Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

Yaya, Sanni; Anjorin, Seun; Adedini, Sunday A.

doi:10.1136/bmjgh-2020-004233

Cited by 15 publications

(13 citation statements)

References 29 publications

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“…Sub-Saharan Africa (SSA) records some of the highest rates of maternal and child mortality. For instance, it is known from the literature that SSA accounts for almost 90% of the global burden of maternal mortality [5]. This high burden of maternal and child mortality in SSA has been linked to several preventable factors including low antenatal care (ANC) utilisation as well as low uptake of postnatal care (PNC), skilled attendant delivery, and health facility delivery [3,6].…”

Section: Introductionmentioning

confidence: 99%

Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries

Seidu

Aboagye

Okyere

et al. 2022

BMC Health Serv Res

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Background Given the intricate relationship between mothers and their children with the continuum of care, it is quintessential for their healthcare and interventions to be enhanced through a continuum of care approach. We examined the factors associated with the continuum of care for maternal, newborn, and child health in sub-Saharan Africa. Methods Data for the study were pooled from the Demographic and Health Surveys of 17 countries in sub-Saharan Africa. We extracted the data from the women’s files in all 17 countries. We included 15,359 married and cohabiting women with the most recent children aged 12–23 months at the time of the survey in the study. Multivariable multilevel logistic regression analysis was performed to examine the factors associated with continuum of care. Results were presented as adjusted odds ratios (aORs) with their 95% confidence interval. Results Women whose partners had secondary or higher level of education [aOR = 1.52; 95%CI = 1.07, 2.16], those with health insurance [aOR = 1.64; 95%CI = 1.18, 2.30], those who decide alone on their healthcare [aOR = 1.38; 95%CI = 1.01, 1.89], those with joint healthcare decision [aOR = 1.33; 95%CI = 1.02, 1.74], those exposed to radio [aOR = 1.38; 95%CI = 1.06, 1.79], those who started antenatal care early [aOR = 1.88; 95%CI = 1.50, 2.36] and those in southern Africa [aOR = 7.02; 95%CI = 3.23, 15.27] had higher odds of completing the continuum of care. Conclusion We found that only 3.4% of women across the 17 sub-Saharan African countries included in this study completed all of the 11 maternal, newborn, and child health care interventions along the continuum of care. The factors that are associated with the maternal, newborn, and child health continuum of care include women’s autonomy in decision-making, partners’ level of education, health insurance coverage, early initiation of antenatal care, exposure to radio, and residing in Southern Africa. Problem with the distance to the facility lowered women’s odds of completing the continuum of care. Governments and departments of health services across sub-Saharan African countries must leverage the radio to disseminate critical messages about the need to complete the continuum of care. Much commitment must be made toward advancing the autonomy of women. Health insurance coverage would have to be extended to reach all women to facilitate the completion of the continuum of care.

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Section: Introductionmentioning

confidence: 99%

Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries

Seidu

Aboagye

Okyere

et al. 2022

BMC Health Serv Res

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“…For example, investing in an efficient and reliable transport network could translate into improved access to health facilities by women during and after PLOS GLOBAL PUBLIC HEALTH pregnancy and childbirth and prevent maternal deaths. Similarly, investing in gender equity and empowerment initiatives may help resolve some individual and health facility-level contributing factors [24]. Social scientists using political economy methods explored the explanations for the variations in maternal mortality rates between countries.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

“…So far, most articles that have explored the relationship between contributory factors and maternal deaths in Africa used statistically modelled population-level data from the WHO Global Health Observatory, Human Development Report, World Bank and United Nations bodies [11,[19][20][21][22][23][24]. A single study utilised primary data from hospital-based studies [25].…”

Section: Introductionmentioning

confidence: 99%

Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review

Muriithi

Banke-Thomas

Gakuo

et al. 2022

PLOS Glob Public Health

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The number of women dying during pregnancy and after childbirth remains unacceptably high, with African countries showing the slowest decline. The leading causes of maternal deaths in Africa are preventable direct obstetric causes such as haemorrhage, infection, hypertension, unsafe abortion, and obstructed labour. There is an information gap on factors contributing to maternal deaths in Africa. Our objective was to identify these contributing factors and assess the frequency of their reporting in published literature. We followed the Arksey and O’Malley methodological framework for scoping reviews. We searched six electronic bibliographic databases: MEDLINE, SCOPUS, African Index Medicus, African Journals Online (AJOL), French humanities and social sciences databases, and Web of Science. We included articles published between 1987 and 2021 without language restriction. Our conceptual framework was informed by a combination of the socio-ecological model, the three delays conceptual framework for analysing the determinants of maternal mortality and the signal functions of emergency obstetric care. We included 104 articles from 27 African countries. The most frequently reported contributory factors by level were: (1) Individual—level: Delay in deciding to seek help and in recognition of danger signs (37.5% of articles), (2) Health facility—level: Suboptimal service delivery relating to triage, monitoring, and referral (80.8% of articles) and (3) Wider health system—level: Transport to and between health facilities (84.6% of articles). Our findings indicate that health facility—level factors were the most frequently reported contributing factors to maternal deaths in Africa. There is a lack of data from some African countries, especially those countries with armed conflict currently or in the recent past. Information gaps exist in the following areas: Statistical significance of each contributing factor and whether contributing factors alone adequately explain the variations in maternal mortality ratios (MMR) seen between countries and at sub-national levels.

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“…The region has a lifetime risk of maternal deaths of 1 in 38 with an estimated 530 000 maternal deaths occurring each year [ 5 ]. Compared with developed countries, Sub-Saharan Africa cumulates many physical, economic, social, and psychological handicaps, especially in its rural areas: scattered settlements, poor health infrastructure, shortage of qualified healthcare personnel, transportation, and health awareness, and low levels of income and education [ 6 , 7 ]. A study by Wilunda et al [ 8 ] reported that access to health services in South Sudan is hampered by a poorly functioning health system that is plagued by chronic problems such as a shortage of human resources, lack of health infrastructure and supplies, and weak management [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The healthcare system and client failures contributing to maternal mortality in rural Kenya

Masaba

Mmusi-Phetoe

Rono

et al. 2022

BMC Pregnancy Childbirth

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Background The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. Methods An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. Results Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence. Conclusion In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.

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Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

Cited by 15 publications

References 29 publications

Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries

Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries

Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review

The healthcare system and client failures contributing to maternal mortality in rural Kenya

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