Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis

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.

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Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

Scientific Reports ◽

10.1038/s41598-021-87889-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Adeniyi Francis Fagbamigbe ◽

A. Olalekan Uthman ◽

Latifat Ibisomi

Keyword(s):

Risk Factors ◽

National Level ◽

Cross Sectional ◽

Middle Income ◽

Contextual Risk ◽

Under Five ◽

Factors Associated ◽

Under Five Children ◽

Middle Income Countries ◽

Low And Middle Income

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

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Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention

Burns ◽

10.1016/j.burns.2006.04.002 ◽

2006 ◽

Vol 32 (5) ◽

pp. 529-537 ◽

Cited By ~ 242

Author(s):

S.N. Forjuoh

Keyword(s):

Risk Factors ◽

Descriptive Epidemiology ◽

Middle Income ◽

Middle Income Countries ◽

Treatment And Prevention ◽

Low And Middle Income

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Seroprevalence of SARS CoV-2 infection in Low and Middle-Income Countries and risk classification in the context of rolling out vaccine candidate across these countries : Protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-578481/v1 ◽

2021 ◽

Author(s):

Martin Ackah ◽

Louise Ameyaw ◽

Kwadwo Owusu Akuffo ◽

Cynthia Osei Yeboah ◽

Nana Esi Wood ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Vaccine Candidate ◽

Meta Analysis ◽

Cochrane Library ◽

Research Database ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Low And Middle Income

Abstract Background Seroprevalence of SARS Cov-2 provides a good indication of the extent of exposure and spread in the population, as well as those likely to benefit from a vaccine candidate. To date, there is no published or ongoing systematic review on the seroprevalence of COVID-19 in Low- and Middle-Income Countries (LMICs). This systematic review and meta-analysis will estimate SARS Cov-2 seroprevalence and the risk factors for SARS Cov-2 infection in LMICs.Methods We will search PubMed, EMBASE, WHO COVID-19 Global research database, Google Scholar, the African Journals Online, LILAC, HINARI, medRxiv, bioRxiv and Cochrane Library for potentially useful studies on seroprevalence of COVID-19 in LMICs from December 2019 to December 2020 without language restriction. Two authors will independently screen all the articles, select studies based on pre-specified eligibility criteria and extract data using a pre-tested data extraction form. Any disagreements will be resolved through discussion between the authors. The pooled seroprevalence of SARS CoV-2 for people from LMICs will be calculated. Random effects model will be used in case of substantial heterogeneity in the included studies, otherwise fixed-effect model will be used. A planned subgroup, sensitivity and meta-regression analyses will be performed. For comparative studies, the analyses will be performed using Review Manager v 5.4; otherwise, STATA 16 will be used. All effect estimates will be presented with their confidence intervals.Discussion The study will explore and systematically review empirical evidence on SARS Cov-2 seroprevalence in LMICs, and to assess the risk factors for SARS Cov-2 infection in Low Middle Income Countries in the context of rolling out vaccines in these countries. Finally, explore risk classifications to help with the rolling out of vaccines in LMICs.Systematic review registration: The protocol for this review has been registered in PROSPERO (CRD422020221548).

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Abstract WP280: Barriers to the Early Management of Patients With Transient Ischemic Attack in Low and Middle Income Countries

Stroke ◽

10.1161/str.48.suppl_1.wp280 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Fernanda J Teixeira ◽

Bernardo C Portal ◽

Gustavo H Tomasi ◽

Paula C Gasperin ◽

Viviane M Vedana ◽

...

Keyword(s):

Risk Factors ◽

Hospital Admission ◽

Average Length ◽

Specific Treatment ◽

Imaging Features ◽

Middle Income ◽

Early Management ◽

Middle Income Countries ◽

Imaging Characteristics ◽

Low And Middle Income

Background: Although much progress has been made in the acute ischemic stroke care in low- and middle-income countries (LMIC), there is a paucity of specific data on the early management of TIA patients. Patients with TIA present a substantial risk of stroke during the first few hours of symptom onset, when secondary prevention therapies should be urgently initiated. Therefore, hospital admission may offer some advantages for early management. Our aim was to evaluate the benefit of hospital admission of TIA patients in a LMIC. Methods: All TIA patients who arrived at our emergency room (ER) between March 2015 to March 2016 were admitted to the hospital. All patients were submitted to the following diagnostic protocol: brain imaging, intra and extracranial vascular imaging, echocardiography (TT and or TEE) and ECG. Baseline, imaging characteristics and early outcome were analyzed. Results: Among 845 consecutive stroke patients evaluated at our ER, 12.8% were diagnosed as TIA. Although vascular risk factors and presentation with weakness or speech disturbances were frequent findings among our TIA patients, only 1 in 5 patients (17.4%) required specific treatment (anticoagulation or carotid revascularization). In addition, half of our patients were classified as cryptogenic TIA. The average length of stay was 7.03 and there were no in-hospital stroke or death. We did not detect significant differences in demographics, risk factors and imaging features between patients that received standard vs. specific treatment. Conclusions: Many TIA patients with mild symptoms may not have reached our ER and among those who were evaluated some may not have required hospital admission. Clustering of risk factors among TIA patients may not be a variable helpful to identify high-risk patients in LMIC. A 24/7 emergency TIA clinic may be an option to improve urgent treatment and reduce acute care cost.

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Maternal morbidity

Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents ◽

10.1093/med/9780198794684.003.0023 ◽

2018 ◽

pp. 112-116

Author(s):

Mary McCauley ◽

Nynke van den Broek

Keyword(s):

Sustainable Development ◽

Maternal Health ◽

Maternal Mortality ◽

Maternal Morbidity ◽

Reproductive Age ◽

Middle Income ◽

Middle Income Countries ◽

Health And Wellbeing ◽

Development Goals ◽

Low And Middle Income

Maternal morbidity describes complications that have a significant effect on women during and after pregnancy, and are a leading cause of ill-health among women of reproductive age, especially in low- and middle-income countries. With the introduction of the new Sustainable Development Goals, the scope of global maternal health targets has been expanded, moving from a focus on preventing maternal mortality to formulating targets and emphasising the importance of maternal health and wellbeing. This chapter introduces the new concept of maternal morbidity, suggests how this relates to maternal mortality, and summarises what is known about the burden of maternal morbidity globally and what interventions and research are needed to improve maternal health during and after pregnancy, with an emphasis on the context of low- and middle-income countries.

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