The evolving contribution of non‐communicable diseases to maternal mortality in Jamaica, 1998–2015: a population‐based study

McCaw-Binns, Affette; Lv, Campbell; Spence, SS

doi:10.1111/1471-0528.15154

Cited by 11 publications

(8 citation statements)

References 35 publications

(38 reference statements)

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“…Postpartum infections, a subset of maternal infections that occur between delivery and the 42nd day postpartum 1 represent the fifth most common cause of maternal death, behind only hypertensive disorders, obstetric hemorrhage, abortion/ectopic gestations, and obstetric embolism. 2 , 3 Improved understanding of postpartum infection is a key to achieving sustainable development goals (SDGs) and executing strategies targeting the reduction of preventable maternal and neonatal mortality.…”

Section: Introductionmentioning

confidence: 99%

Pathogenic Spectrum and Resistance Pattern of Bloodstream Infections Isolated from Postpartum Women: A Multicenter Retrospective Study

Zou

Shen

et al. 2021

IDR

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Purpose Bloodstream infections (BSIs) cause morbidity and mortality in postpartum patients, resulting in poor prognosis for both mother and neonate. Gram-negative bacteremia is a public health threat, with high mortality among vulnerable populations and significant global economic costs. Gram-negative bacteremia and antimicrobial resistance are increasing. This study retrospectively analyzed the pathogen distribution and drug sensitivity among postpartum patients with BSIs to identify appropriate antibacterial agents for perioperative therapy. Material and Methods All bacteremia cases between January 2015 and December 2020 from three Health Centers for Women and Children in Chongqing, China, were retrospectively reviewed. Clinical data were collected from medical records and charts. Blood samples were cultured by BD BACTEC FX200. Bacterial and fungal species and bacterial susceptibility were identified by a BD Phoenix TM M50 automatic detection machine. Results In total, 274 pathogenic strains were isolated from 272 blood samples. Excluding 25 suspected contamination strains, 248 blood samples yielded 249 microorganisms, including 214 gram-negative bacteria (85.9%), 34 gram-positive bacteria (13.6%), and 1 fungus (0.5%). Escherichia coli ( E. coli ) was the most frequently isolated pathogen, both overall and among gram-negative bacilli (73.5%). Streptococcus agalactiae represented 3.6% of gram-positive cocci (n = 9). Laboratory-confirmed anaerobic infections comprised 9.2% of cases (n = 23). Additionally, 47.4% of postpartum patients with BSIs suffered premature rupture of membranes (PROM), a suspected infection risk factor. Drug sensitivity levels remained unchanged for less commonly used drugs, but resistance increased against commonly used drugs. Specifically, E. coli resistance against fourth-generation cephalosporins increased during this study period. Conclusion E. coli is the most common gram-negative bacillus in postpartum patients with BSIs, and increased anaerobic bacterial detections suggest genital tract inflammation control before delivery is necessary. Effective drug resistance monitoring remains necessary to alleviate bacterial resistance, such as preventing inappropriate antibiotic applications.

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Section: Introductionmentioning

confidence: 99%

Pathogenic Spectrum and Resistance Pattern of Bloodstream Infections Isolated from Postpartum Women: A Multicenter Retrospective Study

Zou

Shen

et al. 2021

IDR

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“…As more women delay childbearing, they are also more likely to present in pregnancy with cardiovascular and metabolic disorders, such as the hypertensive disorders of pregnancy, thromboembolic disorders, heart disease and diabetes mellitus. 20 …”

Section: Discussionmentioning

confidence: 99%

“… 17 In Jamaica (1998–2007), MMRs of 719 and 78 per 100,000 respectively were noted but with a different cause profile; 40% (17/42) died from SCD complications; 24% (10/42) other medical conditions, while 29% (12/42) were direct deaths. 18 , 19 , 20 , 21 When deaths attributed to SCD were excluded, women with SCD were 4–6 times as likely to experience maternal death than non-SCD women, 18 challenging health care providers to manage this chronic disease alongside childbearing.…”

Section: Introductionmentioning

confidence: 99%

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

McCaw-Binns

Campbell²,

Harris

et al. 2022

eClinicalMedicine

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Summary Background Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. Methods Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. Findings Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with ( p = 0.502) and without SCD ( p = 0.629). The MMR among women with and without SCD in 2008–17 was 378.1 ( n = 41) and 89.2/100,000 live births ( n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07–5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36–3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). Interpretation MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. Funding No external funding was provided.

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“…Changing demographics and mortality risks are reflected in the evolution of non‐communicable diseases contributing to maternal mortality; since 1998, non‐communicable disease pregnancy‐related mortality ratios have increased with increasing cardiovascular deaths 8 . Proper management and procedures for cardiopulmonary resuscitation in the parturient are lacking, highlighting the need for focused cardiac arrest training as rates increase 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…Previously recorded studies of SBT throughout Guatemala are limited to studies by Walker and colleagues, 3,7 Changing demographics and mortality risks are reflected in the evolution of non-communicable diseases contributing to maternal mortality; since 1998, non-communicable disease pregnancy-related mortality ratios have increased with increasing cardiovascular deaths. 8 Proper management and procedures for cardiopulmonary resuscitation in the parturient are lacking, highlighting the need for focused cardiac arrest training as rates increase. 9,10 Of the many obstetric emergencies, shoulder dystocia (SD) continues to be the most unpredictable, often diagnosed at the time of birth and increasing the risk of birth-related injuries for both the mother and the fetus.…”

Section: Introductionmentioning

confidence: 99%

Changing the landscape of obstetric resident education in low‐ and middle‐income countries using simulation‐based training

Meza

Bianco

Herrarte

et al. 2021

Intl J Gynecology & Obste

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Objective To evaluate simulation‐based training (SBT) in low‐ and‐middle‐income countries (LMIC) and the long‐term retention of knowledge and self‐efficacy. Methods We conducted an SBT course on the management of postpartum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) in three government teaching hospitals in Guatemala. We evaluated changes in knowledge and self‐efficacy using a multiple‐choice questionnaire for 46 obstetrics/gynecology residents. A paired Student's t test was used to analyze changes at 1 week and 6 months after the SBT. Results There was an increase in scores in clinical knowledge of MCA (p < 0. 001, 95% confidence interval [CI] 0.81–1.49) and SD (p < 0.001, 95% CI 0.41–1.02) 1 week after SBT, and a statistically insignificant increase in PPH scores (p = 0.617, 95% CI −0.96 to 0.60). This increase in scores was maintained after 6 months for MCA (p < 0.001, 95% CI 0.69–1.53), SD (p = 0.02 95% CI 0.07–0.85), and PPH (p = 0.04, 95% CI 0.01–1.26). For MCA and SD, the levels of self‐efficacy were increased 1 week following training (p < 0.001, 95% CI 0.83–2.30 and p = 0.008, 95% CI 0.60–3.92, respectively), and at 6 months (p < 0.001, 95% CI 0.79–2.42 and p = 0.006, 95% CI 0.66–3.81, respectively). There was a slight increase in PPH self‐efficacy scores 1 week after SBT (p = 0.73, 95% CI −6.05 to 4.41), maintained after 6 months (p = 0.38, 95% CI −6.85 to 2.85). Conclusion SBT was found to be an effective and feasible method to increase short‐ and long‐term clinical knowledge and self‐efficacy of obstetric emergencies in LMIC.

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The evolving contribution of non‐communicable diseases to maternal mortality in Jamaica, 1998–2015: a population‐based study

Abstract: Maternal survival (SDG 3.1) in LMICs requires better care for women with both non-communicable diseases and obstetric conditions.

Cited by 11 publications

References 35 publications

Pathogenic Spectrum and Resistance Pattern of Bloodstream Infections Isolated from Postpartum Women: A Multicenter Retrospective Study

Pathogenic Spectrum and Resistance Pattern of Bloodstream Infections Isolated from Postpartum Women: A Multicenter Retrospective Study

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

Changing the landscape of obstetric resident education in low‐ and middle‐income countries using simulation‐based training

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