Determinants for High Maternal Mortality in Multiethnic Populations in Western China

Du, Qing; Nass, Oyvind; Bergsjø, Per; Kumar, Bernadette Nirmal

doi:10.1080/07399330903052137

Cited by 26 publications

(41 citation statements)

References 24 publications

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“…It has been shown that the reduction in maternal mortality is strongly associated with socio-economic development in China and our findings confirm this in Guizhou province [9,[16][17][18] . The GDP of non-minority counties was three times more than that of minority counties in Guizhou, and this gap is increasing.…”

Section: Discussionsupporting

confidence: 92%

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The trends in maternal mortality between 1996 and 2009 in Guizhou, China: Ethnic differences and associated factors

Lian

Næss

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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China bears a large burden of global maternal mortality, and the largest burden of maternal deaths in China is in poor western provinces. This study aimed to investigate the trends in maternal mortality and its associated factors in Guizhou province of western China between 1996 and 2009, and examine differences between minority and non-minority counties. A population-based, longitudinal, retrospective study was performed in a poor western province of China with a considerably large ethnic minority population. All 86 counties/districts of Guizhou were included with population at county, township and village level. Maternal mortality data were collected from routine reporting database of Guizhou Provincial Health Bureau. Trend and comparative analyses and multivariate linear regression analyses were performed using SPSS 17.0. Maternal mortality ratio (MMR) and its change over time, differences between ethnic groups were analyzed. A declining trend in maternal mortality and rising trend in hospital delivery in Guizhou was observed; ethnic differences between two ethnic groups persisted. The reduction in maternal mortality between 1996 and 2009 was related with increased gross domestic product, decreased male illiteracy rate, and increased hospital delivery rate. We found the declining trends in maternal mortality in Guizhou with persisting ethnic differences. The declining trends are related with economic development, hospital delivery and male illiteracy. Effective health education on maternal health is urgently needed for the minority groups, and basic education for the new generation should be enhanced to eradicate the illiteracy.

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Section: Discussionsupporting

confidence: 92%

“…That means rural areas have provided free hospital delivery services for a few years, and it does help to improve the hospital delivery rate. But for ethnic minorities, this topic is not only an economic issue, it also involves traditional culture, beliefs and customs [17,25] .…”

Section: Discussionmentioning

confidence: 99%

The trends in maternal mortality between 1996 and 2009 in Guizhou, China: Ethnic differences and associated factors

Lian

Næss

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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“…In China causes of maternal death are related to biomedical, reproductive, health service, socioeconomic and cultural factors [7]–[10]. Biomedical factors include direct and indirect obstetric causes.…”

Section: Introductionmentioning

confidence: 99%

Progress on the Maternal Mortality Ratio Reduction in Wuhan, China in 2001–2012

et al. 2014

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BackgroundMost 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).MethodsThis 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.ResultsThe 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.ConclusionsWith 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.

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“…Henan Province, located in central China and with over 100 million mainly Han inhabitants, has the largest population and is the biggest agricultural province in the country. There are pronounced differences between urban and rural areas in the province, closely resembling those found in the whole nation due to multi-ethnicity and unbalanced economic development [7], [9], [10].…”

Section: Introductionmentioning

confidence: 70%

“…This study reveals huge differences in maternal mortality related to education. It indicates that although economic situation is an important factor affecting MMR, variations between poor countries [3] or areas [9], [10] cannot be completely explained by this factor. Economic status may be associated with other factors which may, in turn, play a greater role [10].…”

Section: Discussionmentioning

confidence: 99%

Maternal Mortality in Henan Province, China: Changes between 1996 and 2009

et al. 2012

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BackgroundMaternal 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 FindingsThis 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.ConclusionThere 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.

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Determinants for High Maternal Mortality in Multiethnic Populations in Western China

Cited by 26 publications

References 24 publications

The trends in maternal mortality between 1996 and 2009 in Guizhou, China: Ethnic differences and associated factors

The trends in maternal mortality between 1996 and 2009 in Guizhou, China: Ethnic differences and associated factors

Progress on the Maternal Mortality Ratio Reduction in Wuhan, China in 2001–2012

Maternal Mortality in Henan Province, China: Changes between 1996 and 2009

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