Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial’s Baseline Study Results

Abstract

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)–Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013–2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women’s and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013–2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013–14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.

Trends and determinants of stillbirth in developing countries: results from the Global Network’s Population-Based Birth Registry

“…In India, the stillbirth rates in different states reportedly range from 20 to 66/1000 births. Bellad et al reported a stillbirth rate of 28.6/1000 births from Karnataka where one of our Indian sites is situated [ 16 ]. The stillbirth rate for Maharashtra district where Nagpur is located as reported by the State Health Department is 17.8/1000 births.…”

Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial

“…A 12-month mixed methods feasibility study preceded the internal pilot phase (1 February to 31 October 2014) in four clusters [7] , [8] , [9] , [13] , [14] , [15] , [16] . Progression to the definitive phase (additional eight clusters (1 November 2014 to 31 October 2016)) was based on the criterion of ≥50% acceptance of CLIP-indicated health facility referral.…”

A study of maternal mortality due to non-obstetric causes

“…The result of our study was in comparison to the study done by Bellad MB et al, and the UNICEF data which showed 69% and 66% of unbooked cases. 7,9 However, findings of the studies done by Puri A et al,…”

“…70.58% were from rural region (as per Table 3) which is in relation to the other studies done by Bellad MB et al, Urmila M et al, and Usharam et al, which were 69%, 76% and 75% respectively. [6][7][8] Maternal mortality is higher in rural population because of illiteracy, inadequate antenatal visits, inaccessible emergency health care services, lack of transportation facilities and late referral. Many patients are referred very late, in critical condition, unaccompanied by health care worker.…”