Maternal mortality risk indicators: Case-control study at a referral hospital in Guinea

Diallo, Abdourahamane; Michałek, Irmina Maria; Bah, Ibrahima; Diallo, Ibrahima; Sy, Telly; Roth‐Kleiner, Matthias; Desseauve, David

doi:10.1016/j.ejogrb.2020.05.066

Cited by 7 publications

(11 citation statements)

References 14 publications

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“…Generally, the number of pregnancy-related death outside health facilities was the highest in Selangor, followed by Johor and Sabah for three consecutive years (13). This nding corresponding to study conducted in Guinea (24) revealed that maternal death signi cantly associated in case of transfer from another hospital (OR 24.60, ). In contrast, Chinkumba et al reported a study conducted in sub-Saharan Africa; the odds for maternal mortality who deliver in health facilities were two times higher compared to home delivery (25) The reason that might account for this result includes those seeking care at facilities may be complicated cases with a higher risk of mortality and referral-based secondary and tertiary facilities in treating women with more complex conditions.…”

Section: Multiple Logistic Regressionsupporting

confidence: 73%

Postpartum Death in Malaysia 2013 - 2019 A Case Control Study

Daud¹,

Bahari²,

Ahmad³

et al. 2020

Preprint

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Background: Information regarding factors associated with postpartum death enhances the understanding of the root cause of the problem; hence, facilitate the formation of effective remedial measure. Literatures on postpartum death in Malaysia are limited despite the increasing trend of mortality in the state of Selangor. This study aimed to determine the associated factors with postpartum death in Malaysia. Method: A case-control was conducted using data from the Selangor State Health Department. All 114 postpartum death cases that were notified to the health department from 2013 to 2016 were selected. Controls (ratio case 1: control 4) were mothers who survived six weeks of postpartum within the same year range and selected via simple random sampling. A set of datasheets was used to gather information on; i) socio-demographic characteristics, ii) past medical/surgical history and iii) obstetrics history. Analyses were conducted using IBM Statistical Product and Service Solution Statistics Version 25.Results: The odds of postpartum deaths were almost three times higher among the non-Malaysian citizen (aOR 2.78, 95% CI: 1.35-5.72). The presence of medical/ surgical problems was associated with a 3-fold increase in the odds of postpartum death (aOR 3.22, 95% CI: 1.85-5.61). The odds of death were nine times higher for those who delivered in non-health facilities (home/en-route) (aOR 9.13,95% CI: 2.05-40.77) than those delivered in health facilities. Women who attended antenatal care at government health facilities and practised family planning had low odds for postpartum deaths [(aOR 0.35, 95% CI: 0.20-0.64) and (aOR 0.46, 95% CI: 0.25-0.85), respectively. Conclusions: Postpartum deaths could be prevented reduce by ensuring adequate health service delivery to the non-citizen, enhanced medical care on underlying medical/surgical illness and restrict delivery in non-health facilities. This reduction can be achieved by promoting attendance to antenatal care in government health facilities and practicing family planning. Future health programme aimed to curb this death should be designed with emphasis on education to these target group as early as pre-pregnancy and throughout the antenatal period.

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Section: Multiple Logistic Regressionsupporting

confidence: 73%

Postpartum Death in Malaysia 2013 - 2019 A Case Control Study

Daud¹,

Bahari²,

Ahmad³

et al. 2020

Preprint

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“…The other studies were: case-control (n = 1) [ 38 ], Confidential Enquiries into Maternal Deaths (CEMD) or Maternal Death Surveillance and Response (MDSR) audits (n = 4) [ 39 - 42 ], cross-sectional facility and community surveys (n = 4) [ 43 - 46 ], prospective facility and community studies (n = 2) [ 47 , 48 ], Reproductive Age Mortality Study (RAMOS) (n = 2) [ 49 , 50 ], pre and post evaluation (n = 1) [ 51 ], and step-wedge randomised controlled trials (RCT) (n = 1) [ 52 ]. The methods of assigning the causes of death were: study expert panels (n = 21) [ 17 , 18 , 21 , 22 , 24 , 26 , 28 , 29 , 33 - 35 , 37 , 39 , 43 - 46 , 48 - 50 , 52 ], facility/MDSR audit teams (n = 8) [ 16 , 23 , 25 , 31 , 41 , 42 , 51 , 53 ], routine clinical assessments (n = 5) [ 19 , 20 , 27 , 30 , 32 ], physician verbal autopsy coders (n = 1) [ 47 ], and not stated (n = 3) [ 15 , 36 , 38 ]. South Africa contributed 21% of the deaths from 2 studies [ 22 , 41 ], Nigeria 18% from 13 studies [ 15 , 21 , 23 - 25 , 28 - 31 , 35 , 37 , 46 , 48 ], Tanzania 15% from 3 studies [ 16 , 18 , 39 ], and Zimbabwe 9% from 2 studies [ 20 , 42…”

Section: Resultsmentioning

confidence: 99%

“…These challenges are endemic in SSA, where delivery at home and in unequipped primary care facilities is typical. First delay (delay in deciding to present at a health facility) and second delay (delay to move a patient to an appropriate level of care) are common because of poor health-seeking behaviours, long distances to health facilities, and lack of transport to tertiary institutions [ 19 , 39 , 45 ]. In Guinea, maternal death odds ratios were significantly elevated in cases transferred from another hospital [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…First delay (delay in deciding to present at a health facility) and second delay (delay to move a patient to an appropriate level of care) are common because of poor health-seeking behaviours, long distances to health facilities, and lack of transport to tertiary institutions [ 19 , 39 , 45 ]. In Guinea, maternal death odds ratios were significantly elevated in cases transferred from another hospital [ 19 ]. In Ethiopia, the second delay contributed 40%, while the third delay (delay to receive adequate care when an appropriate facility is reached) contributed 22% of maternal deaths [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

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Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

et al. 2021

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Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease – 10 th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words “maternal mortality”, “maternal death”, “pregnancy-related death”, “reproductive age mortality” and “causes” as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data s...

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“…Efforts to reduce unskilled deliveries at home and ill-equipped primary-care facilities, improve emergency transport and increase access to the right care should continue. [55][56][57][58][59] Hypertensive diseases in pregnancy must also be kept in check as NCDs increase in SSA. 26,27,60,61 Strengths and weaknesses…”

Section: Discussionmentioning

confidence: 99%

Changes in Causes of Maternal Mortality in Zimbabwe 2007-08 to 2018-19: Findings From Two Reproductive Age Mortality Surveys

Musarandega

Ngwenya²,

Murewanhema

et al. 2022

Preprint

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Background: Reducing maternal mortality is a priority of Sustainable Development Goal (SDG) 3.1 which requires frequent epidemiological analysis of trends, patterns and causes of maternal deaths. We conducted two reproductive age mortality surveys (RAMOS) to analyse the epidemiology of maternal mortality in Zimbabwe; assessing changes in the causes of death between 2007-08 and 2018-19. Methods: We collected data for deaths among women of reproductive ages (WRAs), and pregnancy-related deaths (PRDs) in 11 districts using multi-stage cluster and simple random sampling. We calculated mortality incidence rates (IR) and incidence rate ratios (IRR) per 10000 WRA with 95% confidence intervals (CIs) in ICD-10 groups. We calculated IR and IRR (per 10000 births) for PRDs with 95% CIs in ICD-MM groups. We also calculated maternal mortality ratios (MMR), per 100 000 live births, for selected causes of PRDs.Results: We identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in WRAs decreased by 81% in certain infectious or parasitic diseases, by 82% in diseases of the respiratory system, and by 79% in diseases of the digestive system. Pregnancy-related deaths from direct causes decreased by 61% and deaths from indirect causes by 84%. HIV/AIDS-related deaths decreased by 81% in WRAs and by 91% in pregnant women. However, direct causes of death still had a three-fold MMR (151 deaths) than indirect causes (51 deaths per 100 000), and obstetric haemorrhage alone had equal MMR as all indirect causes in 2018-19. Conclusion: HIV-related mortality has declined significantly in Zimbabwe in WRAs and pregnant women, though it is still an important cause of death. Zimbabwe has also reduced pregnancy-related deaths from direct causes significantly, through multipronged interventions. The focus is to improve coverage and quality of antenatal care to reduce deaths from indirect causes, and increase access to emergency obstetric care to further reduce deaths from the direct causes.

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Maternal mortality risk indicators: Case-control study at a referral hospital in Guinea

Cited by 7 publications

References 14 publications

Postpartum Death in Malaysia 2013 - 2019 A Case Control Study

Postpartum Death in Malaysia 2013 - 2019 A Case Control Study

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

Changes in Causes of Maternal Mortality in Zimbabwe 2007-08 to 2018-19: Findings From Two Reproductive Age Mortality Surveys

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