan Africa. Design: Data are from 81 Demographic and Health Surveys from 35 sub-Saharan African countries. Using ecological time-series and child-level regression models, we estimated the effect of MNCH interventions (summarized by the percent composite coverage index, or CCI on child mortality with in the first 5 years of life net of temporal trends and covariates at the household, maternal, and child levels. Results: At the ecologic level, a unit increase in standardized CCI was associated with a reduction in under-5 child mortality rate (U5MR of 29.0 per 1,000 (95% CI: −43.2, −14.7 after adjustment for survey period effects and country-level per capita gross domestic product (pcGDP. At the child level, a unit increase in standardized CCI was associated with an odds ratio of 0.86 for child mortality (95% CI: 0.82–0.90 after adjustment for survey period effect, country-level pcGDP, and a set of household-, maternal-, and child-level covariates. Conclusions: MNCH interventions are important in reducing U5MR, while the effects of economic growth in sub-Saharan Africa remain weak and inconsistent. Improved coverage of proven life-saving interventions will likely contribute to further reductions in U5MR in sub-Saharan Africa.

  1. The impact of the worldwide Millennium Development Goals campaign on maternal and under-five child mortality reduction: 'Where did the worldwide campaign work most effectively?'

    Science.gov (United States)

    Cha, Seungman

    2017-01-01

    As the Millennium Development Goals campaign (MDGs) came to a close, clear evidence was needed on the contribution of the worldwide MDG campaign. We seek to determine the degree of difference in the reduction rate between the pre-MDG and MDG campaign periods and its statistical significance by region. Unlike the prevailing studies that measured progress in 1990-2010, this study explores by percentage how much MDG progress has been achieved during the MDG campaign period and quantifies the impact of the MDG campaign on the maternal and under-five child mortality reduction during the MDG era by comparing observed values with counterfactual values estimated on the basis of the historical trend. The low accomplishment of sub-Saharan Africa toward the MDG target mainly resulted from the debilitated progress of mortality reduction during 1990-2000, which was not related to the worldwide MDG campaign. In contrast, the other regions had already achieved substantial progress before the Millennium Declaration was proclaimed. Sub-Saharan African countries have seen the most remarkable impact of the worldwide MDG campaign on maternal and child mortality reduction across all different measurements. In sub-Saharan Africa, the MDG campaign has advanced the progress of the declining maternal mortality ratio and under-five mortality rate, respectively, by 4.29 and 4.37 years. Sub-Saharan African countries were frequently labeled as 'off-track', 'insufficient progress', or 'no progress' even though the greatest progress was achieved here during the worldwide MDG campaign period and the impact of the worldwide MDG campaign was most pronounced in this region in all respects. It is time to learn from the success stories of the sub-Saharan African countries. Erroneous and biased measurement should be avoided for the sustainable development goals to progress.

  2. Maternal and neonatal tetanus

    Science.gov (United States)

    Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R

    2017-01-01

    Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58 000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. PMID:25149223

  3. [Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic].

    Science.gov (United States)

    León Carmona, Julio César; Hernández Alvarez, Luis Alfredo Ignacio; Hernández Hernández, Ma Adriana Cecilia

    2002-07-01

    This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950% of participants were married, 22.62% in free union, 4.98% single and 0.45% separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95% confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired

  4. [Maternal filicide in Japan: analyses of 96 cases and future directions for prevention].

    Science.gov (United States)

    Taguchi, Hisako

    2007-01-01

    Maternal filicide is not an isolated phenomenon. When a mother kills her child, she may be affected by many factors and confronted with different problems based on the child's developmental stage. In this study in Japan, a judicial sample of 96 adult women, convicted in their first trial for the murder or attempted murder of their children, was divided into four groups of mothers according to the age of the victim (25 women killed neonates, 22 women infants, 27 women preschool children, and 22 women schoolchildren and/or teenagers) in order to identify the factors that have a major impact on filicide in each group. The socio-demographic, clinical, forensic, circumstantial, and offense characteristics, and legal disposition of 96 cases drawn from judicial records were compared among the four groups using the Kruskal-Wallis test; comparison of two groups was conducted using the Mann-Whitney test. Neonaticide cases were distinguished from the other three groups by marked differences: a significantly higher rate of unmarried mothers, financial difficulties, absence of mental illness, and admission of not wanting an illegitimate child. In the other groups, mental disorders were frequent; in particular, post-partum depression was the primary cause of infanticide. For the two groups of cases involving a child older than one year, filicidal mothers were more affected by circumstantial factors such as health problems of the child or severe marital discord. These problems may then have caused a reactive mental disorder among these mothers. The risk of fatal abuse or neglect was higher for handicapped preschool children. Filicide-suicide was most frequently seen among school-aged children and/or teenagers who had serious behavioral problems, and these children often had a mental disorder. The classification of maternal filicide by age of the child demonstrated that there are specific issues for each group. Based on these findings, future directions for prevention include

  5. Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

    Science.gov (United States)

    Cisse, C

    2017-06-01

    The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many

  6. The intrauterine metabolic environment modulates the gene expression pattern in fetal rat islets: prevention by maternal taurine supplementation

    DEFF Research Database (Denmark)

    Reusens, B; Sparre, T; Kalbe, L

    2008-01-01

    Aims/hypothesis  Events during fetal life may in critical time windows programme tissue development leading to organ dysfunction with potentially harmful consequences in adulthood such as diabetes. In rats, the beta cell mass of progeny from dams fed with a low-protein (LP) diet during gestation...... is decreased at birth and metabolic perturbation lasts through adulthood even though a normal diet is given after birth or after weaning. Maternal and fetal plasma taurine levels are suboptimal. Maternal taurine supplementation prevents these induced abnormalities. In this study, we aimed to reveal changes...... in gene expression in fetal islets affected by the LP diet and how taurine may prevent these changes. Methods  Pregnant Wistar rats were fed an LP diet (8% [wt/wt] protein) supplemented or not with taurine in the drinking water or a control diet (20% [wt/wt] protein). At 21.5 days of gestation, fetal...

  7. Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: results from nine states in India.

    Science.gov (United States)

    Randive, Bharat; San Sebastian, Miguel; De Costa, Ayesha; Lindholm, Lars

    2014-12-01

    Proportion of women giving birth in health institutions has increased sharply in India since the introduction of cash incentive program, Janani Suraksha Yojana (JSY) in 2005. JSY was intended to benefit disadvantaged population who had poor access to institutional care for childbirth and who bore the brunt of maternal deaths. Increase in institutional deliveries following the implementation of JSY needs to be analysed from an equity perspective. We analysed data from nine Indian states to examine the change in socioeconomic inequality in institutional deliveries five years after the implementation of JSY using the concentration curve and concentration index (CI). The CI was then decomposed in order to understand pathways through which observed inequalities occurred. Disparities in access to emergency obstetric care (EmOC) and in maternal mortality reduction among different socioeconomic groups were also assessed. Slope and relative index of inequality were used to estimate absolute and relative inequalities in maternal mortality ratio (MMR). Results shows that although inequality in access to institutional delivery care persists, it has reduced since the introduction of JSY. Nearly 70% of the present inequality was explained by differences in male literacy, EmOC availability in public facilities and poverty. EmOC in public facilities was grossly unavailable. Compared to richest division in nine states, poorest division has 135 more maternal deaths per 100,000 live births in 2010. While MMR has decreased in all areas since JSY, it has declined four times faster in richest areas compared to the poorest, resulting in increased inequalities. These findings suggest that in order for the cash incentive to succeed in reducing the inequalities in maternal health outcomes, it needs to be supported by the provision of quality health care services including EmOC. Improved targeting of disadvantaged populations for the cash incentive program could be considered. Copyright

  8. Strengthening health systems capacity to monitor and evaluate programmes targeted at reducing abortion-related maternal mortality in Jessore district, Bangladesh.

    Science.gov (United States)

    Huda, Fauzia Akhter; Ahmed, Anisuddin; Ford, Evelyn Rebecca; Johnston, Heidi Bart

    2015-09-28

    Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Yet complications from menstrual regulation (MR) and unsafe abortion continue to cause deleterious health, economic and social consequences for women in the country. This quasi experimental design study with a baseline (January to December 2008) and an endline survey (August to October 2009) was conducted in 69 public, private, and NGO sector health facilities in Jessore district of Bangladesh with the objective of adapting and implementing a set of process indicators, specifically to supplement the indicators for monitoring emergency obstetric care interventions. At the baseline, we collected retrospective data from all 69 health facilities that provided MR, legal abortion or post-abortion care (PAC), by reviewing their last one year's records. Three months after introducing the safe menstrual regulation and abortion care (SMRAC) model, endline data was collected. Signal function (critical services that facilities must perform in order to prevent and treat abortion complications) analysis was used to characterize facilities as providing basic care, comprehensive care, or neither. Facility mapping, and records on services provided and complications treated were used to further characterize service availability and to describe service use and quality. No facilities fulfilled criteria for 'comprehensive' care at either the baseline or end line while only one met the 'basic' criteria during the endline of the project. Recommended uterine evacuation technology, manual vacuum aspiration (MVA) was used for 100.0 % of MR clients but only for 8.0 % or fewer PAC patients. MR clients were 37.5 times more likely than PAC patients to leave facilities with a contraceptive method (75.0 % vs. 2.0 %). Persistent use of older uterine evacuation technologies was observed when recommended techniques were widely available in the facilities

  9. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement.

    Science.gov (United States)

    LeFevre, Michael L

    2014-12-02

    Update of the 1996 U.S. Preventive Services Task Force (USPSTF) recommendation on aspirin prophylaxis in pregnancy. The USPSTF reviewed the evidence on the effectiveness of low-dose aspirin in preventing preeclampsia in women at increased risk and in decreasing adverse maternal and perinatal health outcomes, and assessed the maternal and fetal harms of low-dose aspirin during pregnancy. This recommendation applies to asymptomatic pregnant women who are at increased risk for preeclampsia and who have no prior adverse effects with or contraindications to low-dose aspirin. The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. (B recommendation).

  10. Mortalidad materna en Guatemala: diferencias entre muerte hospitalaria y no hospitalaria Maternal mortality in Guatemala: differences between hospital and non-hospital deaths

    Directory of Open Access Journals (Sweden)

    Ana Marina Tzul

    2006-06-01

    Guatemala during 2000, comparing characteristics of intra- and extra-hospital maternal deaths. Multivariate statistical analysis was conducted using Stata 7.0 software RESULTS: Out of 649 registered MM cases, 270 (41.6% were classified as intra-hospital MM and 379 (58.4% as extra-hospital MM. A larger proportion of deaths occurred in women over 35 years of age (29.28%, those of indigenous ethnicity (65.49%, married or cohabiting (87.83%, who had unpaid employment (94.78%, and without formal education (66.56%. Compared with intra-hospital MM cases, the risk of extra-hospital MM was greater among indigenous women (OR 3.4; CI95% 2.8-5.3, those who had unpaid employment (OR 8.95; CI95% 1.7-46.4, a low level of formal education (OR 1.96; CI95% 1.0-3.8 and hemorrhaging as the immediate cause of death (OR 4.28; CI95% 2.3-7.9. CONCLUSIONS: Although some characteristics of intra- and extra-hospital MM cases are similar, a greater proportion of deaths were extra-hospital. This could be related to the high percentage of the population that lives in rural or marginalized areas, which in addition to certain cultural aspects (related to the fact that most of the population is indigenous may impede access to health services. The results of this study can be useful for determining intervention strategies to prevent maternal mortality in intra- and extra-hospital contexts in Guatemala.

  11. Survey of HBsAg-positive pregnant women and their infants regarding measures to prevent maternal-infantile transmission

    Directory of Open Access Journals (Sweden)

    Meina Hu

    2010-02-01

    Full Text Available Abstract Background Intrauterine infection is the main contributor to maternal-infantile transmission of HBV. This is a retrospective study of 158 HBsAg-positive pregnant women who delivered children from Jan 1st, 2004 to Dec.31th, 2006 in Wuhan City, China. We investigated the measures taken to prevent maternal-infantile transmission of hepatitis B virus and the infection status of children. Methods HBsAg-positive pregnant women were selected by a random sampling method when they accepted prenatal care in district-level Maternal and Child Health Hospitals. On a voluntary basis, these women completed questionnaires by face-to-face or phone interviews. The collected data were used to evaluate the immunization programs that pregnant women had received for preventing hepatitis B maternal-infantile transmission. Results Among the 158 women, 143(90.5% received Hepatitis B immune globulin during pregnancy, and 86.0% of their children were given Hepatitis B immune globulin and Hepatitis B vaccine. The rate of cesarean section was 82.3%, and 28.5% of these were aimed at preventing HBV infection. The rate of bottle feeding was 51.9%, and 89.0% of bottle feeding cases were for the purpose of preventing HBV infection. There were 71 cases of participants who were HBeAg-positive. Compared with the HBsAg+ HBeAg- group (only HBsAg-positive, the HBsAg + HBeAg+ group (HBsAg-positive and HBeAg-positive had significantly higher rates of the caesarean section and bottle feeding resulting from hepatitis B (P Conclusion Most HBsAg positive pregnant women have a growing awareness of maternal-infantile transmission of Hepatitis B virus and are receiving some form of preventative treatment, like combined immunization. Caesarean and bottle feeding are very common, often primarily to prevent transmission. Relatively few intrauterine infections were identified in this sample, but many infants did not appear to seroconvert after vaccination.

  12. Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013.

    Science.gov (United States)

    Lamadrid-Figueroa, Hector; Montoya, Alejandra; Fritz, Jimena; Olvera, Marisela; Torres, Luis M; Lozano, Rafael

    2016-01-01

    Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p definition.

  13. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

    Science.gov (United States)

    Kassebaum, Nicholas J; Bertozzi-Villa, Amelia; Coggeshall, Megan S; Shackelford, Katya A; Steiner, Caitlyn; Heuton, Kyle R; Gonzalez-Medina, Diego; Barber, Ryan; Huynh, Chantal; Dicker, Daniel; Templin, Tara; Wolock, Timothy M; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsène Kouablan; Adsuar, José C; Agardh, Emilie E; Akena, Dickens; Alasfoor, Deena; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Al Kahbouri, Mazin J; Alla, François; Allen, Peter J; AlMazroa, Mohammad A; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzmán, Nelson; Amankwaa, Adansi A; Amare, Azmeraw T; Amini, Hassan; Ammar, Walid; Antonio, Carl A T; Anwari, Palwasha; Ärnlöv, Johan; Arsenijevic, Valentina S Arsic; Artaman, Ali; Asad, Majed Masoud; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Badawi, Alaa; Balakrishnan, Kalpana; Basu, Arindam; Basu, Sanjay; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L; Bernabe, Eduardo; Beyene, Tariku J; Bhutta, Zulfiqar; Abdulhak, Aref Bin; Blore, Jed D; Basara, Berrak Bora; Bose, Dipan; Breitborde, Nicholas; Cárdenas, Rosario; Castañeda-Orjuela, Carlos A; Castro, Ruben Estanislao; Catalá-López, Ferrán; Cavlin, Alanur; Chang, Jung-Chen; Che, Xuan; Christophi, Costas A; Chugh, Sumeet S; Cirillo, Massimo; Colquhoun, Samantha M; Cooper, Leslie Trumbull; Cooper, Cyrus; da Costa Leite, Iuri; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Degenhardt, Louisa; De Leo, Diego; del Pozo-Cruz, Borja; Deribe, Kebede; Dessalegn, Muluken; deVeber, Gabrielle A; Dharmaratne, Samath D; Dilmen, Uğur; Ding, Eric L; Dorrington, Rob E; Driscoll, Tim R; Ermakov, Sergei Petrovich; Esteghamati, Alireza; Faraon, Emerito Jose A; Farzadfar, Farshad; Felicio, Manuela Mendonca; Fereshtehnejad, Seyed-Mohammad; de Lima, Graça Maria Ferreira; Forouzanfar, Mohammad H; França, Elisabeth B; Gaffikin, Lynne; Gambashidze, Ketevan; Gankpé, Fortuné Gbètoho; Garcia, Ana C; Geleijnse, Johanna M; Gibney, Katherine B; Giroud, Maurice; Glaser, Elizabeth L; Goginashvili, Ketevan; Gona, Philimon; González-Castell, Dinorah; Goto, Atsushi; Gouda, Hebe N; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Hankey, Graeme J; Harb, Hilda L; Havmoeller, Rasmus; Hay, Simon I; Heredia Pi, Ileana B; Hoek, Hans W; Hosgood, H Dean; Hoy, Damian G; Husseini, Abdullatif; Idrisov, Bulat T; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H; Jahangir, Eiman; Jee, Sun Ha; Jensen, Paul N; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B; Juel, Knud; Kabagambe, Edmond Kato; Kan, Haidong; Karam, Nadim E; Karch, André; Karema, Corine Kakizi; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kazi, Dhruv S; Kemp, Andrew H; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz Ahmed; Khang, Young-Ho; Knibbs, Luke; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kulkarni, Chanda; Kulkarni, Veena S; Kumar, G Anil; Kumar, Kaushalendra; Kumar, Ravi B; Kwan, Gene; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lansingh, Van C; Larsson, Anders; Lee, Jong-Tae; Leigh, James; Leinsalu, Mall; Leung, Ricky; Li, Xiaohong; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S; Lin, Hsien-Ho; Lipshultz, Steven E; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K; London, Stephanie J; Lotufo, Paulo A; Ma, Jixiang; Ma, Stefan; Machado, Vasco Manuel Pedro; Mainoo, Nana Kwaku; Majdan, Marek; Mapoma, Christopher Chabila; Marcenes, Wagner; Marzan, Melvin Barrientos; Mason-Jones, Amanda J; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Memish, Ziad A; Mendoza, Walter; Miller, Ted R; Mills, Edward J; Mokdad, Ali H; Mola, Glen Liddell; Monasta, Lorenzo; de la Cruz Monis, Jonathan; Hernandez, Julio Cesar Montañez; Moore, Ami R; Moradi-Lakeh, Maziar; Mori, Rintaro; Mueller, Ulrich O; Mukaigawara, Mitsuru; Naheed, Aliya; Naidoo, Kovin S; Nand, Devina; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Nelson, Robert G; Neupane, Sudan Prasad; Newton, Charles R; Ng, Marie; Nieuwenhuijsen, Mark J; Nisar, Muhammad Imran; Nolte, Sandra; Norheim, Ole F; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O; Omer, Saad B; Opio, John Nelson; Orisakwe, Orish Ebere; Pandian, Jeyaraj D; Papachristou, Christina; Park, Jae-Hyun; Caicedo, Angel J Paternina; Patten, Scott B; Paul, Vinod K; Pavlin, Boris Igor

    2014-01-01

    Summary Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990–2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017–327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483–407 574) in 1990. The global annual rate of change in the MMR was −0·3% (−1·1 to 0·6) from 1990 to 2003, and −2·7% (−3·9 to −1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290–2866) maternal deaths were related to HIV in 2013, 0·4% (0·2–0·6) of the global total. MMR was highest in the

  14. maternal mortality in Malawi

    African Journals Online (AJOL)

    Tanzania (1996) 0-0877. Chad (1996) 0-4260. Ethiopia (2000) NA. Peru (2000) NA. % of population aged 15-49 with HIV/AIDS (2001 data)10. 0.4. <0.05. 1.9 ... The urban popula- tion tends to be wealthier than their rural counterparts: 71% of the urban population is in the highest quintile compared with only 11% of the rural ...

  15. Prevalence of Congenital Anomalies in an Indian Maternal Cohort: Healthcare, Prevention, and Surveillance Implications.

    Directory of Open Access Journals (Sweden)

    Prajkta Bhide

    Full Text Available India lacks a national birth defects surveillance. Data on the prevalence of congenital anomalies are available mostly from hospital-based, cross-sectional studies. This is the first cohort study from India, where 2107 women were followed till pregnancy outcome, in order to measure the prevalence and types of congenital anomalies, their contribution to neonatal mortality, implications for surveillance, and the health service needs for prevention and management.The study followed a cohort of 2107 pregnant women till outcome which was miscarriage, termination of pregnancy, live or stillbirth, neonatal and post-neonatal mortality. Case ascertainment of congenital anomalies was done through visual examination, followed by various investigations. Rates of congenital anomaly affected births were reported per 10 000 births. Health service needs were described through retrospective analysis of events surrounding the diagnosis of a congenital anomaly.Among 1822 births, the total prevalence of major congenital anomalies was 230.51 (170.99-310.11 per 10 000 births. Congenital heart defects were the most commonly reported anomalies in the cohort with a prevalence of 65.86 (37.72-114.77 per 10 000 births. Although neural tube defects were two and a half times less as compared to congenital heart defects, they were nevertheless significant at a prevalence of 27.44 (11.73-64.08 per 10 000 births. In this cohort, congenital anomalies were the second largest cause of neonatal deaths. The congenital anomaly prenatal diagnosis prevalence was 10.98 per 1000 births and the congenital anomaly termination of pregnancy rate was 4.39 per 1000 births.This first cohort study from India establishes that the congenital anomaly rates were high, affecting one in forty four births in the cohort. The prevalence of congenital anomalies was identical to the stillbirth prevalence in the cohort, highlighting their public health importance. The results of this study identify the

  16. SMFM Special Report: Putting the "M" back in MFM: Reducing racial and ethnic disparities in maternal morbidity and mortality: A call to action.

    Science.gov (United States)

    Jain, Joses A; Temming, Lorene A; D'Alton, Mary E; Gyamfi-Bannerman, Cynthia; Tuuli, Methodius; Louis, Judette M; Srinivas, Sindhu K; Caughey, Aaron B; Grobman, William A; Hehir, Mark; Howell, Elizabeth; Saade, George R; Tita, Alan T N; Riley, Laura E

    2018-02-01

    Racial and ethnic disparities in maternal morbidity and mortality rates are an important public health problem in the United States. Because racial and ethnic minorities are expected to comprise more than one-half of the US population by 2050, this issue needs to be addressed urgently. Research suggests that the drivers of health disparities occur at 3 levels: patient, provider, and system. Although we have recognized this issue and identified elements that contribute to it, knowledge must be converted into action to address it. In addition, despite available funding and databases, research directed towards understanding and reducing these disparities is lacking. This document summarizes findings of a workshop convened at the 2016 Society for Maternal-Fetal Medicine's 36th Annual Pregnancy meeting in Atlanta, GA, to review and make recommendations about immediate actions in clinical care and research that will serve to reduce racial and ethnic disparities in maternal morbidity and mortality rates in the United States. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. [Maternal phenylketonuria].

    Science.gov (United States)

    Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László

    2013-05-05

    Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.

  18. The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA project

    Directory of Open Access Journals (Sweden)

    Ellard David

    2012-10-01

    Full Text Available Abstract Background Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses. Methods/design This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15. Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention. Primary outcome will be maternal and perinatal (defined as until discharge from health facility mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews will be undertaken to evaluate the intervention implementation. Discussion Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings

  19. Time Trends in Incidence and Mortality of Acute Myocardial Infarction, and All-Cause Mortality following a Cardiovascular Prevention Program in Sweden.

    Directory of Open Access Journals (Sweden)

    Gunilla Journath

    Full Text Available In 1988, a cardiovascular prevention program which combined an individual and a population-based strategy was launched within primary health-care in Sollentuna, a municipality in Stockholm County. The aim of this study was to investigate time trends in the incidence of and mortality from acute myocardial infarction and all-cause mortality in Sollentuna compared with the rest of Stockholm County during a period of two decades following the implementation of a cardiovascular prevention program.The average population in Sollentuna was 56,589 (49% men and in Stockholm County (Sollentuna included 1,795,504 (49% men during the study period of 1987-2010. Cases of hospitalized acute myocardial infarction and death were obtained for the population of Sollentuna and the rest of Stockholm County using national registries of hospital discharges and deaths. Acute myocardial infarction incidence and mortality were estimated using the average population of Sollentuna and Stockholm in 1987-2010.During the observation period, the incidence of acute myocardial infarction decreased more in Sollentuna compared with the rest of Stockholm County in women (-22% vs. -7%; for difference in slope <0.05. There was a trend towards a greater decline in Sollentuna compared to the rest of Stockholm County in the incidence of acute myocardial infarction (in men, acute myocardial mortality, and all-cause mortality but the differences were not significant.During a period of steep decline in acute myocardial infarction incidence and mortality in Stockholm County the municipality of Sollentuna showed a stronger trend in women possibly compatible with favorable influence of a cardiovascular prevention program.ClinicalTrials.gov NCT02212145.

  20. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam

    Directory of Open Access Journals (Sweden)

    Hoang Van Minh

    2016-02-01

    Full Text Available Introduction: Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH, termed ‘barriers’. Methods: Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15–49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383 was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1 antenatal care, 2 skilled birth attendants, and 3 child death in the previous 15 years. Independent predictor variables were: 1 low education (incomplete secondary education, 2 lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs and 95% confidence intervals (95% CI were used to report regression results. Results: In Vietnam, about 54% of women aged 15–49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14

  1. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam.

    Science.gov (United States)

    Van Minh, Hoang; Giang, Kim Bao; Hoat, Luu Ngoc; Chung, Le Hong; Huong, Tran Thi Giang; Phuong, Nguyen Thi Kim; Valentine, Nicole B

    2016-01-01

    Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed 'barriers'. Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15-49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. In Vietnam, about 54% of women aged 15-49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14-0.55; OR=0.19, 95% CI: 0.05-0.80) and a higher

  2. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam

    Science.gov (United States)

    Minh, Hoang Van; Giang, Kim Bao; Hoat, Luu Ngoc; Chung, Le Hong; Huong, Tran Thi Giang; Phuong, Nguyen Thi Kim; Valentine, Nicole B.

    2016-01-01

    Introduction Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed ‘barriers’. Methods Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15–49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. Results In Vietnam, about 54% of women aged 15–49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14–0.55; OR=0

  3. Maternal education, dental visits and age of pacifier withdrawal: pediatric dentist role in malocclusion prevention.

    Science.gov (United States)

    Pérez-Suárez, V; Carrillo-Diaz, M; Crego, A; Romero, M

    2013-01-01

    Although discouraged, pacifier usage is widespread and often practiced beyond two years of age. The current study explored the effects of maternal education and dental visits on the age of pacifier withdrawal. The dental histories of 213 children (53.1% male) attending a primary school in Madrid were obtained along with maternal education level and age at pacifier withdrawal. Data were analyzed by using independent samples t-test, one-way ANOVA two-way ANOVA and a complementary non-parametric approach was also used. There was a significant effect of maternal education on the age of pacifier withdrawal; the higher the maternal education, the younger the age of withdrawal. The frequency of dental visits influenced the relationship between maternal education and the age of pacifier withdrawal. Dental visits considerably shortened pacifier use among children with low- and medium-educated mothers. Pediatric dentists play a critical role in the correction of unhealthy oral habits such as prolonged pacifier use. The educational component of pediatric dentistry could reverse the lack of knowledge or misinformation among high-risk groups (e.g. low maternal education). As a consequence, we recommend that children start dental visits at an early age and maintain visits with a high frequency.

  4. Role of breastfeeding cessation in mediating the relationship between maternal HIV disease stage and increased child mortality among HIV-exposed uninfected children.

    Science.gov (United States)

    Fox, Matthew P; Brooks, Daniel R; Kuhn, Louise; Aldrovandi, Grace; Sinkala, Moses; Kankasa, Chipepo; Horsburgh, Robert; Thea, Donald M

    2009-04-01

    Maternal CD4 count predicts child mortality in HIV-uninfected children born to HIV-infected women. To explore the mediating role of breastfeeding cessation in this relationship, we compared marginal structural models of maternal CD4 count on child death with and without adjustment for breastfeeding. In crude analyses, children of mothers with CD4500. Earlier breastfeeding cessation was also associated with low CD4 (HR 1.8; CI 1.2-2.7). After adjusting for breastfeeding and low birth weight using a marginal structural model, the low CD4 count-child mortality association through 18 months was reduced 17%. The change was overestimated using a traditional Cox proportional hazards model (35% reduction in HR from 3.4 to 2.5). Our analysis suggests that only a small part of the effect of low vs high CD4 count on child mortality through 18 months is mediated through breastfeeding cessation. Our results must be taken into account when deciding whether or not to recommend breastfeeding for infants of HIV-infected mothers.

  5. Reduction in maternal and child mortality in sub-Saharan Africa: the yo-yo effect in delivering on the promises.

    Science.gov (United States)

    Mwalali, Philip; Ngui, Emmanuel

    2009-01-01

    Trends in maternal and child mortality (MCM) in sub-Saharan Africa do not follow the patterns seen in developed nations or match the funds and effort invested so far. This paper critically explores trends in MCM, global efforts to reduce MCM, and some of the underlying policies and programmatic issues that have shaped the slow progress or failure in reducing MCM in sub-Saharan Africa. We describe a "yo-yo" effect in policies and funding of Maternal and Child Health, Family Planning, and HIV/AIDS/STI programs in the region, and how this yo-yo effect may limit sustained community level reductions in MCM. We conclude by highlighting how renewed interest in the Alma-Ata declaration, particularly its primary health care concepts with their strong emphasis on horizontally integrated linkage of programs and resources, greater community involvement in program design and implementation, and economic development can contribute to sustainable reductions in MCM in the region.

  6. Which strategies reduce breast cancer mortality most? Collaborative modeling of optimal screening, treatment, and obesity prevention.

    Science.gov (United States)

    Mandelblatt, Jeanne; van Ravesteyn, Nicolien; Schechter, Clyde; Chang, Yaojen; Huang, An-Tsun; Near, Aimee M; de Koning, Harry; Jemal, Ahmedin

    2013-07-15

    US breast cancer mortality is declining, but thousands of women still die each year. Two established simulation models examine 6 strategies that include increased screening and/or treatment or elimination of obesity versus continuation of current patterns. The models use common national data on incidence and obesity prevalence, competing causes of death, mammography characteristics, treatment effects, and survival/cure. Parameters are modified based on obesity (defined as BMI  ≥  30 kg/m(2) ). Outcomes are presented for the year 2025 among women aged 25+ and include numbers of cases, deaths, mammograms and false-positives; age-adjusted incidence and mortality; breast cancer mortality reduction and deaths averted; and probability of dying of breast cancer. If current patterns continue, the models project that there would be about 50,100-57,400 (range across models) annual breast cancer deaths in 2025. If 90% of women were screened annually from ages 40 to 54 and biennially from ages 55 to 99 (or death), then 5100-6100 fewer deaths would occur versus current patterns, but incidence, mammograms, and false-positives would increase. If all women received the indicated systemic treatment (with no screening change), then 11,400-14,500 more deaths would be averted versus current patterns, but increased toxicity could occur. If 100% received screening plus indicated therapy, there would be 18,100-20,400 fewer deaths. Eliminating obesity yields 3300-5700 fewer breast cancer deaths versus continuation of current obesity levels. Maximal reductions in breast cancer deaths could be achieved through optimizing treatment use, followed by increasing screening use and obesity prevention. © 2013 American Cancer Society.

  7. Behavioral counseling to prevent childhood obesity--study protocol of a pragmatic trial in maternity and child health care.

    Science.gov (United States)

    Mustila, Taina; Keskinen, Päivi; Luoto, Riitta

    2012-07-03

    Prevention is considered effective in combating the obesity epidemic. Prenatal environment may increase offspring's risk for obesity. A child starts to adopt food preferences and other behavioral habits affecting weight gain during preschool years. We report the study protocol of a pragmatic lifestyle intervention aiming at primary prevention of childhood obesity. A non-randomized controlled pragmatic trial in maternity and child health care clinics. The control group was recruited among families who visited the same clinics one year earlier. Eligibility criteria was mother at risk for gestational diabetes: body mass index ≥ 25 kg/m2, macrosomic newborn in any previous pregnancy, immediate family history of diabetes and/or age ≥ 40 years. All maternity clinics in town involved in recruitment. The gestational intervention consisted of individual counseling on diet and physical activity by a public health nurse, and of two group counseling sessions. Intervention continues until offspring's age of five years. An option to participate a group counseling at child's age 1 to 2 years was offered. The intervention includes advice on healthy diet, physical activity, sedentary behavior and sleeping pattern. The main outcome measure is offspring BMI z-score and its changes by the age of six years. Early childhood is a critical time period for prevention of obesity. Pragmatic trials targeting this period are necessary in order to find effective obesity prevention programs feasible in normal health care practice.

  8. Enterocyte-specific epidermal growth factor prevents barrier dysfunction and improves mortality in murine peritonitis.

    Science.gov (United States)

    Clark, Jessica A; Gan, Heng; Samocha, Alexandr J; Fox, Amy C; Buchman, Timothy G; Coopersmith, Craig M

    2009-09-01

    Systemic administration of epidermal growth factor (EGF) decreases mortality in a murine model of septic peritonitis. Although EGF can have direct healing effects on the intestinal mucosa, it is unknown whether the benefits of systemic EGF in peritonitis are mediated through the intestine. Here, we demonstrate that enterocyte-specific overexpression of EGF is sufficient to prevent intestinal barrier dysfunction and improve survival in peritonitis. Transgenic FVB/N mice that overexpress EGF exclusively in enterocytes (IFABP-EGF) and wild-type (WT) mice were subjected to either sham laparotomy or cecal ligation and puncture (CLP). Intestinal permeability, expression of the tight junction proteins claudins-1, -2, -3, -4, -5, -7, and -8, occludin, and zonula occludens-1; villus length; intestinal epithelial proliferation; and epithelial apoptosis were evaluated. A separate cohort of mice was followed for survival. Peritonitis induced a threefold increase in intestinal permeability in WT mice. This was associated with increased claudin-2 expression and a change in subcellular localization. Permeability decreased to basal levels in IFABP-EGF septic mice, and claudin-2 expression and localization were similar to those of sham animals. Claudin-4 expression was decreased following CLP but was not different between WT septic mice and IFABP-EGF septic mice. Peritonitis-induced decreases in villus length and proliferation and increases in apoptosis seen in WT septic mice did not occur in IFABP-EGF septic mice. IFABP-EGF mice had improved 7-day mortality compared with WT septic mice (6% vs. 64%). Since enterocyte-specific overexpression of EGF is sufficient to prevent peritonitis-induced intestinal barrier dysfunction and confers a survival advantage, the protective effects of systemic EGF in septic peritonitis appear to be mediated in an intestine-specific fashion.

  9. Preventing heat-related morbidity and mortality: new approaches in a changing climate.

    Science.gov (United States)

    O'Neill, Marie S; Carter, Rebecca; Kish, Jonathan K; Gronlund, Carina J; White-Newsome, Jalonne L; Manarolla, Xico; Zanobetti, Antonella; Schwartz, Joel D

    2009-10-20

    Due to global climate change, the world will, on average, experience a higher number of heat waves, and the intensity and length of these heat waves is projected to increase. Knowledge about the implications of heat exposure to human health is growing, with excess mortality and illness occurring during hot weather in diverse regions. Certain groups, including the elderly, the urban poor, and those with chronic health conditions, are at higher risk. Preventive actions include: establishing heat wave warning systems; making cool environments available (through air conditioning or other means); public education; planting trees and other vegetation; and modifying the built environment to provide proper ventilation and use materials and colors that reduce heat build-up and optimize thermal comfort. However, to inspire local prevention activities, easily understood information about the strategies' benefits needs to be incorporated into decision tools. Integrating heat health information into a comprehensive adaptation planning process can alert local decision-makers to extreme heat risks and provide information necessary to choose strategies that yield the largest health improvements and cost savings. Tools to enable this include web-based programs that illustrate effective methods for including heat health in comprehensive local-level adaptation planning; calculate costs and benefits of several activities; maps showing zones of high potential heat exposure and vulnerable populations in a local area; and public awareness materials and training for implementing preventive activities. A new computer-based decision tool will enable local estimates of heat-related health effects and potential savings from implementing a range of prevention strategies.

  10. Training-of-trainers of nurses and midwives as a strategy for the reduction of eclampsia-related maternal mortality in Nigeria

    Directory of Open Access Journals (Sweden)

    Jamilu Tukur

    2016-01-01

    Full Text Available Background: Preeclampsia and eclampsia (PE/E are major contributors to maternal and perinatal mortality in Nigeria. Despite the availability of current curriculum at Nigerian schools of nursing and midwifery, the knowledge on the management of PE/E among the students has remained poor. In order to reduce maternal and perinatal mortality in developing countries, targeted training and supportive supervision of frontline health care providers have been recommended. Methodology: A total of 292 tutors from 171 schools of nursing and midwifery participated in the training of the trainers' workshops on current management of PE/E across the country. Pre- and post-test assessments were administered. Six months after the training, 29 schools and 84 tutors were randomly selected for follow-up to evaluate the impact of the training. Results: Significant knowledge transfer occurred among the participants as the pretest/posttest analysis showed knowledge transmission across all the 13 knowledge items assessed. The follow-up evaluation also showed that the trained tutors conducted 19 step-down trainings and trained 157 other tutors in their respective schools. Subsequently, 2382 nursing and midwifery students were properly trained. However, six of the monitored schools (24.2% lacked all the essential kits for teaching on PE/E. Conclusion: Updating the knowledge of tutors leads to improved preservice training of the future generation of nurses and midwives. This will likely result in higher quality of care to patients and reduce PE/E-related maternal and perinatal mortality. However, there is need to provide essential training kits for teaching of student nurses and midwives.

  11. Maternal health and human rights | Ratsma | Malawi Medical Journal

    African Journals Online (AJOL)

    In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality.

  12. Choline prevents fetal overgrowth and normalizes placental fatty acid and glucose metabolism in a mouse model of maternal obesity.

    Science.gov (United States)

    Nam, Juha; Greenwald, Esther; Jack-Roberts, Chauntelle; Ajeeb, Tamara T; Malysheva, Olga V; Caudill, Marie A; Axen, Kathleen; Saxena, Anjana; Semernina, Ekaterina; Nanobashvili, Khatia; Jiang, Xinyin

    2017-11-01

    Maternal obesity increases placental transport of macronutrients, resulting in fetal overgrowth and obesity later in life. Choline participates in fatty acid metabolism, serves as a methyl donor and influences growth signaling, which may modify placental macronutrient homeostasis and affect fetal growth. Using a mouse model of maternal obesity, we assessed the effect of maternal choline supplementation on preventing fetal overgrowth and restoring placental macronutrient homeostasis. C57BL/6J mice were fed either a high-fat (HF, 60% kcal from fat) diet or a normal (NF, 10% kcal from fat) diet with a drinking supply of either 25 mM choline chloride or control purified water, respectively, beginning 4 weeks prior to mating until gestational day 12.5. Fetal and placental weight, metabolites and gene expression were measured. HF feeding significantly (P<.05) increased placental and fetal weight in the HF-control (HFCO) versus NF-control (NFCO) animals, whereas the HF choline-supplemented (HFCS) group effectively normalized placental and fetal weight to the levels of the NFCO group. Compared to HFCO, the HFCS group had lower (P<.05) glucose transporter 1 and fatty acid transport protein 1 expression as well as lower accumulation of glycogen in the placenta. The HFCS group also had lower (P<.05) placental 4E-binding protein 1 and ribosomal protein s6 phosphorylation, which are indicators of mechanistic target of rapamycin complex 1 activation favoring macronutrient anabolism. In summary, our results suggest that maternal choline supplementation prevented fetal overgrowth in obese mice at midgestation and improved biomarkers of placental macronutrient homeostasis. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. A parsimonious explanation for intersecting perinatal mortality curves: understanding the effects of race and of maternal smoking

    Directory of Open Access Journals (Sweden)

    Joseph K S

    2004-04-01

    Full Text Available Abstract Background Neonatal mortality rates among black infants are lower than neonatal mortality rates among white infants at birth weights Methods We used data on births in the United States in 1997 after excluding those with a birth weight Results Perinatal mortality rates (calculated per convention were lower among blacks than whites at lower birth weights and at preterm gestational ages, while blacks had higher mortality rates at higher birth weights and later gestational ages. With the fetuses-at-risk approach, mortality curves did not intersect; blacks had higher mortality rates at all gestational ages. Increases in birth rates and (especially growth-restriction rates presaged gestational age-dependent increases in perinatal mortality. Similar findings were obtained in comparisons of smokers versus nonsmokers. Conclusions Formulating perinatal risk based on the fetuses-at-risk approach solves the intersecting perinatal mortality curves paradox; blacks have higher perinatal mortality rates than whites and smokers have higher perinatal mortality rates than nonsmokers at all gestational ages and birth weights.

  14. Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking

    Science.gov (United States)

    Ride, Jemimah; Lorgelly, Paula; Tran, Thach; Wynter, Karen; Rowe, Heather; Fisher, Jane

    2016-01-01

    Objectives Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems. Design The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial. Setting 48 Maternal and Child Health Centres in Victoria, Australia. Participants Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm. Intervention WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue. Outcome measures The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics. Results The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold. Conclusions The results

  15. Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking.

    Science.gov (United States)

    Ride, Jemimah; Lorgelly, Paula; Tran, Thach; Wynter, Karen; Rowe, Heather; Fisher, Jane

    2016-11-18

    Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems. The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial. 48 Maternal and Child Health Centres in Victoria, Australia. Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm. WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue. The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics. The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold. The results suggest that, although WWWT shows promise as a preventive intervention for postnatal

  16. Prevention of Prespawning Mortality: Cause of Salmon Headburns and Cranial Lesions

    Energy Technology Data Exchange (ETDEWEB)

    Neitzel, Duane A.; Elston, R A.; Abernethy, Cary S.

    2004-06-01

    This project was to undertaken to provide information about a condition known as ''headburn''. Information from the project will enable U.S. Corps of Engineers managers to make adjustments in operational procedures or facilities on the Columbia and Snake rivers to prevent loss of pre-spawning adult salmonids that migrate through the facilities. Headburn is a descriptive clinical term used by fishery biologists to describe scalping or exfoliation of skin and ulceration of underlying connective tissue and muscle, primarily of the jaw and cranial region of salmonids observed at fish passage facilities. Headburn lesions are primarily caused when fish collide with concrete or other structures at dams and fish passage facilities, and may be exacerbated in some fish that ''fallback'' or pass over spillways or through turbine assemblies after having passed the dam through a fish ladder. Prespawning mortality of headburned salmonids can be prevented or greatly reduced by therapeutic treatment of both hatchery and wild fish. Treatments would consist of topical application of an anti-fungal agent, injection of replacement plasma electrolytes into the peritoneal cavity, and injection of a broad-spectrum antibacterial agent at fish passage and trapping facilities or hatcheries.

  17. Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Marta C Nunes

    2018-01-01

    Full Text Available The influenza virus circulates yearly and causes global epidemics. Influenza infection affects all age groups and causes mild to severe illness, and young infants are at particular risk for serious disease. The most effective measure to prevent influenza disease is vaccination; however, no vaccine is licensed for use in infants younger than 6 months old. Thus, there is a crucial need for other preventive strategies in this high-risk age group. Influenza vaccination during pregnancy protects both the mothers and the young infants against influenza infection. Vaccination during pregnancy boosts the maternal antibodies and increases the transfer of immunoglobulin G from the mother to the fetus through the placenta, which confers protection against infection in infants too young to be vaccinated. Data from clinical trials and observational studies did not demonstrate adverse effects to the mother, the fetus, or the infant after maternal influenza vaccination. We present the current data on the effectiveness and safety of influenza vaccination during pregnancy in preventing disease in the young infant.

  18. Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries.

    Science.gov (United States)

    McKinnon, Britt; Harper, Sam; Kaufman, Jay S

    2016-02-01

    To examine socioeconomic and health system determinants of wealth-related inequalities in neonatal mortality rates (NMR) across 48 low- and middle-income countries. We used data from Demographic and Health Surveys conducted between 2006 and 2012. Absolute and relative inequalities for NMR and coverage of antenatal care, facility-based delivery, and Caesarean delivery were measured using the Slope Index of Inequality and Relative Index of Inequality, respectively. Meta-regression was used to assess whether variation in the magnitude of NMR inequalities was associated with inequalities in coverage of maternal health services, and whether country-level economic and health system factors were associated with mean NMR and socioeconomic inequality in NMR. Of the three maternal health service indicators examined, the magnitude of socioeconomic inequality in NMR was most strongly related to inequalities in antenatal care. NMR inequality was greatest in countries with higher out-of-pocket health expenditures, more doctors per capita, and a higher adolescent fertility rate. Determinants of lower mean NMR (e.g., higher government health expenditures and a greater number of nurses/midwives per capita) differed from factors associated with lower NMR inequality. Reducing the financial burden of maternal health services and achieving universal coverage of antenatal care may contribute to a reduction in socioeconomic differences in NMR. Further investigation of the mechanisms contributing to these cross-national associations seems warranted.

  19. Effects of prenatal micronutrient and early food supplementation on maternal hemoglobin, birth weight, and infant mortality among children in Bangladesh: the MINIMat randomized trial.

    Science.gov (United States)

    Persson, Lars Åke; Arifeen, Shams; Ekström, Eva-Charlotte; Rasmussen, Kathleen M; Frongillo, Edward A; Yunus, Md

    2012-05-16

    Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences. To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes. A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009. Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation). Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed. Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, -0.9 g/L; 95% CI, -1.7 to -0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5

  20. Maternal L-glutamine supplementation prevents prenatal alcohol exposure-induced fetal growth restriction in an ovine model.

    Science.gov (United States)

    Sawant, Onkar B; Wu, Guoyao; Washburn, Shannon E

    2015-06-01

    Prenatal alcohol exposure is known to cause fetal growth restriction and disturbances in amino acid bioavailability. Alterations in these parameters can persist into adulthood and low birth weight can lead to altered fetal programming. Glutamine has been associated with the synthesis of other amino acids, an increase in protein synthesis and it is used clinically as a nutrient supplement for low birth weight infants. The aim of this study was to explore the effect of repeated maternal alcohol exposure and L-glutamine supplementation on fetal growth and amino acid bioavailability during the third trimester-equivalent period in an ovine model. Pregnant sheep were randomly assigned to four groups, saline control, alcohol (1.75-2.5 g/kg), glutamine (100 mg/kg, three times daily) or alcohol + glutamine. In this study, a weekend binge drinking model was followed where treatment was done 3 days per week in succession from gestational day (GD) 109-132 (normal term ~147). Maternal alcohol exposure significantly reduced fetal body weight, height, length, thoracic girth and brain weight, and resulted in decreased amino acid bioavailability in fetal plasma and placental fluids. Maternal glutamine supplementation successfully mitigated alcohol-induced fetal growth restriction and improved the bioavailability of glutamine and glutamine-related amino acids such as glycine, arginine, and asparagine in the fetal compartment. All together, these findings show that L-glutamine supplementation enhances amino acid availability in the fetus and prevents alcohol-induced fetal growth restriction.

  1. The role of the parents’ perception of the postpartum period and knowledge of maternal mortality in uptake of postnatal care: a qualitative exploration in Malawi

    Directory of Open Access Journals (Sweden)

    Zamawe CF

    2015-06-01

    Full Text Available Collins F Zamawe, Gibson C Masache, Albert N Dube Parent and Child Health Initiative (PACHI, Research Centre, Lilongwe, Malawi Background: Postpartum is the most risky period for both mothers and newborn babies. However, existing evidence suggests that utilization of postnatal care is relatively lower when compared to uptake of other similar health care services. Therefore, the aim of this study was to examine the perceptions of parents toward the postpartum period and postnatal care in order to deepen our understanding of the maternal care-seeking practices after childbirth. Methods: A descriptive qualitative study, comprising four focus group discussions with 50 parents aged between 18 and 35 years, was conducted in Malawi between January and March 2014. Only young men and women who had either given birth or fathered a baby within 12 months prior to the study were eligible to participate in this study. This was to ensure that only participants who had recent first-hand postpartum experience were included. Local leaders purposively identified all parents who met the inclusion criteria and then simple random sampling was used to select participants from this pool of parents. Data analysis followed the six steps of thematic approach developed by Braun and Clarke, and NVivo software aided the process. Findings: The parents interviewed described the various factors relating to pregnancy, childbirth, and postpartum periods that may possibly influence uptake of postnatal care. These factors were categorized into the following three themes: beliefs about the causes of maternal morbidity and mortality; risks associated with the pregnancy, childbirth and postpartum periods; and the importance of and barriers to postnatal care. Most participants perceived pregnancy and childbirth as the most risky periods to women, and their understanding of the causes of maternal death differed considerably from the existing evidence. In addition, segregation of mother

  2. Fine Particulate Matter and Total Mortality in Cancer Prevention Study Cohort Reanalysis

    Directory of Open Access Journals (Sweden)

    James E. Enstrom

    2017-03-01

    Full Text Available Background: In 1997 the US Environmental Protection Agency (EPA established the National Ambient Air Quality Standard (NAAQS for fine particulate matter (PM2.5, largely because of its positive relationship to total mortality in the 1982 American Cancer Society Cancer Prevention Study (CPS II cohort. Subsequently, EPA has used this relationship as the primary justification for many costly regulations, most recently the Clean Power Plan. An independent analysis of the CPS II data was conducted in order to test the validity of this relationship. Methods: The original CPS II questionnaire data, including 1982 to 1988 mortality follow-up, were analyzed using Cox proportional hazards regression. Results were obtained for 292 277 participants in 85 counties with 1979-1983 EPA Inhalable Particulate Network PM2.5 measurements, as well as for 212 370 participants in the 50 counties used in the original 1995 analysis. Results: The 1982 to 1988 relative risk (RR of death from all causes and 95% confidence interval adjusted for age, sex, race, education, and smoking status was 1.023 (0.997-1.049 for a 10 µg/m3 increase in PM2.5 in 85 counties and 1.025 (0.990-1.061 in the 50 original counties. The fully adjusted RR was null in the western and eastern portions of the United States, including in areas with somewhat higher PM2.5 levels, particularly 5 Ohio Valley states and California. Conclusion: No significant relationship between PM2.5 and total mortality in the CPS II cohort was found when the best available PM2.5 data were used. The original 1995 analysis found a positive relationship by selective use of CPS II and PM2.5 data. This independent analysis of underlying data raises serious doubts about the CPS II epidemiologic evidence supporting the PM2.5 NAAQS. These findings provide strong justification for further independent analysis of the CPS II data.

  3. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial.

    Science.gov (United States)

    Dumont, Alexandre; Fournier, Pierre; Abrahamowicz, Michal; Traoré, Mamadou; Haddad, Slim; Fraser, William D

    2013-07-13

    Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second

  4. Annual rates of decline in child, maternal, HIV, and tuberculosis mortality across 109 countries of low and middle income from 1990 to 2013: an assessment of the feasibility of post-2015 goals.

    Science.gov (United States)

    Verguet, Stéphane; Norheim, Ole Frithjof; Olson, Zachary D; Yamey, Gavin; Jamison, Dean T

    2014-12-01

    Measuring a country's health performance has focused mostly on estimating levels of mortality. An alternative is to measure rates of decline in mortality, which are more sensitive to changes in health policy than are mortality levels. Historical rates of decline in mortality can also help test the feasibility of future health goals (eg, post-2015). We aimed to assess the annual rates of decline in under-5, maternal, tuberculosis, and HIV mortality over the past two decades for 109 low-income and middle-income countries. For the period 1990-2013, we estimated annual rates of decline in under-5 mortality (deaths per 1000 livebirths), the maternal mortality ratio (deaths per 100 000 livebirths), and tuberculosis and HIV mortality (deaths per 100 000 population per year) using published data from UNICEF and WHO. For every 5-year interval (eg, 1990-95), we defined performance as the size of the annual rate of decline for every mortality indicator. Subsequently, we tested the feasibility of post-2015 goals by estimating the year by which countries would achieve 2030 targets proposed by The Lancet's Commission on Investing in Health (ie, 20 deaths per 1000 for under-5 mortality, 94 deaths per 100 000 for maternal mortality, four deaths per 100 000 for tuberculosis mortality, and eight deaths per 100 000 for HIV mortality) at observed country and aspirational best-performer (90th percentile) rates. From 2005 to 2013, the mean annual rate of decline in under-5 mortality was 4·3% (95% uncertainty interval [UI] 3·9-4·6), for maternal mortality it was 3·3% (2·5-4·1), for tuberculosis mortality 4·1% (2·8-5·4), and for HIV mortality 2·2% (0·1-4·3); aspirational best-performer rates per year were 7·1% (6·8-7·5), 6·3% (5·5-7·1), 12·8% (11·5-14·1), and 15·3% (13·2-17·4), respectively. The top two country performers were Macedonia and South Africa for under-5 mortality, Belarus and Bulgaria for maternal mortality, Uzbekistan and Macedonia for

  5. Maternal Medication and Herbal Use and Risk for Hypospadias: Data from the National Birth Defects Prevention Study, 1997--2007

    Science.gov (United States)

    Lind, Jennifer N.; Tinker, Sarah C.; Broussard, Cheryl S.; Reefhuis, Jennita; Carmichael, Suzan L.; Honein, Margaret A.; Olney, Richard S.; Parker, Samantha E.; Werler, Martha M.

    2014-01-01

    Purpose Investigate associations between maternal use of common medications and herbals during early pregnancy and risk for hypospadias in male infants. Methods We used data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. We analyzed data from 1,537 infants with second-or third-degree isolated hypospadias and 4,314 liveborn male control infants without major birth defects, with estimated dates of delivery from 1997–2007. Exposure was reported use of prescription or over-the-counter medications or herbal products, from 1 month before to 4 months after conception. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using multivariable logistic regression, adjusting for maternal age, race/ethnicity, education, pre-pregnancy BMI, previous live births, maternal sub-fertility, study site, and year. Results We assessed 64 medication and 24 herbal components. Maternal uses of most components were not associated with an increased risk of hypospadias. Two new associations were observed for venlafaxine (aOR 2.4; 95% CI 1.0, 6.0) and progestin only oral contraceptives (aOR 1.9, 95% CI 1.1, 3.2). The previously reported association for clomiphene citrate was confirmed (aOR 1.9, 95% CI 1.2, 3.0). Numbers were relatively small for exposure to other specific patterns of fertility agents, but elevated aORs were observed for the most common of them. Conclusions Overall, findings were reassuring that hypospadias is not associated with most medication components examined in this analysis. New associations will need to be confirmed in other studies. Increased risks for hypospadias associated with various fertility agents raises the possibility of confounding by underlying subfertility. PMID:23620412

  6. Maternal occupational exposure to polycyclic aromatic hydrocarbons and craniosynostosis among offspring in the National Birth Defects Prevention Study.

    Science.gov (United States)

    O'Brien, Jacqueline L; Langlois, Peter H; Lawson, Christina C; Scheuerle, Angela; Rocheleau, Carissa M; Waters, Martha A; Symanski, Elaine; Romitti, Paul A; Agopian, A J; Lupo, Philip J

    2016-01-01

    Evidence in animal models and humans suggests that exposure to polycyclic aromatic hydrocarbons (PAHs) may lead to birth defects. To our knowledge, this relationship has not been evaluated for craniosynostosis, a birth defect characterized by the premature closure of sutures in the skull. We conducted a case-control study to examine associations between maternal occupational exposure to PAHs and craniosynostosis. We used data from craniosynostosis cases and control infants in the National Birth Defects Prevention Study (NBDPS) with estimated delivery dates from 1997 to 2002. Industrial hygienists reviewed occupational data from the computer-assisted telephone interview and assigned a yes/no rating of probable occupational PAH exposure for each job from 1 month before conception through delivery. We used logistic regression to assess the association between occupational exposure to PAHs and craniosynostosis. The prevalence of exposure was 5.3% in case mothers (16/300) and 3.7% in control mothers (107/2,886). We observed a positive association between exposure to