Institutional maternal and perinatal deaths: a review of 40 low and middle income countries

Bailey, Patricia; Andualem, Wasihun; Brun, Michel; Freedman, Lynn P.; Gbangbade, Sourou; Kante, Malick; Keyes, Emily; Libamba, Edwin; Moran, Allisyn C.; Mouniri, Halima; Joud, Dahada Ould El; Singh, Kavita

doi:10.1186/s12884-017-1479-1

Cited by 65 publications

(64 citation statements)

References 23 publications

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“…Obstetric hemorrhage, severe pre-eclampsia and eclampsia, postpartum sepsis and obstructed labor have been shown as the leading direct causes of maternal death in countries from sub-Saharan Africa [17,21,25]. This is consistent with the findings in our study.…”

Section: Discussionsupporting

confidence: 93%

“…Several studies carried out in Ethiopia have pointed to a changing trend in the distribution of causes of maternal death [15][16][17][18][19][20][21]. In 2014 a systematic review revealed that the major causes of maternal death were obstructed labor/uterine rupture (36%), hemorrhage (22%), hypertensive disorders of pregnancy (19%) and sepsis/infection (13%) [22].…”

Section: Introductionmentioning

confidence: 99%

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Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

Hadush¹,

Dagnaw

Getachew

et al. 2020

BMC Pregnancy Childbirth

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Background: Triangulating findings from MDSR with other sources can better inform maternal health programs. A national Emergency Obstetric and Newborn Care (EmONC) assessment and the Maternal Death Surveillance and Response (MDSR) system provided data to determine the coverage of MDSR implementation in health facilities, the leading causes and contributing factors to death, and the extent to which life-saving interventions were provided to deceased women.Methods: This paper is based on triangulation of findings from a descriptive analysis of secondary data extracted from the 2016 EmONC assessment and the MDSR system databases. EmONC assessment was conducted in 3804 health facilities. Data from interview of each facility leader on MDSR implementation, review of 1305 registered maternal deaths and 679 chart reviews of maternal deaths that happened form May 16, 2015 to December 15, 2016 were included from the EmONC assessment. Case summary reports of 601 reviewed maternal deaths were included from the MDSR system. Results: A maternal death review committee was established in 64% of health facilities. 5.5% of facilities had submitted at least one maternal death summary report to the national MDSR database. Postpartum hemorrhage (10-27%) and severe preeclampsia/eclampsia (10-24.1%) were the leading primary causes of maternal death. In MDSR, delay-1 factors contributed to 7-33% of maternal deaths. Delay-2, related to reaching a facility, contributed to 32% & 40% of maternal deaths in the EmONC assessment and MDSR, respectively. Similarly, delay-3 factor due to delayed transfer of mothers to appropriate level of care contributed for 29 and 22% of maternal deaths. From the EmONC data, 72% of the women who died due to severe pre-eclampsia or eclampsia were given anticonvulsants while 48% of those dying of postpartum haemorrhage received uterotonics. Conclusion:The facility level implementation coverage of MDSR was sub-optimal. Obstetric hemorrhage and severe preeclampsia or eclampsia were the leading causes of maternal death. Delayed arrival to facility (Delay 2) was the predominant contributing factor to facility-based maternal deaths. The limited EmONC provision should be the focus of quality improvement in health facilities.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

Hadush¹,

Dagnaw

Getachew

et al. 2020

BMC Pregnancy Childbirth

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“…This is supported by our results in which for one‐third of all screened cases, anemia was an underlying reason and in those identified as near‐misses a mortality index of 8% and 6% in Tanzania and Uganda respectively, was observed. An interesting finding of the present study was the large number of ectopic pregnancies identified; the mortality index was low in ectopic pregnancy as reported elsewhere …”

Section: Discussionsupporting

confidence: 78%

“…An interesting finding of the present study was the large number of ectopic pregnancies identified; the mortality index was low in ectopic pregnancy as reported elsewhere. 27 The present study has both strengths and limitations. A large number of primary and secondary level facilities adhering to the same implementation principles were included, the standard WHO nearmiss tool was used, and the study was conducted in a similar way in the two settings, Tanzania and Uganda.…”

Section: Proportion Of Complications Per Reported Deliveries (%)mentioning

confidence: 92%

Rethinking the definition of maternal near‐miss in low‐income countries using data from 104 health facilities in Tanzania and Uganda

Pembe

Hirose

Al‐beity

et al. 2019

Intl J Gynecology & Obste

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Objective To assess the consistency of maternal near‐miss incidence and mortality index between two definitions across 104 facilities in Tanzania and Uganda. Methods Based on WHO guidance, cross‐sectional near‐miss data were collected in Tanzania (July 2015 to October 2016) and Uganda (June 2016 to September 2017). Prepartum hemorrhage and abortion were included as additional screening events and the number of blood units transfused was recorded. Near‐miss incidence and mortality index were determined by using two near‐miss definitions: the WHO standard definition, and a modified definition including women receiving at least 1 unit of blood. A sensitivity analysis excluded the additional screening events. Results Near‐miss incidence differed between Tanzania and Uganda (1.79 and 4.00, respectively, per 100 deliveries) when estimated by the standard definition, but was similar (5.24 and 4.94, respectively) by the modified definition. The mortality index was higher in Tanzania than in Uganda when estimated by the standard definition (8.56% vs 3.54%), but was similar by the modified definition (3.10% vs 2.89%). Conclusion The modified definition provided a more consistent estimate of near‐miss incidence and mortality index. Lowering the threshold for units of blood transfusion might improve comparability between settings, but more research is needed.

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“…In sub-Saharan Africa, obstetric haemorrhage accounted for 24.5% of maternal deaths [2]. Extrauterine gestation is a key contributor and accounts for approximately 7% of mortalities due to obstetric haemorrhage and 2% of maternal mortalities in low and middle income countries [3]. Most cases of extrauterine gestation are not picked up early prior to rupture in low resource countries [4] [5] [6] [7].…”

Section: Introductionmentioning

confidence: 99%

Extrauterine Pregnancy: A Nine-Year Review of Incidence, Seasonality and Management at a Tertiary Hospital in Southern Ghana

Agbeno¹,

Ofori²,

Osarfo³

et al. 2020

OJOG

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Introduction: Most cases of extrauterine pregnancies present in the ruptured state in low-resource settings and patients with haemodynamic instability risk mortality without swift intervention. An idea of when ectopic gestations are likely to present may be useful for logistic planning and facility readiness for case management. The study sought to assess the incidence of extrauterine gestation, mode of management and any link with seasonal and/or sociocultural events within the Cape Coast metropolis of Ghana over a 9-year review period. Methods: A retrospective review of all cases of extrauterine pregnancies managed at the Cape Coast Teaching Hospital (CCTH) from January 2010 to December 2018 was conducted. Data on patient age, parity, month of presentation, site and laterality of ectopic gestation, number of abortions and deliveries were retrieved from hospital records and analysed. Yearly and monthly aggregated incidence of extrauterine pregnancies were computed. Result: A total of 480 ectopic pregnancies out of 26,850 total pregnancies were seen over the period, giving an overall occurence of 17.9/1000 pregnancies and almost all were managed surgically. Half of all the cases occurred in the 20-29 years age group while the extremes of age recorded the lowest. An average of about 53 cases per year was recorded for the period under review. The peak months of occurrence were October and November. About 83% were ruptured with the ampulla region being the commonest site. Conclusion: The data suggests increased ectopic gestation occurrence in the Cape Coast metropolis about two months after the major traditional festivals and this may have implications for instituting mitigating measures, logistic management and facility preparedness for case management.

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Institutional maternal and perinatal deaths: a review of 40 low and middle income countries

Cited by 65 publications

References 23 publications

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

Rethinking the definition of maternal near‐miss in low‐income countries using data from 104 health facilities in Tanzania and Uganda

Extrauterine Pregnancy: A Nine-Year Review of Incidence, Seasonality and Management at a Tertiary Hospital in Southern Ghana

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