Study Factors Involved in Maternal Deaths Attributed to COVID-19 in a Disadvantaged Area in Southeast of Iran

Abstract

Objective: It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women.
 Materials and methods: This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis.
 Results: From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth).
 Conclusion: The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.

Perfil epidemiológico da mortalidade materna por COVID-19: revisão integrativa

“…Foi utilizada a estratégia PVO, onde P é a população de interesse ou condição/ problema investigado (Gestantes e Puérperas); V a variável de interesse (Pandemia de LÓPEZ-RODRÍGUEZ, et al, 2021;DOMINGUEZ, et al, 2021;NAKAMURA-PEREIRA, et al, 2021;. O perfil epidemiológico, associação de comorbidade e grupos com maior risco de desfecho desfavorável, foram citados também em seis artigos (MOGHADAM, et al, 2020;MOUDI, et al, 2022;TAKEMOTO, et al, 2020;HANTOUSHZADEH, et al, 2020;TORRES-TORRES, et al, 2022;VILLAR, et al 2021;BELOKRINITSKAYA, et al, 2021). Estudos comparativos entre grupos distintos como de gestantes com COVID-19 e mulheres com COVID-19 apresentou a propensão do risco de óbito em mulheres gestantes (GONÇALVES, et al, 2021).…”

“…Ao final, foram selecionados 15 artigos para composição da amostra final (Figura 1).Figura 1. Fluxograma do processo de seleção das publicações para o estudo As publicações ocorreram entre os anos de 2020 a 2022, sendo a maior proporção no ano de 2021 com 09 artigos (ALSAKAR, et al 2021; BASU; CHAUKE; MAGORO; 2021; CARVALHO-SAUER, et al 2021; LÓPEZ-RODRÍGUEZ, et al 2021;DOMINGUES, et al 2021;NAKAMURA-PEREIRA, et al 2021; GONÇALVES et al 2021;VILLAR, et al 2021;BELOKRINITSKAYA et al 2021), seguido pelo ano de 2020 com 03 artigos(MOGHADA, et al, 2020;TAKEMOTO, et al, 2020; HANTOUSHZ, et al, 2020), e o ano de 2022 com 03TORRES-TORRES, et al;2022, MOUDI, et al;. Os países de origem dos estudos foram Índia, Estados Unidos, México, Irã, Brasil, Rússia, além de um estudo multicêntrico em 16 países (Argentina, Brasil, Egito, França, Gana, Índia, Indonésia, Itália, Japão, México, Nigéria, Macedônia do Norte, Paquistão, Rússia, Espanha, Suíça, Reino Unido e Estados Unidos).Ao que tange os níveis das hierarquias das evidências(MELNYK et al, 2010), os 15 artigos foram caracterizados com o Nível IV, estudos observacionais de coorte ou caso controle, o que evidencia a necessidade de pesquisas mais robustas para melhor compreensão das condições que envolvem a mortalidade materna em decorrência da COVID-19.…”

Gill parasites of Schizocypris altidorsalis (Pisces: Cyprinidae), a threatened freshwater fish in Iran

“…Known locally as 'anjak' (see www.briancoad.com), S. altidorsalis has become an integral part of the cultural and culinary heritage of the surrounding communities. Its delicate flavour and succulent flesh, along with limited options for other food resources, have made it a sought-after edible fish among the locals, a highly disadvantaged population (Moudi et al 2022).…”