Institutional maternal and perinatal deaths: a review of 40 low and middle income countries

BMC Pregnancy and Childbirth

Research Article

Malick Kante¹  Lynn Freedman¹  Emily Keyes²  Patricia E. Bailey²  Wasihun Andualem³  Sourou Gbangbade⁴  Edwin Libamba⁵  Dahada Ould el Joud⁶  Halima Mouniri⁷  Kavita Singh⁸  Allisyn C. Moran⁹  Michel Brun^1,10 

[1] Averting Maternal Death & Disability, Columbia University, New York, NY, USA;Global Health Programs, FHI 360, 359 Blackwell Street, 27701, Durham, NC, USA;Averting Maternal Death & Disability, Columbia University, New York, NY, USA;Independent consultant, Addis Ababa, Ethiopia;Independent consultant, Cotonou, Benin;Independent consultant, Lilongwe, Malawi;Independent consultant, Nouakchott, Mauritania;Independent consultant, Rabat, Morocco;MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, 27516, Chapel Hill, NC, USA;Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 27599, Chapel Hill, NC, USA;U.S. Agency for International Development, Washington, DC, USA;UNFPA, New York, NY, USA;

关键词: Cause of maternal death;    Direct and indirect deaths;    Cause specific case fatality rate;    Stillbirth rate;    Early neonatal death rate;    Perinatal mortality;   

DOI  :  10.1186/s12884-017-1479-1

 received in 2017-02-09, accepted in 2017-08-30,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundUnderstanding the magnitude and clinical causes of maternal and perinatal mortality are basic requirements for positive change. Facility-based information offers a contextualized resource for clinical and organizational quality improvement. We describe the magnitude of institutional maternal mortality, causes of death and cause-specific case fatality rates, as well as stillbirth and pre-discharge neonatal death rates.MethodsThis paper draws on secondary data from 40 low and middle income countries that conducted emergency obstetric and newborn care assessments over the last 10 years. We reviewed 6.5 million deliveries, surveyed in 15,411 facilities. Most of the data were extracted from reports and aggregated with excel.ResultsHemorrhage and hypertensive diseases contributed to about one third of institutional maternal deaths and indirect causes contributed another third (given the overrepresentation of sub-Saharan African countries with large proportions of indirect causes). The most lethal obstetric complication, across all regions, was ruptured uterus, followed by sepsis in Latin America and the Caribbean and sub-Saharan Africa. Stillbirth rates exceeded pre-discharge neonatal death rates in nearly all countries, possibly because women and their newborns were discharged soon after birth.ConclusionsTo a large extent, facility-based findings mirror what population-based systematic reviews have also documented. As coverage of a skilled attendant at birth increases, proportionally more deaths will occur in facilities, making improvements in record-keeping and health management information systems, especially for stillbirths and early neonatal deaths, all the more critical.

【 授权许可】

CC BY   
© The Author(s). 2017