Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 5. Mortality assessment

Abstract

Background The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality. Methods The Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST). Findings The leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively. Conclusion The baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups

“…Additional medium-to long-term follow-up will be necessary to determine whether these female Care Group participants will continue at a more active level of participation in community affairs and whether this will result in more community activities and decisions that benefit women directly. However, the gains in empowerment detected through this study are likely to have contributed to the significant improvements in childhood nutritional status, healthcare utilization, healthy household behaviors, and improvements in mortality demonstrated in the other articles in this series [6][7][8] as well as to longer-term improvements in health and well-being, as suggested by the literature [61,62]. The benefits of the Care Group approach for maternal and child health as well as for the social well-being of Care Group participants (in terms of increased self-respect and respect perceived from others in the community, the increased agency, and the stronger social bonds that emerged) provide strong evidence for the value of Care Groups as a valuable component of health programs more broadly.…”

“…When the Care Group met again, they would discuss their experiences and learn a new message. They would also report any vital events (births or deaths) that may have occurred among their neighbors, which formed the basis of our mortality assessment (analyzed in Paper 5 in this series [8]. Fig.…”

“…This article is part of a series of 10 articles that summarize the findings of an evaluation of the Project [4][5][6][7][8][9][10][11][12]. In this article we describe changes in aspects of women's empowerment, including perceived respect/social status, self-efficacy, decision-making autonomy, and formation of social capital, as reported by participants in the Care Group activities of the Project.…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 8. Impact on women’s empowerment

“…Across the FGDs the FGDs, multiple themes emerge about what facilitates and what impedes women’s empowerment. The detailed findings from the FGDs regarding these issues as expressed by both men and women who participated are available in the full report of the implementation research [ 52 ]. Table 6 summarizes these findings.…”

“…Table 1 provides a brief description of the CBIO+ Approach. In addition to Papers 1, 2, 7 and the current paper, there are six additional papers in this series [43][44][45][46][47][48].…”