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PubMed2004

[Maternal mortality estimation in France, according to a new method].

OBJECTIVE: Ten years after implementation of maternal mortality monitoring in France, we established a new estimate of the current maternal mortality ratio (MMR) and revisited maternal death data collection. MATERIAL AND METHODS: Linkages were set up between female deaths and childbirths and between female deaths and causes of death. Information provided by confidential inquiries into maternal deaths carried out by the National Committee for maternal mortality study was added. The World Health Organization (WHO) definitions were used for maternal death and maternal mortality ratio. The study concerned deaths occurring in 1999. Results were compared with data from 1989. RESULTS: The official data showed 20% fewer maternal deaths than our inquiry. Estimated from our data, the MMR was 9 per 100000 live births in 1999. Direct obstetric causes were more often recorded than indirect causes. Hemorrhage was the leading obstetric cause of maternal death (21%). In comparison with the 1989-90 data, the underestimation of maternal deaths and maternal mortality ratios are improving (from 18 to 9 per 100000). CONCLUSION: These results, obtained while the mean maternal age at childbirth increased regularly, are interpreted as a sign of improvement in care. But the persistence of post partum hemorrhages as the leading cause of maternal death and the high rate of avoidable deaths, disclose important targets for further progress.

Cause of Death↗

PubMed1998

Maternal mortality regionalization and trend in Mexico (1937-1995)

BACKGROUND: The objectives were to establish regions by level of maternal mortality in order to evaluate its trend from 1937-1995 and to analyze characteristics of cases which occurred from 1990-1995. METHODS: Regionalization of the country by maternal mortality level was carried out using Poisson regression. Level and mortality trends were analyzed globally and compared by regions using Poisson and linear regression. Characteristics of cases were analyzed from 1990-1995 using proportions and X2 test. RESULTS: Four well-differentiated and independent regions were established. Low and medium maternal mortality rate regions were found in northern and northwestern Mexico. High and very high maternal mortality regions were found in the South and the Southeast of the country. Even when maternal mortality had descended, the speed of the descent has decreased and in the last few years, maternal mortality has increased. The quality of health care is a challenge for regions with low mortality rates, while the problem of accessibility is present in those with very high mortality rates. CONCLUSION: The employment of this regionalization approach in maternal mortality analysis would be useful to determine specific problems for each region. The establishment of programs according to this analysis could contribute to decrease in maternal mortality cases in Mexico.

Adolescent↗

PubMed1975

Maternal mortality in Western Nigeria.

Data on maternal deaths were collected from a randomly selected sample of medical institutions in the Western State of Nigeria for the years 1972 and 1973. An overall maternal mortality rate of 3.8/1000 total births were recorded for 1972 and 1973 respectively. The major causes of maternal mortality were haemorrhage, obstructed labour, eclampsia, anaemia of pregnancy and infection.

Anemia↗

PubMed1997

Underreporting and misclassification of maternal mortality in Taiwan.

BACKGROUND: Underreporting and misclassification of maternal deaths are universal. The purposes of this study were to quantify the level of underestimation of maternal mortality and to analyze possible factors that contribute to underreporting and misclassification of maternal mortality. METHODS: An interview census of all registered deaths that occurred during 1984-1988 in women of reproductive age was undertaken in Taiwan. Pregnancy-related deaths were screened from all collected questionnaires and death certificates by the researchers. The screened pregnancy-related deaths were then reviewed and evaluated by obstetrician-gynecologists; a cause of each death was assigned. RESULTS: For the five years, on average, the rate of underreporting of maternal mortality is 58.38% and the correct/confirmed rate of classification is 53.28%. Underreported and misclassified maternal deaths are more likely for women aged 20-24, with stillbirth and fetal death, care sought for non-obstetric reasons, care received in private hospitals and clinics, occurrence in the home, certification by non-obstetrician-gynecologists and court doctors, and death from non-obstetric causes. CONCLUSIONS: This study shows the limitations of official vital registration and concludes that dependence on death certificates alone to identify maternal deaths is incomplete and incorrect.

Adult↗

PubMed1996

The likely increase in maternal mortality rates in the United Kingdom and in France until 2005.

In the UK, the decline in maternal mortality rates has stopped. In France, where they are higher than in most European countries, maternal mortality rates have been increasing since 1990. Based on the population projections published by Eurostat, maternal mortality predictions have been made for 1995, 2000, 2005 and 2010. A rise in the level of maternal mortality rates of more than 0.5 per 100000 livebirths is expected between now and 2005, in both countries. In the present context of near stability, this rise could be viewed as an important increase. Maternal mortality rises with maternal age and the proportion of births to women over thirty is growing and will continue to rise until 2000-2005. This structural and demographic evolution explains the expected rise of maternal mortality rates and shows how the change in the maternal age distribution of births will affect these rates.

Adolescent↗

PubMed1995

Maternal mortality in Mafraq District in Jordan.

The present study followed a multidimensional approach to determine maternal mortality ratio in Mafraq district in Jordan. It included active case (maternal deaths) surveillance combined with Civil Registry and hospital records review. Mafraq, by virtue of its geographic and demographic characteristics, is supposed to have a very high toll of maternal deaths and hence, generalizations reflecting the maximum expected maternal mortality ratio in Jordan could be made. The ratio, and as an average for the five years 1987-1991 covered in retrospect by the study was 42 deaths per 100,000 live births, very close to the estimated one. Establishing a baseline maternal mortality ratio and outlining risks pertaining to maternal survival as done in this study is an important prerequisite for interventions to reduce these risks and monitor progress towards reduction of maternal mortality ratio by half by the year 2000 which is a global goal to which Jordan is committed. The multidimensional approach followed by this study is shown to be superior to single source approaches in determining maternal mortality ratio in instances where populations are small and death registration is weak. The study suggests that maternal deaths (preferably as circumstances around the death and not as ICD coded, to avoid under reporting) should be reported in the same manner as notifiable diseases until improvements in death registration are completed and registries are accurate and valid.

Adolescent↗

PubMed1995

Differences in maternal mortality among black and white women--United States, 1990.

The risk for maternal mortality has consistently been higher among black women than white women. The 1990 national health objective of reducing maternal mortality to no more than five deaths per 100,000 live births for any racial/ethnic group was nearly achieved for white women, for whom the maternal mortality ratio was 5.7 in 1990 (1); for black women, however, the ratio was 18.6. The year 2000 national health objectives include reducing the overall maternal mortality ratio to no more than 3.3 deaths per 100,000 live births and to no more than five for blacks (objective 14.3) (2). This report summarizes race-specific differences in maternal mortality among black and white women for 1990 and compares these with trends in mortality from 1940-1990.

Black or African American↗

PubMed2005

Maternal mortality in health institutions with emergency obstetric care facilities in Enugu State, Nigeria.

In order to assess the current level of maternal mortality in health institutions with comprehensive emergency obstetric care in Enugu State, South Eastern Nigeria, a retrospective analysis of maternal deaths for the years 1999-2003 was carried out to establish the maternal mortality ratios in the eligible health institutions. Each maternal death was studied in detail to establish the socio-demographic characteristics of the women who died; their referral sources, type of delay (if any), medical causes of death and their preventability. In-depth interviews of the service providers were carried out to throw more light on the maternal mortality situation in the state. Five out of seven eligible health institutions were studied. Within the 5-year period (1999-2003), there were 141 maternal deaths and 18,257 live births giving a maternal mortality ratio of 772 maternal deaths per 100,000. The folders of 89 out of the 141 women who died were retrieved. Of these 89 maternal deaths, 51.7% of them were unemployed, 52.4% were referred from private hospitals; type 3 delay was the commonest type of delay encountered in the care of the women. Referral delay was the main cause of delay accounting for 46.4% of all cases of type 3 delay. The leading causes of maternal deaths among the women were obstetric haemorrhage (19.1%), sepsis (18.0%), prolonged obstructed labour/ruptured uterus (16.9%) and pre-eclampsia/eclampsia (16.9%). The in-depth interviews corroborated the high maternal mortality ratio recorded and the type 3 delays in tackling obstetric emergencies. It also showed some discrepancies between reality and the health providers' perception of the magnitude of maternal mortality situation in the state. It was concluded that in health institutions in Enugu State with comprehensive emergency obstetric care facilities, the maternal mortality ratio remains high due to type 3 delays. Most of the referrals come from private hospitals, hence the need to retrain the private practitioners in emergency obstetric care.

Emergency Medical Services↗

PubMed2002

Survey on maternal mortality in Swaziland using the sisterhood method.

Monitoring and evaluating maternal mortality in African countries is impossible without specific and reliable data and indicators. This study of maternal mortality using the 'Sisterhood Method' was undertaken in Swaziland. The crude data on 'sisterhood mortality' were obtained from the 1993-94 Multi-Purpose Household Survey carried out by the Central Statistics Office and Ministry of Health of Swaziland. A total fertility rate of 6.36, as given in the 1986 Swaziland census, was used in estimating these indicators. Prior to this study, the maternal mortality rate (MMR) in Swaziland (based only on health facility data) was considered to lie within the range of 107-125 maternal deaths per 100 000 live births. Use of the 'Sisterhood Method' allowed a more precise estimate of maternal mortality for the general population of Swaziland. The study revealed the estimated MMR to be 229 and the life-time risk of maternal death to be 1 in 69. These values were most probably stable throughout the 6- to 7-year period before the survey.

Adult↗

PubMed2001

Maternal mortality in India.

Authors worked on maternal mortality in India from 1992-94. This article is a review article on the basis of authors' experience. The article starts with the brilliant sentence, 'Maternal mortality in India is unacceptably high' and ends with the suggested strategies to solve the problem.

Adolescent↗

PubMed2006

Racial and ethnic disparities in infant and maternal mortality.

Despite marked improvements in lowering infant and maternal mortality rates, certain racial and ethnic groups have benefited less. The reasons for these inequalities are many and complex. This article reviews the literature to assess the extent and reasons for the disparate outcomes in infant and maternal mortality rates among different racial and ethnic groups in the United States. Some strategies aimed at reducing these disparities are also highlighted. A systematic search of OVID-MEDLINE (1970-2005) electronic databases was conducted. This review, which contains data mostly on Black/White disparities, suggests that infant and maternal mortality rates differ among racial and ethnic groups. Potential strategies to ameliorate these differences include continued funding for community health centers, equitable and timely access to health care, and training of more minority physicians. In addition, continued research on the role of stress in preterm delivery among some minority women is important in any effort to lower these disparities.

Black or African American↗

PubMedDate not supplied

[A systems pathologicoanatomical analysis of the causes of maternal mortality].

Principal nosological forms of the maternal mortality are presented using terminology of the International Classification of Diseases (ICD-10), and a number of morphological markers are described facilitating establishment of primary causes of the maternal mortality. A new approach is suggested to the analysis of autopsies of women in childbirth in the context of the functional system "mother-her target organs-uteroplacental area-placenta-fetus, newborn". The primary cause of death is formulated by summation of macro- and microscopic changes in the above organs and areas.

Cause of Death↗

PubMed1995

Reducing maternal mortality in Kigoma, Tanzania.

An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions.

Developing Countries↗

PubMed1985

Maternal mortality and manpower. Comparisons in relation to anaesthetists, obstetricians, and paediatricians in England and Wales and in Japan.

In 1982 maternal mortality in England and Wales was given seven per 100 000 compared to 18 per 100 000 total births in Japan. This represented 160 more deaths in Japan. Perinatal mortality rates were similar in England and Wales and Japan, being 11.3 and 10.1 per 1000 respectively. The prevalence of obstetricians and paediatricians per 100 000 total births are approximately similar in England and Wales and in Japan, whereas the rates for anaesthetists are five times less in Japan. In England and Wales, 13% of maternal deaths were related to anaesthetic misadventures, but the Japanese incidence is not known. However, more than 50% of anaesthetics for Caesarean sections in district hospitals in Japan are administered by obstetricians. A pilot study in Japan would be necessary to determine the precise role of anaesthetic provision on maternal mortality. Maternal mortality may prove a useful indicator of anaesthetic service deficiency.

Anesthesia, Obstetrical↗

PubMed1994

Too far to walk: maternal mortality in context.

The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality--alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an obstetric emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources.

Decision Making↗

PubMed2000

Maternal mortality in a rural district of southeastern Tanzania: an application of the sisterhood method.

BACKGROUND: Deaths from maternal causes represent the leading cause of death among women of reproductive age in most developing countries. It is estimated that the highest risk occurs in Africa, with 20% of world births but 40% of the world maternal deaths. The level of maternal mortality is difficult to assess especially in countries without an adequate vital registration system. Indirect techniques are an attractive cost-effective tool to provide estimates of orders of magnitude for maternal mortality. METHOD: The level of maternal mortality estimated by the sisterhood method is presented for a rural district in the Morogoro Region of Southeastern Tanzania and the main causes of maternal death are studied. Information from region-specific data using the sisterhood method is compared to data from other sources. RESULTS: The maternal mortality ratio (MMR) was 448 maternal deaths per 100,000 live births (95%CI : 363-534 deaths per 100,000 live births). Maternal causes accounted for 19% of total mortality in this age group. One in 39 women who survive until reproductive age will die before age 50 due to maternal causes. The main cause of death provided by hospital data was puerperal sepsis (35%) and postpartum haemorrhage (17%); this is compatible with the main causes reported for maternal death in settings with high levels of maternal mortality, and similar to data for other regions in Tanzania. The sisterhood method provides data comparable with others, together with a cost-effective and reliable estimate for the determination of the magnitude of maternal mortality in the rural Kilombero District.

Adolescent↗

PubMed2001

Estimates of maternal mortality for 1995.

OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability. METHODS: For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age. FINDINGS: On the basis of this exercise, we have obtained a global estimate of 515,000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100,000 live births. The differences, by region, were very great, with over half (273,000 maternal deaths) occurring in Africa (MMRatio: > 1000 per 100,000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100,000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100,000 live births. These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time. CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes.

Cross-Cultural Comparison↗

PubMed2005

Registering in a health facility for delivery protects against maternal mortality in a developing country setting.

A prospective study on the maternal deaths in public and private health facilities in Ogun State was undertaken for a period of 9 months (November 2003 - July 2004). While data were collected from all of the primary, the secondary and tertiary health facilities, it could only be collected from 123 (18.6%) of the private health facilities in the state. Of the 20,831 live births during the period, 37 maternal deaths occurred giving a maternal mortality ratio of 177.6 deaths per 100,000 live births. Some 84% of maternal deaths were not registered for delivery in the health facilities they delivered. The maternal mortality ratio is comparable with previously reported data for South-West Nigeria. A total of 81% of the deaths were due to three main causes: haemorrhage, eclampsia and infection. The maternal mortality ratio was almost three-fold greater in women above the age of 35 years. There is therefore a need to enhance activities to reduce maternal mortality. Private health facilities registration must be tied to sending data to authorized government departments. There is also a need to capture childbirth and attendant complications and death occurring outside orthodox health facilities.

Adolescent↗