Adverse pregnancy outcomes in rural Maharashtra, India (2008–09): a retrospective cohort study

BMC Public Health

Shailesh Rajaram Deshpande¹  Madhusudan Vamanrao Karantaki²  Prakash Prabhakarrao Doke³ 

[1] Symbiosis School of Biomedical Sciences, Lavale, Taluka; Mulshi, District, Pune, 412 005, India;State Family Welfare Bureau, Government of Maharashtra, Pune, 411 001, India;Community Medicine Department, MGM Medical College, Kamothe, Navi Mumbai 410 210, India

关键词: Tribal areas;    Sex ratio at birth;    Stillbirth;    Abortion;    Relative risk;   

Others  :  1163432
DOI  :  10.1186/1471-2458-12-543

 received in 2012-01-31, accepted in 2012-07-10,  发布年份 2012

【 摘 要 】

Background

The study was carried out to record adverse pregnancy outcomes and to obtain information about sex ratio at birth in rural especially tribal areas in the State of Maharashtra, India. Although the tribal population is considered vulnerable to innumerable adversities, regretfully information about pregnancy wastage among them is not available. About 10% population of the state is tribal. The study of sex ratio at birth was planned as the overall sex ratio and child sex ratio had declined in the state.

Methods

The cohort of antenatal cases registered in rural areas of Maharashtra in the calendar year 2008 was followed up to study the pregnancy outcomes. A retrospective study was carried out from October 2009 to August 2010. The outcomes of all the registered antenatal cases were recorded by the Auxiliary Nurse Midwives. The summary sheets were obtained by Block Medical Officers. The data was entered at the block level by trained data entry operators in specially designed web-based software. Adverse pregnancy outcome was categorized in two groups abortions and stillbirths.

Results

About 1.1 million registered pregnancies were followed up. In the state 5.34% registered pregnancies ended in abortions. In tribal PHCs the relative risk of spontaneous abortion and induced abortion was 0.91and 0.38 respectively. It was also revealed that about 1.55% pregnancies culminated in stillbirth. The relative risk of stillbirths in tribal PHCs was 1.33. The sex ratio at birth in the state was 850. The ratio was 883 in the tribal PHCs. Correlation was observed between sex ratio at birth and induced abortion rate.

Conclusions

The study indicates that women from tribal PHCs are exposed to higher risk of adverse pregnancy outcome in the form of stillbirths. In non-tribal areas high induced abortion rate and poor sex ratio at birth is observed. These two indicators are correlated. The correlation may be explained by the unscrupulous practice of sex selective abortion.

【 授权许可】

   
2012 Doke et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Sample registration system 2001: Report No. 1. Office of the Registrar General of India, Ministry of Home Affairs, Government of India, New Delhi; 2004:152.
• [2]Sample registration system 2007: Report No. 2. Office of the Registrar General of India, Ministry of Home Affairs, Government of India, New Delh; 2008:178.
• [3]National Family Health Survey (NFHS-3). 2005–06 India volume I. International Institute for Population Sciences and Macro International, Mumbai; 2007:187.
• [4]Neonatal and perinatal mortality: country, regional and global estimates. World Health Organization, Geneva; 2006.
• [5]Ngoc NTN, Merialdi M: Abdel- Aleem H, et al. Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. Bull World Health Organ. 2006, 84:699-705.
• [6]Fikree FF, Gray RH: Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan. Paediatr Perinatal Epidemiol. 1996, 10:86-96.
• [7]India, Second Maharashtra Rural Water Supply Sanitation Project. IPP 47. (Draft). Tribal (Indigenous Peoples) Development Plan. Water Supply and Sanitation. Department, Government of Maharashtra, ; April 15, 2003. Retrieved June 16, 2012 from http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/05/30/000094946_03052004071312/Rendered/PDF/multi0page.pdf webcite
• [8]ICD-10: International Classification of Diseases and Related Health Problems. Tenth Revision. Volume 2. 2nd edition. World Health Organization, Geneva; 2004:96.
• [9]Dutta DC: Text Book of Obstetrics. 6th edition. , 159-Calcutta.
• [10]District Level Household and Facility Survey (DLHS-3), 2007–08. International Institute for Population Sciences, India, Maharashtra. Mumbai; 2010.
• [11]District Level Household and Facility Survey (DLHS-3), 2007–08. International Institute for Population Sciences, India. Mumbai; 2010.
• [12]Santhya KG, Verma S: Induced abortion: The current scenario in India. Regional Health Forum WHO South-East Asia Region 2004., 8(2) Retrieved December 24, 2011 from http://www.searo.who.int/en/Section1243/Section1310/Section1343/Section1344/Section1974_9702.htm webcite
• [13]Henshaw SK, Singh S, Hass T: The incidence of Abortion Worldwide. Int Fam Plan Perspect. 1999, 25(Supplement):S30-S38.
• [14]Sedgh G, Henshaw S, Singh S, Ahman E, Shah I: H. Induced abortion: estimated rates and trends worldwide. Lancet. 2007, 370:1338-45.
• [15]Pregnancy outcome in South Australia in 2008, pregnancy outcome unit, Epidemiology branch. SA Health Government of South Australia, ; 2011. Retrieved December 24, 2011 from http://www.health.sa.gov.au/pehs/publications/pregnancyoutcome-operatsions-sahaelth-2008.pdf webcite
• [16]Bang A, Reddy MH, Deshmukh MD: Child mortality in Maharashtra. Economic and Political Weekly. 2002, 37(49):4947-65.
• [17]More NS, Bapat U, Das S, Barnett S, Costello A, Fernandez A, Osrin D: Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai. International Journal for Equity in Health 2009, 8:21. Retrieved December 24, 2011 from http://www.equityhealthj.com/content/pdf/1475-9276-8-21.pdf webcite BioMed Central Full Text
• [18]George K, Prasad J, Singh D, et al.: Perinatal outcomes in a South Asian setting with high rates of low birth weight. BMC Pregnancy and Childbirth 2009, 9:5. Retrieved December 24, 2011 from http://www.biomedcentral.com/1471-2393/9/5 webcite BioMed Central Full Text
• [19]Nielsen BB, Liljestrand J, Hedegaard M, Thilsted SK, Joseph A: Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, South India: community based, cross sectional study. BMJ 1997, 14:1521-4.
• [20]Kumar V, Mahanty S, Misra RP, et al.: Effect of community-based behavior change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomized controlled trial. Lancet 2008, 372:1151-62.
• [21]Baqui AH, Darmstadt GL, Williams EK, et al.: Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes. Bull World Health Organ. 2006, 84(9):706-13.
• [22]Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tuncalp O: Patel Balsara Z, Gupta S, Say L, Lawn JE. National, regional and worldwide estimates of stillbirth rates in 2009 with trends since 1995; a systematic analysis. Lancet 2011, 377:1319-30.
• [23]Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA: 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy and Childbirth. 2009, 9(Suppl 1):S2. Retrieved December 24, 2011 from http://www.biomedcentral.com/1471-2393/9/S1/S2 webcite BioMed Central Full Text
• [24]Carlo WA, Goudar SS, Jehan I, et al.: Newborn-care training and perinatal mortality in developing countries. N Engl J Med. 2010, 362:614-23.
• [25]Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C, GAPPA Review Group: Global report on preterm and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy and Childbirth 2010, 10(Suppl 1):S1. Retrieved December 24, 2011 from http://www.biomedcentral.com/1471-2393/10/S1/S1 webcite BioMed Central Full Text
• [26]Froren FJ, Gordijn SJ, Abdel-Aleem H, et al.: Making stillbirths count, making numbers talk- Issues in data collection for stillbirths. BMC Pregnancy and Childbirth 2009, 9:58. Retrieved December 24, 2011 from http://www.biomedcentral.com/1471-2393/9/58 webcite BioMed Central Full Text
• [27]Mccaw-Binns AM, Fox K, Foster-Williams KE, Ashley DE, Irons AB: Registration of births, stillbirths and infant deaths in Jamaica. Int J Epidemiol 1996, 25:807-13.
• [28]Ronsmans C, Chowdhury ME, Koblinsky M, Ahmed A: Care seeking at the time of childbirth, and maternal and perinatal mortality in Matlab, Bangladesh. Bull World Health Organ. 2010, 88(4):289-96.
• [29]McClure EM, Goldenberg RL, Banna CM: Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. Int J Gynecol Obstet. 2007, 96:139-46.
• [30]Jha P, Kumar R, Vasa P, Dhingra N, Thiruchelvam D, Moineddin R: Low male-to-female sex ratio of children born in India: national survey of 1.1 million households. Lancet 2006, 367:211-8.
• [31]Trends in sex ratio at birth and estimates of girls missing at birth in India. United Nations Population Fund, New Delhi; 2010.
• [32]Chhakulya Muklelya (Missing Daughters). Female to male ratio in 0–6 years (1991-2001-2009): Block wise trend in Maharashtra state. State Health Systems Resource Centre, Pune; 2009.
• [33]Government of India: Ministry of Home Affairs. Office of the Registrar General &Census Commissioner, India; 2012. Retrieved June, 2012 from http://censusindia.gov.in/2011-prov-results/prov_data_products_maha.html webcite
• [34]Prasad R, Singh MN, Das KC, Gupta K, Bhagat RB: Migration to Greater Mumbai Urban Agglomeration: A Study of Characteristics of Principal Migrants and Their Social Linkage. Demography India 2009, 38:319-34.
• [35]Nagarajan R, Mulay S: Ultrasound sonography centres and child sex ratio across Maharashtra. Artha Vijnana 2008, 50(4):433-48.