Pregnancy-related Deaths in Rural Rajasthan, India: Exploring Causes, Context, and Care-seeking Through Verbal Autopsy

Iyengar, Kirti; Iyengar, Sharad D; Suhalka, Virendra; Dashora, Kalpana

doi:10.3329/jhpn.v27i2.3370

Cited by 36 publications

(54 citation statements)

References 8 publications

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“…The main reason for not seeking appropriate care (delay-I) was due to inability to afford treatment or transportation to distant health care facilities or lack of knowledge regarding severity of illness. This was similar to findings by Iyengar et al [14] in rural Rajasthan, where 74 % of deaths occurred at home because of the inability to afford treatment.…”

Section: Discussionsupporting

confidence: 91%

Maternal and Perinatal Death Inquiry and Response Project Implementation Review in India

Dikid

Gupta

Kaur

et al. 2012

J Obstet Gynecol India

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Purpose Profile of maternal deaths in selected districts of four Indian states was studied to examine the regional differences in non-biological causal factors (socioeconomic and sociocultural) in maternal mortality and to examine the method and completeness of implementation of Maternal and Perinatal Death Inquiry and Response (MAPEDIR) process. Methods An integrated qualitative and quantitative method was used to study the MAPEDIR process in selected districts of four states in India, through the use of standardized questionnaire for key informant interviews, participant observation checklist, analysis of verbal autopsy questionnaire, and maternal death reports. ResultsA comparison of Profile's maternal deaths investigated showed that women died between 25 and 27 years of age. Half of the women died at home because of inability to afford transport (Delay II) and treatment costs. One third of the deaths had occurred in a health facility (Delay III) because of lack of specialists, equipments or blood. Two thirds of the delays (Delay I) were in seeking medical care. Review of the implementation process of MAPEDIR highlighted that the social audit review model is a unique field based collaborative initiative comprising of stakeholders from various sector in order to improve maternal health programming by reducing maternal mortality. Conclusions MAPEDIR has been able to identify sociocultural, economic and health care systems related determinants of maternal deaths. Standardization the mechanism for information data sharing at district, sub-district and village level can maximize the use of available evidence for advocacy and policy shifts by developing policies and interventions suited to local needs.

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Section: Discussionsupporting

confidence: 91%

Maternal and Perinatal Death Inquiry and Response Project Implementation Review in India

Dikid

Gupta

Kaur

et al. 2012

J Obstet Gynecol India

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“…31–36,56,57 Three studies used data from a national maternal mortality surveillance system. 37,50 Two studies conducted key-informant surveys in the community 39,48 while three studies used data from household censuses. 28,40,61 Three studies followed up a cohort of women 41,42,47 one of which obtained cohort data from a community-based trial.…”

Section: Resultsmentioning

confidence: 99%

“…28–30,39–43,45,47–50,53,54,59,60 Nine of these used a consensus panel consisting of medical staff or health researchers to agree on the cause of death 28–30,39,42,45,48,49,60 , while six did not specify whether a consensus panel was used or not. 41,47,50,53,54,59 Two VA studies interpreted data using Inter VA-models.…”

Section: Resultsmentioning

confidence: 99%

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Fuhr

Calvert

Ronsmans

et al. 2014

The Lancet Psychiatry

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Summary Background Although suicide is one of the leading causes of deaths among young women in low and middle-income countries (LMIC), the contribution of suicide and injuries to pregnancy-related mortality remains unknown. Methods We conducted a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide and/or injuries in LMIC. Random-effects meta-analysis was used to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in LMIC (burns, poisoning, falling or drowning) as suicide. Findings 36 studies from 21 countries were identified. The pooled total prevalence across the regions was 1·00% for suicide (95% confidence interval (CI): 0·54–1·57) and 5·06% for injuries (95% CI: 3·72–6·58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1·68% (95% CI: 1·09–2·37). Americas (3·03%, 95% CI: 1·20–5·49),the Eastern-Mediterranean region (3·55%, 95% CI: 0·37–9·37), and the South-East Asia region (2·19%, 95% CI: 1·04–3·68) had the highest prevalence for suicide, with the Western-Pacific region (1·16%, 95% CI: 0·00–4·67) and the Africa region (0·65%, 95% CI: 0·45–0·88) having the lowest. Interpretation The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in LMIC with wide regional variations. However, this study may have underestimated suicide deaths due to lack of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in LMIC.

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“…7 Verbal autopsies have been used in many developing countries to explore causes of maternal and neonatal deaths. [8][9][10][11][12][13][14][15][16][17][18] In Bangladesh, maternal death review findings play a key role in providing proper feedback on deaths. 6 However, using…”

Section: Introductionmentioning

confidence: 99%

Social Autopsy of maternal, neonatal deaths and stillbirths in rural Bangladesh: qualitative exploration of its effect and community acceptance

Biswas

Rahman²,

Eriksson

et al. 2016

BMJ Open

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Objectives Social Autopsy (SA) is an innovative strategy where a trained facilitator leads community groups through a structured, standardised analysis of the physical, environmental, cultural and social factors contributing to a serious, non-fatal health event or death. The discussion stimulated by the formal process of SA determines the causes and suggests preventative measures that are appropriate and achievable in the community. Here we explored individual experiences of SA, including acceptance and participant learning, and its effect on rural communities in Bangladesh. The present study had explored the experiences gained while undertaking SA of maternal and neonatal deaths and stillbirths in rural Bangladesh. Design Qualitative assessment of documents, observations, focus group discussions, group discussions and in-depth interviews by content and thematic analyses. Results Each community's maternal and neonatal death was a unique, sad story. SA undertaken by government field-level health workers were well accepted by rural communities. SA had the capability to explore the social reasons behind the medical cause of the death without apportioning blame to any individual or group. SA was a useful instrument to raise awareness and encourage community responses to errors within the society that contributed to the death. People participating in SA showed commitment to future preventative measures and devised their own solutions for the future prevention of maternal and neonatal deaths. Conclusions SA highlights societal errors and promotes discussion around maternal or newborn death. SA is an effective means to deliver important preventative messages and to sensitise the community to death issues. Importantly, the community itself is enabled to devise future strategies to avert future maternal and neonatal deaths in Bangladesh.

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Pregnancy-related Deaths in Rural Rajasthan, India: Exploring Causes, Context, and Care-seeking Through Verbal Autopsy

Cited by 36 publications

References 8 publications

Maternal and Perinatal Death Inquiry and Response Project Implementation Review in India

Maternal and Perinatal Death Inquiry and Response Project Implementation Review in India

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Social Autopsy of maternal, neonatal deaths and stillbirths in rural Bangladesh: qualitative exploration of its effect and community acceptance

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