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PubMedDate not supplied

Estimation of perinatal mortalities in the world's countries from maternal mortalities.

Perinatal mortality was estimated by the regression equation log10 Y = 0.7826log10X + 0.08, obtained by perinatal mortality (Y) and maternal mortality (X) in Japan in 1960-1990. The error rate was approximately 9% in the estimation. Unpublished Japanese perinatal mortality in 1899-1947 was estimated from maternal mortality by using the equation, and appropriate results were obtained. Perinatal mortalities of the world's countries were estimated from their maternal mortalities listed in UNICEF reports with use of the above equation. Two peaks were noted in the country number distribution at 0-19 and 120-140 of estimated perinatal mortality. The mortality was 20-99 in 43% of 111 countries analyzed and 100 or more in 25%. The results suggest that further efforts should be made for the improvement of worldwide maternal and child health.

Australia↗
PubMed1997

Why perinatal mortality cannot be a proxy for maternal mortality.

In recent years, the perinatal mortality rate (PNMR) has been proposed as a proxy measure of maternal mortality, because perinatal deaths are more frequent and potentially more easily measured. This report assesses evidence for an association between these two statistics. This study, based upon data from Matlab, Bangladesh, shows that the maternal mortality ratio (MMR) and the PNMR do not vary together over time, and that the PNMR does not reliably indicate either the magnitude or the direction of change in the MMR from year to year. Statistical analysis shows that the correlation between the PNMR and the MMR is not significantly different from zero. An examination of the major causes of maternal and perinatal deaths indicates that the two measures cannot be expected to vary together. Almost half of perinatal deaths result from causes that do not pose a threat to the mother's life, and almost half of maternal deaths result from causes that do not lead to perinatal death. Monitoring of the PNMR can give an inaccurate picture of maternal mortality and should not be used as a proxy.

Bangladesh↗
PubMed2003

Maternal mortality in Turkey.

All maternal deaths are considered as a social injustice. For this reason, governments should take necessary measures to make motherhood safer. In order to prevent premature deaths of women, causes of deaths must be known. In Turkey, the latest survey conducted in hospitals in selected 53 provinces. This hospital-based survey revealed that maternal mortalities make up 5% of all women deaths and maternal mortality is 49.2 per hundred thousand live births. Factors which are related with the status of women including, education, socio-economic conditions, early marriage age, and fertility level have influence on maternal mortality level in the community. Accessibility and availability of maternal health care services are also very important factors to reduce maternal mortality.

Female↗
PubMed2005

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

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.

Abortion, Induced↗
PubMed1995

[Maternal mortality and birth distribution: a possible explanation of excess mortality in France].

Maternal mortality is higher in France than in most European countries with the same health standards. The analysis of the French rates shows that the changes, between 1975 and 1991, in the birth distribution according to the age of the mothers, explain 14% of all maternal deaths in 1991. The proportion of livebirths from mothers aged 30 years and over has increased from 21% in 1976 to 37% in 1991 in France and only 32% in England and Wales. For the period 1988-1990, crude maternal mortality was 9.4 per 100,000 livebirths in France and 7.4 in England and Wales. Direct standardization removes differences between birth distributions of each country and allows to calculate a standardized mortality rate of 8.6 for the French data. The variation between the crude and the standardized French rates is explained by the fact that 18 of the 210 deaths for the considered period were associated to the older mother's age distribution than in England and Wales.

Adult↗
PubMed1993

Traditional birth attendants and maternal mortality in Ghana.

Maternal mortality is high in most African countries, particularly in rural areas where access to formal health care is limited. The sociopolitical and economic environment complicates the medical factors directly responsible for this high rate. Since the 1970s many African countries have addressed this problem by training traditional birth attendants (TBAs) in health promotion and in the basics of safe delivery and referral. The Danfa Rural Health Project in Ghana has trained and supervised TBAs since 1973. It is located relatively close to the health services of the capital city of Accra, providing an ideal environment for the practice of trained TBAs. Thirty-seven trained TBAs currently practice in the area. Most provide patient education and encourage women to go to the health center for preventive services. However, many report routinely performing the high risk deliveries that they have been taught to refer to higher level care and that when they do refer, their patients may not go. Reasons for referral refusal frequently cited by TBAs include financial limitation or lack of transportation and the patients fear of disrespectful or painful treatment from medical personnel. In the rural environment, the trained TBA's greatest contribution to lower maternal mortality rates may lie in the area of health promotion rather than disease intervention.

Adult↗
PubMed1988

Regional differences in maternal mortality in Greece, 1973-1982.

Maternal mortality in the ten regions of Greece during the period 1973-82 is examined. In Greece as a whole, maternal mortality declined from 27.2 per 100,000 livebirths in 1973, to 12.0 in 1982. During these ten years, the age standardized maternal mortality ratios (SMRs) of two regions was significantly raised, Thrace (SMR = 295, 95% CL = 187-443) and the Aegean Islands (SMR = 197, 95% CL = 117-311). Greater Athens was the only region with significantly reduced maternal mortality (SMR = 77, 95% CL = 59-99). In two regions, Thrace and Epirus, maternal mortality increased during the ten years studied. To explore the possible reasons for the observed geographical differences in maternal mortality, data on three sociodemographic and three obstetric service indicators are presented. Regions with the highest proportion of hospital births had the lowest SMRs (p less than 0.05); and it is suggested that cultural factors in the case of Thrace, mainly emanating from the Muslim minority living in this region, and topographical factors, in the case of the Aegean Islands and Epirus, may have influenced maternal mortality by adversely affecting maternity service usage and availability.

Female↗
PubMedDate not supplied

[Maternal mortality at the Charles Nicolle Hospital Maternity Department in Tunis between 1972 and 1975. With the exclusion of abortions (author's transl)].

The change in maternal mortality during the time of pregnancy, labour and the puerperium is similar in our department to that reported in many countries. The overall figure for maternal mortality between 1972 and 1975 is 0.54 per 1000 (54 per 100,000 deliveries. This is a halving of numbers as compared with our previous statistics. This improvement can be ascribed to several factors, which are increased in number and quality of medical and para-medical personnel, and the better environmental factors of the inhabitants of the region. On the other hand if mortality is looked at in relationship to aetiology, there has been no change in the order of the causes, which are principally haemorrhage and eclampsia. The former is avoidable in most cases by better prevention and blood replacement, which has to be fought for. The second, in spite of the drop of 50%, remains very worrying. Improvement in the prognosis for the mother depends on measures that are taken such as better equipment of maternity departments and informing and educating pregnant women.

Eclampsia↗
PubMedDate not supplied

Causes of maternal mortality in Japan.

CONTEXT: Japan's maternal mortality rate is higher than that of other developed countries. OBJECTIVES: To identify causes of maternal mortality in Japan, examine attributes of treating facilities associated with maternal mortality, and assess the preventability of such deaths. DESIGN AND SETTING: Cross-sectional study of maternal deaths occurring in Japan between January 1, 1991, and December 31, 1992. SUBJECTS: Of 230 women who died while pregnant or within 42 days of being pregnant, 197 died in a hospital and had medical records available, 22 died outside of a medical facility, and 11 did not have records available. MAIN OUTCOME MEASURES: Maternal mortality rates per 100,000 live births by cause (identified by death certificate review and information from treating physicians or coroners); resources and staffing patterns of facilities where deaths occurred; and preventability of death, as determined by a 42-member panel of medical specialists. RESULTS: Overall maternal mortality was 9.5 per 100,000 births. Hemorrhage was the most common cause of death, occurring in 86 (39%) of 219 women. Seventy-two (37%) of 197 deaths occurring in facilities were deemed preventable and another 32 (16%) possibly preventable. Among deaths that occurred in a medical facility with an obstetrician on duty, the highest rate of preventable deaths (4.09/100,000 live births) occurred in facilities with 1 obstetrician. Among the 72 preventable deaths, 49 were attributed to 1 physician functioning as the obstetrician and anesthetist. While the unpreventable maternal death rate was highest in referral facilities, the preventable maternal death rate was 14 times lower in referral facilities than in transferring facilities. CONCLUSIONS: Inadequate obstetric services are associated with maternal mortality in Japan. Reducing single-obstetrician only delivery patterns and establishing regional 24-hour inpatient obstetrics facilities for high-risk cases may reduce maternal mortality in Japan. JAMA. 2000;283:2661-2667.

Adolescent↗
PubMed1998

Maternal mortality in Maiduguri, Nigeria.

Maternal mortality is an index of the standard of antenatal care in a given environment. In developed countries the level of antenatal care has risen to an extent that maternal mortality has virtually disappeared (Nylander and Adekunle, 1990). This is in sharp contrast with the situation in developing countries like Nigeria where maternal mortality is still deplorably high. According to the World Health Organization, only 29-36% of deliveries in Africa are attended to by trained health personnel (World Health Organization, 1985). Therefore the mortality rates reported from most developing countries may be just the tip of the iceberg. Another disturbing dimension to the problem of maternal deaths in developing countries is the fact that most of the deaths are due to causes that can be prevented by the provision of essential obstetric care. Nearly a decade after the launching of the international safe motherhood initiative the tragedy of maternal deaths remains unmitigated in most developing countries such as Nigeria. The purpose of this study is to evaluate the causes of maternal deaths in two tertiary level hospitals in Maiduguri, north-eastern Nigeria and to identify ways of reversing the trend.

Journal Article↗
PubMed1996

Maternal mortality.

A new approach to measuring maternal mortality indicates that there are some 585,000 maternal deaths, 99% of them in developing countries. This is around 80,000 deaths more than earlier estimates have suggested and indicates a substantial underestimation of maternal mortality in the past. There is a greater disparity in levels of maternal mortality between industrialized and developing countries than in any other public health indicator. While significant progress has been made in reducing infant mortality, the same is not true for maternal mortality. Although the actions needed to reduce maternal mortality have long been known, 1 woman in 50 is still dying as a result of pregnancy-related complications and the figure rises to 1 in 10 in many parts of Africa. By contrast, the figure for developed countries can be as low as 1 in 8,000.

Cause of Death↗