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PubMed2005

[Analysis of trends in maternal mortality during a 10 year-follow up in a urban region].

BACKGROUND: Maternal mortality is considered a worldwide health problem, since the WHO has estimated that there are 500,000 maternal deaths annually and that the highest percentage of these deaths occurs in developed countries. It was not until 1970 that this problem became important, by revising the birth's registrations and the maternal causes of morbidity and mortality, and that the mortality committees study began. OBJECTIVE: To determine the epidemiological profile and the trend of the maternal mortality in a urban hospital. MATERIAL AND METHODS: This retrospective and descriptive study was carried out at the Reproductive Health Coordination of the Centro Medico Nacional La Raza, through the registrations of the maternal deaths reported from 1993 to 2002 by the local committees of maternal mortality. Maternal mortality was defined as an event occurred during pregnancy or within 42 days after delivery, by any associated cause and aggravated by the same pregnancy. We used analytic and descriptive statistics, with central trend measurements, as well as chi square test. RESULTS: During the 10 years of analysis, 244 deaths were shown, with mean per year of 24.4 +/- 5.2 deaths. Preeclampsia-eclampsia, hypovolemia and sepsis represented 71.7% of the cases. The highest number of deaths ranged from 30 to 34 years, with 64 deaths. Women with the first pregnancy had the highest number of deaths, with incidence of one maternal death for each 664.7 +/- 135.6 new born in each year. DISCUSSION: The main maternal deaths per year corresponded to direct obstetric causes, with percentages from 53.3 to 86.9% annually, where preeclampsia-eclampsia syndrome maintains these high percentages, with a death average within the international standard parameters considered adequate.

Adolescent↗
PubMed1977

Age and parity influences on maternal mortality: United States, 1919-1969.

Comparisons of crude and standardized rates of maternal mortality show that changes in age and parity distributions of births had some influence on maternal mortality trends for the years 1919-1969 in the United States. Changes in the age and parity distributions of births for cohorts of U.S. women also influenced crude cohort maternal mortality rates to some extent.

Adolescent↗
PubMed1989

[Maternal mortality. Apropos of 212 instances in 7 years (1980-1986) at the Ignace-Deen Maternity Hospital in Conakry (Guinea)].

In Conakry the maternal mortality rate in the University Hospital is not the real maternal mortality rate of the country but it gives an idea of the importance of this problem of public health. The authors try to explain the reasons for this high mortality and propose preventive measures: increase in primary health care, equipping of regional obstetric wards in referral hospitals, training of personnel, health education of the population.

Adolescent↗
PubMed2000

An assessment of DHS maternal mortality indicators.

This study presents an assessment of the quality of data relating to maternal mortality collected in 14 Demographic and Health Surveys (DHS) for 13 countries that included a complete sibling history. Four aspects of data quality are considered: completeness of the data for reported events, evidence of omission in the reporting of events, plausibility of the pattern of sibling deaths, and sampling errors of the maternal mortality estimates. Although the data relating to reported events are complete for most variables, comparisons of sibling-history-based estimates of adult mortality for both males and females with other independent estimates suggest that sibling estimates are more likely to be underestimates than overestimates. The downward bias is probably greater for female mortality than for male mortality. The sampling errors associated with maternal mortality ratios are substantially larger than those associated with other frequently used DHS indicators. This lack of precision precludes the use of these data for trend analysis and has led to the recommendation that this DHS module not be used more than once every ten years in the same country.

Adolescent↗
PubMed2006

Millennium development goal 5: a review of maternal mortality at the Kenyatta National Hospital, Nairobi.

OBJECTIVES: To review if there is a change in the maternal mortality rate at the Kenyatta National Hospital since the inception of the Millennium Development Goal strategy in 1990, compared to earlier reviews. DESIGN: A retrospective descriptive study. SETTING: Kenyatta National Hospital. SUBJECTS: Maternal deaths attributed directly to obstetric causes. MAIN OUTCOME MEASURES: Determination of maternal mortality rates of all patients admitted to the Kenyatta National Hospital Maternity and died after admission up till six weeks of admission. Also determine any avoidable causes of the same. RESULTS: During the period under review, there were 27,455 deliveries and 253 maternal deaths giving a maternal mortality ratio of 921.5 per 100,000 live births. Direct obstetric causes accounted for 71% of all maternal deaths with sepsis, haemorrhage, and hypertension being the leading causes. Respiratory tract infections associated with HIV/ AIDS infection was the prominent indirect cause. 67.5% of deaths occurred in women aged between 25 and 35 years and 78.7% were Para 2 or less. Evidently there was poor antenatal clinic attendance with only 28.6% having had any attendance at all. CONCLUSION: Antenatal clinic attendance needs to be re-emphasised if an impact is to be realised in curbing maternal mortality; moreover there is need for early referrals and encouraging mothers to deliver under skilled care.

Adolescent↗
PubMedDate not supplied

[Preventable maternal mortality in an urban area in Niamey (Niger)].

Maternal mortality is a particularly serious public health problem in Niger. A number of studies suggest that the average rate is 650 to 700 maternal deaths for every 100,000 live births. However, in rural areas, the figure is probably nearer 1,300 and in urban areas 450. We report an analysis of 25 maternal deaths in hospitals or medical centers among patients living in the urban community of Niamey. For nine of these cases, no accurate diagnosis was established, and for twelve others, the death could probably have been avoided. Although this study was not quantitative, it suggests that risk factors for maternal mortality include multiparity, and being a single or primiparous mother. The absence of diagnosis for nine cases was due to the insufficient clinical detail in the medical files (which were scarcely usable), the rarity of paraclinical investigations for economic and organizational reasons, and the absence of post-mortem examination. The avoidable factors leading to death in twelve cases were: negligence on the part of the health service, inappropriate therapy, lack of blood transfusion, lack of vigilance by the patient, absence of medical care for abortion, erroneous diagnosis and transport problems. The patients' relatives appeared to be relatively resigned to the deaths for religious reasons. Further studies are required to understand prevalent attitudes. Numerous studies have concluded that many maternal deaths are often avoidable, both in developing and industrialized countries. This study in Niamey identified various deficiencies and dysfunctions of the system which allow this situation to continue. We propose seven recommendations which could help reduce the incidence of maternal deaths in Niamey.

Adult↗
PubMed1996

Applying the sisterhood method for estimating maternal mortality to a health facility-based sample: a comparison with results from a household-based sample.

BACKGROUND: The sisterhood method is an indirect technique used to estimate maternal mortality in developing countries, where maternal deaths are often poorly registered in official statistics. It has been used successfully in many community-based household surveys. Because such surveys can be costly, this study investigated the suitability of using data collected in outpatient health facilities. METHODS: Adults visiting any one of 91 health centres or posts in a rural region of Nicaragua were randomly sampled and interviewed by health personnel. A sample size, proportional to the population served, was assigned to each facility and 9232 adults were interviewed. Characteristics of health facility users were compared with the general population to identify factors that would allow generalization of results to other settings. RESULTS: Based on these data, the lifetime risk of maternal death was 0.0144 (1 in 69). This estimate is essentially identical to that from a household-based survey in the same region 8 months earlier, which obtained a lifetime risk of 0.0145 (1 in 69). These findings correspond to a maternal mortality ratio of 241 and 243/100000 livebirths, respectively. CONCLUSIONS: This is the first report comparing results of the sisterhood method from household and health facility-based samples. The sisterhood method provided a robust estimate of the magnitude of maternal mortality. Results from the opportunistic health facility-based sample were virtually identical to results from the household-based study. Guidelines need to be developed for applying this low-cost and efficient aproach to estimating maternal mortality in suitable opportunistic settings at subnational levels.

Adolescent↗
PubMed2000

[Maternal mortality in a midsize city, Brazil, 1997].

INTRODUCTION: The real magnitude of maternal mortality in the city of Uberlândia, Brazil, is fairly unknown. The aim is to identify the characteristics of maternal mortality in the city during 1997. METHODS: Death certificates of women between 10-49 years old from Uberlândia were used as a main data source with additional interviews with family members. Only women between 10- 49 years of age at time of death were included. Maternal deaths were further confirmed at the health services level by checking medical records and interviewing physicians. All maternal deaths occurring up to one year after delivery were investigated. Data was collected on delivery conditions, frequency of prenatal care visits, gestational age at death, previous pregnancy complications, site of death, and any avoidable conditions. Maternal mortality rates (MMR) per 100,000 newborns were calculated. RESULTS: There were a total of 204 deaths, but only 173 were from Uberlândia residents. Six maternal deaths were registered, four (66.7%) up to 42 days after delivery, and two (33.3%) up to 43 days to 1 year. Direct obstetric causes (toxemia- 60%; haemorrhage- 40%) were associated with 5 deaths (83.3%), and indirect (16.7%) with 1 death (cardiac disease). The MMR calculated from death certificates was 22.2 but the adjusted rate was 66.6. CONCLUSIONS: The MMR is above the expected. It is necessary to pay more attention to the quality of prenatal and delivery care as well as to the correct way of filling out death certificates.

Adolescent↗
PubMed2000

Reflections on maternal mortality in two decades.

The paper examines developments in the assessment and prevention of maternal mortality over the past 2 decades through review of the relevant literature. Problems of classifying and ranking causes, changing methodologies, discrepancies and illogical trends are demonstrated. Identifying causes of maternal mortality by surveillance and death reviews, rather than measuring ratios, appears to be more effective. Process indicators are considered as important as outcome indicators for monitoring safe motherhood. International technical reappraisal of maternal mortality is needed.

Cause of Death↗
PubMed2005

Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality.

OBJECTIVES: I studied the extent to which maternal deaths are underreported on death certificates. METHODS: We collected data on maternal deaths from death certificates, linkage of death certificates with birth and fetal death records, and review of medical examiner records. RESULTS: Thirty-eight percent of maternal deaths were unreported on death certificates. Half or more deaths were unreported for women who were undelivered at the time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder. CONCLUSIONS: The number of maternal deaths is substantially underestimated when death certificates alone are used to identify deaths, and it is unlikely that the Healthy People 2010 objective of reducing the maternal mortality rate to no more than 3.3 deaths per 100000 live births by 2010 can be achieved. Increasing numbers of births to older women and multiple-gestation pregnancies are likely to complicate efforts to reduce maternal mortality.

Adolescent↗
PubMedDate not supplied

Levels of maternal mortality in developing countries.

This paper is aimed at improving our ability to assess the magnitude of maternal mortality in developing countries, where reliable data on maternal deaths are scarce. First, the upper and lower limits of maternal mortality in a population are determined based on the general levels of mortality and fertility in a population. The relative importance of maternal deaths as a proportion of death among women of reproductive ages may, therefore, vary from less than 1 percent in low-mortality countries to about 25-30 percent in high-mortality countries. Second, the analysis and interpretation of maternal mortality data from health facilities and vital registration systems can be improved if a variety of other data sources are used, such as coverage of deliveries in hospitals and at home, and all causes of death among women of reproductive age. It is estimated that approximately 515,000 women died annually due to pregnancy-related causes in developing countries between 1980 and 1985. Ninety percent of these deaths took place in Africa and South Asia, where births are frequent and maternal mortality levels are high.

Abortion, Induced↗
PubMed2002

Levels and causes of maternal mortality in Senegal.

OBJECTIVES: To report the findings of a direct, community-based, assessment of maternal mortality and medical causes of death using verbal autopsy in three unique cohorts in rural Senegal. METHODS: Methods from ongoing demographic surveillance systems. We obtained records of all deaths and births in women of age 15-49 over a period of 14 years in Niakhar, 10 years in Bandafassi and 13 years in Mlomp. Relatives of all women who died were interviewed using a standard questionnaire. Causes of death were assigned by three physicians independently. Maternal deaths were defined according to the ninth and tenth revisions of the International Classification of Diseases. RESULTS: The maternal mortality ratio was similar in Mlomp [436 per 100 000 live births (95% confidence interval 209-802)] and Niakhar [516 per 100 000 (413-636)] but significantly higher in the more remote area of Bandafassi [852 (587-1196)] [relative risk compared with Niakhar 1.6 (1.0-2.4)]. Two-thirds of the maternal deaths were from direct obstetric causes, haemorrhage being the most common. Abortion was rare. CONCLUSIONS: Demographic surveillance systems are useful tools for the measurement of maternal mortality provided special studies are carried out to arrive at the levels and causes of maternal death. The estimates of maternal mortality reported here are lower than those published by the WHO and UNICEF but remain extremely high, particularly in the very remote areas with very limited health infrastructure, where as many as one in 19 women may be expected to die as a consequence of childbirth.

Adolescent↗
PubMed2003

[Verbal autopsy to measure maternal mortality in rural Senegal].

OBJECTIVES: The aim of this paper is to study the use of verbal autopsy in order to assess maternal mortality indicators in rural settings and to determine the limits and difficulties related to that practice. MATERIAL AND METHODS: This study was carried out in 3 rural sites (Niakhar in the region of Fatick, Bandafassi in Tambacounda region and Mlomp in the region of Ziguinchor). These sites had been under demographic and epidemiological surveillance for several years. Data were collected through two sources: a questionnaire filled out by data collectors during the demographic surveillance and a complementary survey done by an epidemiologist among families completed by information from the registers of health structures. For all female deaths (15-49 years), the detailed sequence of the events leading to the death were stated in a clinical file of verbal autopsy. All the files had been submitted to two independent obstetricians for analysis. The character of maternal death and the cause of the death (direct, indirect ou undetermined) were processed. The discordant cases were submitted to another expert epidemiologist for analysis. The 10th international classification of diseases of WHO was used as a reference to identify maternal deaths and their causes. RESULTS: This demographic surveillance has led to a complete registration of female deaths and the analysis of female deaths has helped to measure maternal indicators during the observed time period. Among the 471 female deaths, 97 maternal deaths were identified in Niakhar, 36 in Bandafassi and 10 in Mlomp. The proportion of maternal deaths was 30.6% in Niakhar, 32.7% in Bandafassi and 22.7% in Mlomp. The ratio of maternal mortality was 575 per 100,000 live births (LB) in Niakhar, 930/100,000 live births in Bandafassi and 436/100,000 LB in Mliomp. The risk of maternal death was 1 women in 21 in Niakhar, 1 in 16 in Bandafassi and 1 in 41 in Mlomp. Maternal mortality rate was 13.3/10,000 reproductive age women in Niakhar, 17/10,000 in Bandafassi and 6.9/10,000 in Mlomp. Sociocultural limits related to interdiction in the society, and language barriers are seen as limits for applying verbal autopsy practices. Also, a lack of precision in data collection because of lack of information delivered by the interviewee or because of lack of experience of the interviewer could be limitations. This study carried out in a rural setting could not show national maternal mortality level. It takes time to complete verbal autopsy leading to excessive cost. CONCLUSION: Verbal autopsy remains an interesting method for measuring maternal mortality. It has advantages in rural areas where many deliveries still occur at home. Further accuracy in data collection is needed for a precise analysis of each case.

Adolescent↗
PubMed2002

Maternal mortality in northern rural Tanzania: assessing the completeness of various information sources.

BACKGROUND: To assess the completeness of various information sources and the subsequent estimates on maternal mortality. METHODS: Maternal deaths in the study area, rural northern Tanzania, in 1995 were identified from hospital records, health centers and dispensaries, registration by village leaders, follow up of an antenatal cohort, and a household survey. Data from some of these sources were also obtained in 1996. RESULTS: In 1995, 22 of a total of 26 maternal deaths were identified at the Haydom hospital. Three of the 15 deaths (20%) reported by the village leaders were not identified at any health facility. Four deaths were found in the antenatal cohort and one death in the household survey. Only two deaths were reported by the official statistics. Of the identified maternal deaths, 85% were found from health facility data. Including data from 1996, a total of 45 maternal deaths were identified; 13 of which were direct and 32 indirect obstetric deaths. The 1995 estimated maternal mortality ratio, based on reports from the multiple source registrations, was 382 (95% confidence interval 250-560) per 100 000 live births. The antenatal cohort yielded an estimate of 322 (95% confidence interval 160-580). The ratio based on official figures for 1995 and 1996 combined was 123 (95% confidence interval 70-200). CONCLUSIONS: Even a high quality routine registration of maternal deaths will miss a small proportion of cases. Investing in better registration of direct and indirect obstetric deaths will give better insight into this important health problem. Estimates based on official reports showed substantial underreporting.

Cohort Studies↗
PubMedDate not supplied

Estimating maternal mortality: the sisterhood method.

This paper describes a new indirect technique for deriving population-based estimates of maternal mortality. The technique, called the "sisterhood method," is relevant to developing countries where the alternative data sources and approaches to estimation are often inadequate and inappropriate. The sisterhood method uses the proportions of adult sisters dying during pregnancy, childbirth, or the puerperium reported by adults during a census or survey, to derive a variety of indicators of maternal mortality. The first field trial of the method was carried out in the North Bank Division of The Gambia, West Africa, in 1987. The results indicate a lifetime risk of maternal mortality of 0.0584, or 1 in 17, approximating a maternal mortality ratio of 1,005 per 100,000 live births, which is consistent with previous estimates for this region.

Data Collection↗
PubMedDate not supplied

Community based study on maternal mortality in Jimma town, south western Ethiopia.

A cross-sectional five years retrospective community based study was conducted in 1990 to determine maternal mortality rate in Jimma town, south-western Ethiopia. The maternal mortality rate was found to be 4.02/1000 live births. The results of the study revealed that major causes of maternal mortality in this area are sepsis, eclampsia and abortion. Out of all deaths, more than 50% occurred after delivery of a child. Besides, the study indicates poor trend in following antenatal care and family planning among maternal mortality cases. Recommendations are made for detailed wide scale study to generate policy issues on the subject.

Adolescent↗
PubMed1988

Factors associated with maternal mortality in Addis Ababa, Ethiopia.

A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia. Maternal mortality for the two-year period from 11 September 1981 was 350/100,000 livebirths (excluding abortions). A logistic regression analysis selected antenatal care, occupation and income as risk factors for maternal mortality, after adjusting for age, parity, education and marital status. Odds ratios were 2.5 for unbooked women compared to those receiving antenatal care, about 3 for students, and maids/janitresses compared to housewives, and between 3 and 5 for those earning less than US$25 monthly, compared to those earning US$150 or more.

Adolescent↗