Under-estimation of maternal and perinatal mortality revealed by an enhanced surveillance system: enumerating all births and deaths in Pakistan

Anwar, Jasim; Torvaldsen, Siranda; Sheikh, Mohamud; Taylor, Richard

doi:10.1186/s12889-018-5363-3

Cited by 32 publications

(30 citation statements)

References 32 publications

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“…This could be due to the reason that: if pregnancy surveillance is active, every stakeholder like; women development group (WDG) and steering committee could be active to attend the pregnancy outcome of each registered pregnant mothers. This finding is supported by a study from Pakistan which revealed that higher mortality detection by enhanced pregnancy surveillance system [47].…”

Section: Discussionsupporting

confidence: 67%

Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects

et al. 2019

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BackgroundMaternal and Perinatal Death Surveillance and Response (MPDSR) was a pilot program introduced in Tigray, Ethiopia to monitor maternal and perinatal death. However; its implementation and operation is not evaluated yet. Therefore, this study aimed to assess the implementation and operational status and determinants of MPDSR using a programmatic data and stakeholders involved in the program.MethodsInstitutional based cross-sectional study was applied in public health facilities (75 health posts, 50 health centers and 16 hospitals) using both qualitative and quantitative methods. Data were entered in to Epi-info and then transferred to SPSS version 21 for analysis. All variables with a p-value of ≤ 0.25 in the bivariate analysis were included in to multivariable logistic regression model to identify the independent predictors. For the qualitative part, manual thematic content analysis was done following data familiarization (reading and re-reading of the transcripts).ResultsIn this study, only 34 (45.3%) of health posts were practicing early identification and notification of maternal/perinatal death. Furthermore, only 36 (54.5%) and 35(53%) of health facilities were practiced good quality of death review and took proper action respectively following maternal/perinatal deaths. Availability of three to four number of Health Extension Workers (HEWs) (Adjusted Odds Ratio (AOR) = 6.09, 95%CI (Confidence Interval): 1.51–24.49), availability of timely Public Health Emergency Management (PHEM) reports (AOR = 4.39, 95%CI: 1.08–17.80) and participation of steering committee’s in death response (AOR = 9.19, 95%CI: 1.31–64.34) were the predictors of early identification and notification of maternal and perinatal death among health posts. Availability of trained nurse (AOR = 3.75, 95%CI: 1.08–12.99) and health facility’s head work experience (AOR = 3.70, 95%CI: 1.04–13.22) were also the predictors of quality of death review among health facilities. Furthermore; availability of at least one cluster review meeting (AOR = 4.87, 95%CI: 1.30–18.26) and uninterrupted pregnant mothers registration (AOR = 6.85, 95%CI: 1.22–38.54) were associated with proper response implementation to maternal and perinatal death. Qualitative findings highlighted that perinatal death report was so neglected. Community participation and intersectoral collaboration were among the facilitators for MPDSR implementation while limited human work force capacity and lack of maternity waiting homes were identified as some of the challenges for proper response implementation.ConclusionThis study showed that the magnitude of: early death identification and notification, review and response implementation were low. Strengthening active surveillance with active community participation alongside with strengthening capacity building and recruitment of additional HEWs with special focus to improve the quality of health service could enhance the implementation of MPDSR in the region.

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Section: Discussionsupporting

confidence: 67%

Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects

et al. 2019

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“…Birth weight below 2.5 kg was found in 26(60.5%) babies in our study. Low birth weight is an important cause of death, as observed in other studies 3,15 . The factors responsible for these can be identified during the antenatal period; most of these can present with conditions that may be associated with low birth weight.…”

Section: Table 1: Distribution Of Deliveries In Perinatal Mortality In One Year Periodsupporting

confidence: 56%

Audit of Neonatal Outcome in Tertiary Care Hospital.

Rashid¹,

Iqbal²,

Nadeem³

2021

Int. j. endorsing health sci. res.

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Background: Every year, 2.7 million stillbirths occur worldwide, mostly in developing countries. The United Nations Sustainable Development Goals (SDGs) include reducing childhood mortality under five years of age. Perinatal death audit is an intervention to reduce preventable neonatal mortality. The aim of this study was to determine the Perinatal Mortality Rate (PMR) and the factors responsible for perinatal deaths at a Tertiary Care Hospital in Karachi-Pakistan. Methodology: This was a prospective study of all the stillbirths and early neonatal deaths in Abbasi Shaheed Hospital Karachi, Gynecology Unit I. Details of each perinatal death were filled in the standard form. We used Aberdeen Obstetric classification to classify causes of perinatal deaths. Results: There were 1627 deliveries and 43 perinatal deaths during the study period. Our study's perinatal mortality rate was 27.14/1000 births, and the stillbirth rate was 13.25/1000 births. Antepartum hemorrhage (APH), pregnancy-induced hypertension (PIH) and anemia were the common causes of perinatal deaths. Conclusion: Antepartum hemorrhage, pregnancy-induced hypertension and anemia are the leading causes of perinatal deaths. Most of these complications can be reduced by educating women and providing effective antenatal care.

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“…Serial data from demographic health surveys conducted in Pakistan shows a NMR of 55 deaths per 1,000 live births between 1992 to 2012 which improved to 42 deaths per 1,000 live births in the most current 5-year period (14,15). This minimal improvement shown was even challenged by research that shows that neonatal mortality rates in the study area were under-estimated by 50% (16).…”

Section: Introductionmentioning

confidence: 92%

Measuring coverage of WHO recommended Essential Newborn Care practices in the squatter settlements of Islamabad Capital Territory in Pakistan.

Hassan

Hamid

Raza

et al. 2020

Preprint

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Background: Pakistan has shown significant progress in reducing child mortality, however, significant challenges exist in reducing neonatal mortality rate. WHO recommends a package of “essential newborn care” practices based on effective coverage to improve newborn survival. This study assessed the level of effective coverage of newborn care in the squatter settlements of Islamabad Capital Territory (ICT) and also determined if the care received is within the parameters of essential newborn care as defined by WHO guidelines.Methods: A cross-sectional survey was conducted to gather community-based data on newborn care practices from 416 mothers who delivered a live baby in the past twelve months within a randomly selected squatter population of ICT. Three composite outcomes (safe cord care, optimal thermal care and good neonatal feeding) were generated by combining individual practices from a list of essential newborn care practices recommended by WHO. All International ethical standards were followed including informed consent and confidentiality of respondents. Ethical clearance was obtained from the ethical review board of Health Services Academy (HSA).Results: Despite a very high number of institutional deliveries, the study showed that only 2.9% of newborns received all components of WHO recommended essential newborn care. Only 17.1% of the newborns received essential elements of safe cord care, 40.4% received recommended optimal thermal care and 28.8% followed WHO guidelines of good neonatal feeding practice. This low uptake of essential practices was due to the application of various substances on the cord, delayed skin to skin contact and feeding of pre-lacteals to the newborn.Conclusion: The study highlighted that the current level of effective essential newborn care is extremely low in the country. We found multiple cultural and societal misconceptions, that translate into harmful practices for newborns. Interventions such as educating mothers through front line workers, updating health care staff on WHO recommended guidelines for newborn care and declaring widespread harmful traditional practices hazardous for the health of newborn, can help improve essential newborn care in Pakistan.

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Under-estimation of maternal and perinatal mortality revealed by an enhanced surveillance system: enumerating all births and deaths in Pakistan

Cited by 32 publications

References 32 publications

Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects

Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects

Audit of Neonatal Outcome in Tertiary Care Hospital.

Measuring coverage of WHO recommended Essential Newborn Care practices in the squatter settlements of Islamabad Capital Territory in Pakistan.

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