scholarly journals Impacts of discriminated PM2.5 on global under-five and maternal mortality

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Patrick Opiyo Owili ◽  
Tang-Huang Lin ◽  
Miriam Adoyo Muga ◽  
Wei-Hung Lien
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Intervention Strategy ◽  
Positive Association ◽  
Global Scale ◽  
Low Income Countries ◽  
Maternal Deaths ◽  
Under Five ◽  
Life Years ◽  
Increased Risk

Abstract Globally, it was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. Most studies, however, have focused only on the clinical causes of maternal and under-five deaths, and yet there could be other factors such as ambient particulate matter (PM). The current global estimates indicate that exposure to ambient PM2.5 (with ≤ 2.5 microns aerodynamic diameter) has caused about 7 million deaths and over 100 million disability-adjusted life-years. There are also several health risks that have been linked PM2.5, including mortality, both regionally and globally; however, PM2.5 is a mixture of many compounds from various sources. Globally, there is little evidence of the health effects of various types of PM2.5, which may uniquely contribute to the global burden of disease. Currently, only two studies had estimated the effects of discriminated ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mortality using satellite measurements, and this study found a positive association in Africa and Asia. However, the study area was conducted in only one region and may not reflect the spatial variations throughout the world. Therefore, in this study, we discriminated different ambient PM2.5 and estimated the effects on a global scale. Using the generalized linear mixed-effects model (GLMM) with a random-effects model, we found that biomass PM2.5 was associated with an 8.9% (95% confidence interval [CI] 4.1–13.9%) increased risk of under-five deaths, while dust PM2.5 was marginally associated with 9.5% of under-five deaths. Nevertheless, our study found no association between PM2.5 type and global maternal deaths. This result may be because the majority of maternal deaths could be associated with preventable deaths that would require clinical interventions. Identification of the mortality-related types of ambient PM2.5 can enable the development of a focused intervention strategy of placing appropriate preventive measures for reducing the generation of source-specific PM2.5 and subsequently diminishing PM2.5-related mortality.

scholarly journals Review Article on Emergency Obstetric Care

2018 ◽  
Vol 1 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Silas Ochejele
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Skilled Birth Attendant ◽  
Obstetric Care ◽  
Functional Health ◽  
Low Income Countries ◽  
Mortality Reduction ◽  
Maternal Deaths

Maternal death was once a common occurrence worldwide but today, 99% of maternal deaths occur in low income countries. Most of the maternal deaths are due to direct obstetric complications. Emergency obstetric care is the intervention required to save the lives of these women. It is based on a tripod of signal functions, skilled birth attendants and a functional health system. The objective of this article was to discuss the role of Emergency obstetric care in maternal mortality reduction. A systematic review of available articles on Emergency obstetric care; and Emergency obstetric care training materials, experience and observations used/made between 2003 and 2017 in Nigeria was used for this work. Emergency obstetric care is the nucleus on which all other maternal mortality reduction activities are hinged. The paradigm evolvement of Emergency obstetric care offers the last hope for a woman with direct obstetric complication. However, the skilled birth attendant must have the right attitude in addition to her/his professional skills for effective implementation of these interventions. Women need access to and availability of Emergency obstetric care as well as a continuum of care that includes antenatal, intra-partum and postnatal care, newborn care and family planning services to reduce maternal mortality.

scholarly journals Maternal deaths in developing countries: A preventable tragedy

2009 ◽  
Vol 15 (2) ◽  
Author(s):  
Gunnar Kvåle ◽  
Bjørg Evjen Olsen ◽  
Sven Gudmund Hinderaker ◽  
Magnar Ulstein ◽  
Per Bergsjø
Keyword(s):  
Public Health ◽  
Health Care ◽  
Maternal Mortality ◽  
Low Income ◽  
Health Care Systems ◽  
Health Problems ◽  
Low Income Countries ◽  
Public Health Importance ◽  
Maternal Deaths ◽  
Care Systems

The neglected tragedy of persistent high maternal mortality in the low-income countries is described. One of the millennium development goals states that the current number of maternal deaths of around 500,000 per year should be reduced by three quarters by 2015. Since the major causes and avenues for prevention are known, this may seem an achievable goal. It is concluded, however, that unless all stakeholders globally and within individual countries will demonstrate a real commitment to translate policy statements into actions, it is unlikely that the goal will be reached. A substantial increase in the resources for reproductive health care services is needed, and the human resource crises in the health care systems must be urgently addressed. Epidemiologists have an important role to play by designing randomized controlled trials for estimating the effect of different health care systems interventions aimed at reducing maternal mortality and other major health problems in low resource settings. The public health importance of such trials may be greater than the potential benefit of randomized trials for investigating effects of new vaccines and drugs. Within the field of perinatal epidemiology the disparity in public health importance of research conducted in the rich versus the poor world is glaring. Time is overdue for perinatal epidemiologists to turn their attention to the areas of the world where the maternal and perinatal health problems are overwhelming.

scholarly journals Facteurs Associes Aux Deces Maternels A L’hôpital De Zone Saint Jean De Dieu De Tanguieta De 2015 A 2019

2021 ◽  
Vol 17 (29) ◽  
pp. 93
Author(s):  
Atade Sèdjro Raoul ◽  
Hounkponou Ahouingnan Fanny Maryline Nouessèwa ◽  
Obossou Achille Awadé Afoukou ◽  
Gabkika Bray Madoué ◽  
Doha Sèna Mireille Isabelle ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Maternal Mortality Ratio ◽  
Public Health Problem ◽  
Low Income Countries ◽  
Maternal Deaths ◽  
Live Births ◽  
Factors Associated ◽  
Mortality Ratio ◽  
Faible Revenu

Introduction: La mortalité maternelle est un problème de santé publique au Bénin ; Elle est estimée à 397 pour 100 000 Naissances Vivantes (NV) en 2017. Dans les pays à faible revenu le ratio de mortalité maternelle est de 239 pour 100 000 Naissances Vivantes (NV). Objectifs: Identifier les facteurs associés aux décès maternels à l’Hôpital de Zone Saint Jean de Dieu de Tanguiéta de 2015 à 2019. Méthode d’étude: Il s’est agi d’une étude rétrospective à visée descriptive et analytique. Les dossiers des femmes ont été dépouillés pour collecter les informations relatives aux variables de l’étude. Résultat: Durant la période d’étude, nous avons recensé 222 dossiers. Le ratio de mortalité maternelle intra-hospitalière était de 1173 décès pour 100 000 naissances. L’âge moyen des femmes décédées était de 25,4 ans. Les femmes décédées étaient des ménagères dans 72,1%. Plus de la moitié des femmes décédées (55,9%) n’avaient bénéficié d’aucune consultation prénatale. La référence était le principal mode d’entrée à l’hôpital (64%). Les causes obstétricales directes des décès étaient dominées par les hémorragies (25,8%), les troubles hypertensifs (22,8%) et les infections puerpérales (21,2%). Les facteurs associés aux décès maternels étaient : le milieu de résidence (p = 0,004), le délai (de 5jours et plus) entre l’apparition des symptômes et l’admission à l’hôpital (p = 0,019), le transport non médicalisé (p=0,013) et le troisième retard (p < 0,001). Conclusion: Le ratio de mortalité maternelle était élevé à l’hôpital de zone Saint Jean de Dieu de Tanguieta. Il importe que des actions soient menées en agissant sur les différents facteurs en vue de réduire la mortalité maternelle dans cet hôpital. Introduction: Maternal mortality is a public health problem in Benin, it is estimated at 397 per 100,000 Live Births (LB) in 2017. In low-income countries the maternal mortality ratio is 239 per 100,000 Live Births (LB). Objectives: Identify the factors associated with maternal deaths at the Saint Jean de Dieu Zone Hospital in Tanguiéta from 2015 to 2019. Study Method: This was a retrospective study with a descriptive and analytical aim. Women's records were searched to collect information on study variables. Result: During the study period, we identified 222 cases. The intrahospital maternal mortality ratio was 1,173 deaths per 100,000 births. The average age of the deceased women was 25.4 years. 72.1% of the deceased women were housewives. More than half of the women who died (55.9%) had not received any prenatal consultation. Referral was the main mode of entry to hospital (64%). The direct obstetric causes of death were dominated by haemorrhages (25.8%), hypertensive disorders (22.8%) and puerperal infections (21.2%). Factors associated with maternal deaths were: place of residence (p = 0.004), the time (5 days or more) between the onset of symptoms and admission to hospital (p = 0.019), unsafe transportation (p = 0.013) and The third delay (p <0.001). Conclusion: The maternal mortality ratio was high at the Saint Jean de Dieu hospital in Tanguieta. It is important that actions be taken by acting on the various factors in order to reduce maternal mortality in this hospital.

scholarly journals Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

2020 ◽  
Vol 17 (S3) ◽  
Author(s):  
Melissa Bauserman ◽  
Vanessa R. Thorsten ◽  
Tracy L. Nolen ◽  
Jackie Patterson ◽  
Adrien Lokangaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Maternal Mortality ◽  
Maternal Deaths ◽  
Middle Income ◽  
Maternal Risk ◽  
Live Births ◽  
Middle Income Countries ◽  
Risk Of Death ◽  
Increased Risk ◽  
Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

Injury prevention and control

2021 ◽  
pp. 361-376
Author(s):  
Corinne Peek-Asa ◽  
Adnan A. Hyder
Keyword(s):  
Injury Prevention ◽  
Low Income ◽  
Prevention And Control ◽  
Low Income Countries ◽  
Middle Income ◽  
Injury Rates ◽  
Middle Income Countries ◽  
Disability Adjusted Life ◽  
Life Years ◽  
And Control

Injuries are among the leading causes of death and disability throughout the world and contribute disproportionately to premature life lost. Injury rates are highest among middle- and low-income countries. According to analyses of the 2016 Global Burden of Disease data, injuries cause over 4.6 million deaths per year, accounting for nearly 8.4% of all deaths and 10.7% of disability-adjusted life years. Many opportunities to implement injury prevention strategies exist, and a systematic approach to injury prevention can help identify the most effective and efficient approaches. Building capacity for injury prevention activities in low- and middle-income countries is an important public health priority.

Reducing the distance to walk: establishing a remote maternity facility in Runga, Hoima District, Uganda

2020 ◽  
Vol 14 (2) ◽  
pp. 1-8
Author(s):  
Rhiannon Grindle ◽  
Sofia Giannopoulou ◽  
Harriet Jacobs ◽  
Jerome Barongo ◽  
Alexandra Elspeth Cairns
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Health Facility ◽  
Low Income ◽  
Local Level ◽  
Substantial Reduction ◽  
Care Quality ◽  
Low Income Countries ◽  
Health Seeking ◽  
Birth Attendance

Despite a substantial reduction in global maternal mortality, rates in low-income countries remain unacceptably high. Multiple contributing factors exist, grouped into three delays: health-seeking behaviour; accessibility of care; quality of care. In the Hoima District, rates of health facility delivery and skilled birth attendance remain low and maternal mortality exceeds the national average. Establishing the Midwives At Maternity Azur Clinic (February 2017) has addressed these issues at a local level. Health education and antenatal care are provided at the clinic, encouraging women to seek timely, appropriate intrapartum care. Access from surrounding villages is facilitated by a waiting home and weekly transport for antenatal care, alongside transport to a health facility with a staffed operating theatre, when required. It is run by a resident midwife, with regular training updates, and is stocked with the necessary resources for quality healthcare. Since its advent, village leaders report all-cause burials have reduced from one a day to one a week.

scholarly journals Developing obstetric medicine training in Latin America

2017 ◽  
Vol 10 (1) ◽  
pp. 16-20 ◽  
Author(s):  
José Rojas-Suarez ◽  
Niza Suarez ◽  
Oier Ateka-Barrutia
Keyword(s):  
Latin America ◽  
Maternal Mortality ◽  
Latin American ◽  
Low Income ◽  
Morbidity And Mortality ◽  
Low Income Countries ◽  
Important Indicator ◽  
Obstetric Medicine ◽  
The Impact ◽  
In Pregnancy

Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes. Medical problems in pregnancy remain an important cause of morbidity and mortality in this region. Previous data indicate the need for a call to action for adequate diagnosis and care of medical diseases in obstetric care. The impact of nonobstetric and medical pathologies on maternal mortality in Latin America is largely unknown. In Latin America, two educational initiatives have been proposed to improve skills in maternity care. The Advanced Life Support in Obstetrics (ALSO®) was first started to address obstetric emergencies, and subsequently adapted for low-middle-income country settings as the Global ALSO®. In parallel, the Latin American obstetric anesthesia community has progressively focused on improvement of several intrapartum/intraoperative issues, which has secondarily taken them to embrace the obstetric medicine area on interest and join the former initiatives. In the present review, we summarize the available data regarding medical morbidity and mortality in pregnancy in Latin America, as well as the challenges, achievements, issues, initiatives, and future directions encouraging maternal health educators, health care trainers, and physicians in middle- and low-income countries, such as many Latin American ones, to improve and/or change attitudes, if needed, on current clinical practice.

scholarly journals Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil

2017 ◽  
Vol 43 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Jessica M Ferreira ◽  
Ilza Monteiro ◽  
Arlete Fernandes ◽  
Maria V Bahamondes ◽  
Ana Pitoli ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Child Mortality ◽  
Low Income ◽  
Teaching Hospitals ◽  
Disability Adjusted Life Years ◽  
Mortality And Morbidity ◽  
Live Births ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Maternal Mortality And Morbidity

BackgroundThe objective was to analyse the contribution of the provision at no cost to users of the 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS) towards disability-adjusted life years (DALY) averted over a 9-year period.MethodsWe analysed data from 15 030 new users of the LNG-IUS who had the device inserted at 26 Brazilian teaching hospitals between January 2007 and December 2015. The devices came from the International Contraceptive Access Foundation (ICA), a not-for-profit foundation that donates the devices to developing countries for use by low-income women who desire long-term contraception and who freely choose to use this device. Estimation of the DALY averted included live births averted, maternal morbidity and mortality, child mortality and unsafe abortions averted.ResultsA total of 15 030 women chose the LNG-IUS as a contraceptive method during the study period. Over the 9 years of evaluation, the estimated cumulative contribution of the Brazilian program in terms of DALY averted consisted of 486 live births, 14 cases of combined maternal mortality and morbidity, 143 cases of child mortality and 410 unsafe abortions.ConclusionsProvision of the LNG-IUS at no cost to low-income Brazilian women reduced unwanted pregnancies and probably averted maternal mortality and morbidity, child mortality and unsafe abortions. Family planning programs, policymakers and stakeholders based in low-resource settings could take advantage of the information that the provision of this contraceptive at no cost, or at affordable cost to a publicly-insured population, is an effective policy to help promote women’s health.

scholarly journals Income and Marital Status Interact on Obesity Among Black and White Men

2019 ◽  
Vol 13 (1) ◽  
pp. 155798831982995 ◽  
Author(s):  
Caryn N. Bell ◽  
Roland J. Thorpe
Keyword(s):  
Marital Status ◽  
Black Men ◽  
Low Income ◽  
Positive Association ◽  
White Men ◽  
Poverty Line ◽  
High Income ◽  
Never Married ◽  
Black And White ◽  
Increased Risk

Racial disparities in obesity among men are accompanied by positive associations between income and obesity among Black men only. Race also moderates the positive association between marital status and obesity. This study sought to determine how race, income, and marital status interact on obesity among men. Using data from the 2007 to 2014 National Health and Nutrition Examination Survey, obesity was measured as body mass index ≥30 kg/m2 among 6,145 Black and White men. Income was measured by percentage of the federal poverty line and marital status was categorized as currently, formerly, or never married. Using logistic regression and interaction terms, the associations between income and obesity were assessed by race and marital status categories adjusted for covariates. Black compared to White (OR = 1.19, 95% CI [1.03, 1.38]), currently married compared to never married (OR = 1.45, 95% CI [1.24, 1.69]), and high-income men compared to low income men (OR = 1.26, 95% CI [1.06, 1.50]) had higher odds of obesity. A three-way interaction was significant and analyses identified that income was positively associated with obesity among currently married Black men and never married White men with the highest and lowest probabilities of obesity, respectively. High-income, currently married Black men had higher obesity rates and may be at increased risk for obesity-related morbidities.

scholarly journals Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria

2018 ◽  
Vol 6 (6) ◽  
pp. 1153-1158 ◽  
Author(s):  
Thomas U. Agan ◽  
Emmanuel Monjok ◽  
Ubong B. Akpan ◽  
Ogban E. Omoronyia ◽  
John E. Ekabua
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Post Partum ◽  
Maternal Mortality Ratio ◽  
Low Income Countries ◽  
Live Births ◽  
Mortality Ratio ◽  
Post Partum Haemorrhage ◽  
The University ◽  
Hypertensive Diseases

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial” was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

Sign in / Sign up

Export Citation Format

Share Document