The Role of Pregnancy Outcomes in the Maternal Mortality Rates of Two Areas in Matlab, Bangladesh

Rahman, Mizanur; DaVanzo, Julie; Razzaque, Abdur

doi:10.1363/3617010

Cited by 18 publications

(10 citation statements)

References 17 publications

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“…In 2005, the under–five mortality rate was 46.6 in the intervention area and 62.4 in the Comparison Area (25% less) [14,15]. Over the period from 1982 to 2005, the maternal mortality rate (that is, the number of maternal deaths per 100 000 women of reproductive age) was 37% lower in the Intervention Area than in the Comparison Area, mainly as a result of a lower pregnancy rate and lower case–fatality rates for induced abortion, miscarriages and stillbirths [16]. …”

Section: Resultsmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Perry

Rassekh

Gupta³

et al. 2017

Journal of Global Health

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BackgroundThere is limited evidence about the long–term effectiveness of integrated community–based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030.MethodsA database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH–FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India.ResultsThese four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1– to 4–year mortality, or under–5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community–based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first–level hospital care.ConclusionsThe shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of ending preventable child and maternal deaths by the year 2030.

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Section: Resultsmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Perry

Rassekh

Gupta³

et al. 2017

Journal of Global Health

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“…[19][20][21] The other half, known as the comparison area, is typical of much of Bangladesh in contraceptive use, 22 fertility and childhood mortality, 23 and maternal mortality. 2 The MCH-FP area has lower rates of fertility, 24 pregnancy termination 9 and maternal mortality, 12,23 provides greater coverage of antenatal care and offers better access to basic and emergency obstetric care 13,24 than the comparison area does.…”

Section: Study Areamentioning

confidence: 99%

“…In Bangladesh, maternal mortality is lowest for women who have live births and highest for women with stillbirths; mortality rates among women who have miscarriages or terminate their pregnancies fall in between. 12 However, the mortality risks associated with MR and abortion may differ considerably. Worldwide, the estimated fatality rate associated with unsafe abortion was about 220 per 100,000 procedures in 2008-around 350 times that of legal abortion in the United States.…”

Section: Maternal Mortality In Bangladeshmentioning

confidence: 99%

“…12 The sample for the mortality analyses thus consisted of 110,152 singleton pregnancies-104,941 resulting in live births, 3,489 ending in MR and 1,722 ending in abortion. Using DSS identification numbers to match death records with records on pregnancy outcomes, we identified 2010, and the proportion seeking treatment at facilities nearly doubled, from 15% to 29%.…”

Section: Hypothesesmentioning

confidence: 99%

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Pregnancy Termination in Matlab, Bangladesh: Maternal Mortality Risks Associated with Menstrual Regulation and Abortion

Rahman¹,

DaVanzo²,

Razzaque³

2014

IPSRH

Self Cite

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CONTEXT: In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (known or suspected) RESULTS:In Matlab as a whole, the proportion of pregnancies ending in MR increased from 1.9% in 1989-1999 to 4.2% in 2000-2008, while the proportion ending in abortion decreased from 1.6% to 1.1%. The odds of mortality from MR were 4.1 times those from live birth in 1989-1999, but were no longer elevated in 2000-2008. The odds of mortality from abortion were 12.0 and 4.9 times those of live birth in 1989-1999 and 2000-2008, respectively. Reduction in mortality risk was greater in the MCH-FP area than the comparison area (90% vs. 75%).CONCLUSION: MR is no longer associated with higher mortality risk than live birth in Bangladesh, but abortion is.

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“…These factors include age of the woman at the birth of her most recent child (5, 7, 12, 19, 21, 26), migration status (20, 27, 28) (defined as: never moved, internal migration (within the surveillance area) only, external migration (migration in/out of the surveillance area) only, and both internal and external migration), HIV status (21, 29, 30) (defined as: participated in the HIV surveillance and positive, participated in the HIV surveillance and negative, and unknown status for those who never participated in the HIV surveillance), area of residence (rural, urban, and peri-urban), parity at most recent birth, pregnancy outcome summarized across maternity history (12, 31) (all live births, one or more pregnancy ended in a stillbirth, no pregnancy outcome reported), contraceptive use (ever or never use), marital status (ever married and never married), self-reported general health status (lowest self-reported health status over the period; defined as good, fair or poor), highest education level (4, 19) (categorized as eight or more years in school, less than eight years in school and no school at all), employment status (ever or never employed) and wealth index of the household where the woman lives (minimum wealth index of all households a woman has ever stayed in during the study period; the derivation of the wealth index is explained below).…”

Section: Methodsmentioning

confidence: 99%

Mortality in women of reproductive age in rural South Africa

Nabukalu

Klipstein‐Grobusch

Herbst

et al. 2013

Global Health Action

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ObjectiveTo determine causes of death and associated risk factors in women of reproductive age in rural South Africa.MethodsDeaths and person-years of observation (pyo) were determined for females (aged 15–49 years) resident in 15,526 households in a rural South African Demographic and Health Surveillance site from 2000 to 2009. Cause of death was ascertained by verbal autopsy and ICD-10 coded; causes were categorized as HIV/TB, non-communicable, communicable/maternal/perinatal/nutrition, injuries, and undetermined (unknown). Characteristics of women were obtained from regularly updated household visits, while HIV and self-reported health status was obtained from the annual HIV surveillance. Overall and cause-specific mortality rates (MRs) with 95% confidence intervals (CI) were calculated. The Weibull regression model (HR, 95% CI) was used to determine risk factors associated with mortality.ResultsA total of 42,703 eligible women were included; 3,098 deaths were reported for 212,607 pyo. Overall MRwas 14.6 deaths/1,000 pyo (95% CI: 14.1–15.1), peaking in 2003 (MR 18.2/1,000 pyo, 95% CI: 16.4–20.1) and declining thereafter (2009: MR 9.6/1,000 pyo, 95% CI: 8.4–10.9). Mortality was highest for HIV/TB (MR 10.6/1,000 pyo, 95% CI: 10.2–11.1), accounting for 73.1% of all deaths, ranging from 61.2% in 2009 to 82.7% in 2002. Adjusting for education level, marital status, age, employment status, area of residence, and migration, all-cause mortality was associated with external migration (adjusted hazard ratio, or aHR), 1.70, 95% CI: 1.41–2.05), self-reported poor health status (aHR 8.26, 95% CI: 2.94–23.15), and HIV-infection (aHR 7.84, 95% CI: 6.26–9.82); external migration and HIV infection were also associated with causes of mortality other than HIV/TB (aHR 1.62, 95% CI: 1.12–2.34 and aHR 2.59, 95% CI: 1.79–3.75).ConclusionHIV/TB was the leading cause of death among women of reproductive age, although rates declined with the rollout of HIV treatment in the area from 2004. Women's age, external migration status and HIV-positive status were significantly associated with all-cause and cause-specific mortality.

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The Role of Pregnancy Outcomes in the Maternal Mortality Rates of Two Areas in Matlab, Bangladesh

Cited by 18 publications

References 17 publications

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Pregnancy Termination in Matlab, Bangladesh: Maternal Mortality Risks Associated with Menstrual Regulation and Abortion

Mortality in women of reproductive age in rural South Africa

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