The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Abstract Background Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures. Methods Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters. Results Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions. Conclusion These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

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Millennium Development Goal 5 and adolescents: looking back, moving forward

Archives of Disease in Childhood ◽

10.1136/archdischild-2013-305514 ◽

2015 ◽

Vol 100 (Suppl 1) ◽

pp. S43-S47 ◽

Cited By ~ 21

Author(s):

Joshua P Vogel ◽

Cynthia Pileggi-Castro ◽

Venkatraman Chandra-Mouli ◽

Vicky Nogueira Pileggi ◽

João Paulo Souza ◽

...

Keyword(s):

Maternal Health ◽

Reproductive Health ◽

Maternal Mortality ◽

Universal Access ◽

Maternal Mortality Ratio ◽

Millennium Development Goal ◽

Reproductive Health Services ◽

Development Goal ◽

Health Community ◽

Mortality Ratio

Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5; improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of <70 deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality.

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Global burden for dengue and the evolving pattern in the past 30 years

Journal of Travel Medicine ◽

10.1093/jtm/taab146 ◽

2021 ◽

Author(s):

Xiaorong Yang ◽

Mikkel B M Quam ◽

Tongchao Zhang ◽

Shaowei Sang

Keyword(s):

Southeast Asia ◽

South Asia ◽

Human Mobility ◽

Viral Disease ◽

Global Burden ◽

Disability Adjusted Life ◽

Life Years ◽

National Burden ◽

Global Burden Of Diseases ◽

Incident Cases

Abstract Background: Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. We present the global, regional, and national burden of dengue from 1990 to 2019 based on the findings from the Global Burden of Diseases, Injures, and Risk Factors Study 2019 (GBD 2019). Methods: Based upon GBD 2019 dengue data on age-standardized incidence rate (ASIR), age-standardized death rate (ASDR) and age-standardized disability-adjusted life years (DALYs) rate, this study estimates and presents annual percentage change (EAPC) to quantify trends over time to assess potential correlates of increased dengue activity such as global travel, and warming. Results: Globally from 1990 to 2019, dengue incident cases, deaths and DALYs gradually increased. Those under 5, once accounting for the largest portion of deaths and DALYs in 1990, were eclipsed by those 15–49 years old in 2019. Age standardized incidence (ASIR: EAPC 3.16, 95%CI: 2.90–3.43), death (ASDR: EAPC 5.42, 95%CI: 2.64–8.28), and DALY rates (EAPC 2.31, 95%CI: 2.00–2.62) accelerated most among high-middle and high socio-demographic index (SDI) regions. Southeast Asia and South Asia had most of the dengue incident cases, deaths and DALYs, but East Asia had the fastest rise in ASIR (EAPC 4.57, 95%CI: 4.31, 4.82), while Tropical Latin America led in ASDR (EAPC 11.32, 95%CI: 9.11, 13.58) and age-standardized DALYs rate (EAPC 4.13, 95%CI: 2.98, 5.29). SDI showed consistent bell shape relationship with ASIR, ASDR and age-standardized DALYs rate. Global Land-Ocean Temperature Index and air passenger travel metrics were found to be remarkably positively correlated with dengue burden. Conclusions: The burden of dengue has become heavier from 1990 to 2019, amidst the three decades of urbanization, warming climates and increased human mobility in much of the world. Southeast Asia and South Asia remain regions of concern, especially in conjunction with the Americas swift rise in dengue burden.

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Global Burden of Sexually Transmitted Infections: 1990 - 2019

10.21203/rs.3.rs-847312/v1 ◽

2021 ◽

Author(s):

Jiaofeng Huang ◽

Su Lin ◽

Jinshui Pan ◽

Lingling Lu ◽

Bang Liu ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Incidence Rate ◽

Disease Burden ◽

Global Burden ◽

Sexually Transmitted ◽

Disability Adjusted Life ◽

Younger Age ◽

Life Years ◽

Disease Study ◽

Incident Cases

Abstract BackgroundSexually transmitted infections (STIs) are major public health problems worldwide. Understanding the disease burden are crucial for health policy making. This study was to assess global and regional STIs incidence, mortality and disability‐adjusted life years (DALYs) from 1990 to 2019.MethodsData were extracted from the Global Burden of Disease study 2019, which is an open database for download. Age-standardized rate and estimated annual percentage changes (EAPC) were calculated to evaluate the burden of STIs over time.ResultsIn 2019, the total number of incident cases of STIs was 769.85 million worldwide. The age-standardized incidence rate was stable from 1990 to 2019 with the EAPC of −0.04 (95% UI: −0.09 to 0.01). In 2019, the number of deaths caused by STIs was 89.89×103, which was 15.51% lower than that of 1990 (106.52×103). A decreasing trend from 1990 to 2019 was observed in the age-standardized death and DALYs. The age-standardized death and DALYs rate due to STIs were the highest in the younger age (<14 years old). As for different diseases, syphilis was the least common STIs with an age-standardized incidence rate of 178.48/100,000, while syphilis was also the main contributor to the age-standardized death and DALYs rate. These two indicators were negatively associated with sociodemographic level.ConclusionsThe global incidence of STIs has been persistently high from 1990 to 2019, while the age-standardized death and DALYs rate has decreased recently. More attention should be paid to the younger population, patients with syphilis and regions with low sociodemographic index.

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Epidemiology and Clinical Features of Maternal Sepsis：A Retrospective Study of Whole Pregnancy Period

10.21203/rs.3.rs-604723/v1 ◽

2021 ◽

Author(s):

Xuan Zhong ◽

Rongfeng Lin ◽

Wenni Zhang ◽

Yiping Luo ◽

Ding Wang

Keyword(s):

Epidemiological Study ◽

Clinical Features ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Fetal Mortality ◽

Control Group ◽

Incidence And Mortality ◽

Mortality Ratio ◽

Maternal Sepsis ◽

Poor Outcomes

Abstract Background: Maternal sepsis results in poor outcomes such as fetal or maternal death. The incidence and mortality rates of maternal sepsis are variable in different places because of differences in economic development, race, medical conditions, etc. Identifying the clinical features and determining the possible mechanisms for avoiding morbidity and preventing poor outcomes would benefit committed patients. Therefore, this study was an epidemiological study at a maternity transfer centre in Southeast China that aimed to identify local disease features of maternal sepsis.Methods: This was a local epidemiological study in at a tertiary care center in Guangzhou, China, from 2015 to 2019. A total of 74969 pregnant women experiencing childbirth were included in this study; of these women, 74 patients with maternal sepsis were diagnosed by the sepsis criterion, and 118 patients without sepsis in the same period were selected randomly as the control group to study possible reasons for postpartum sepsis. This experiment covers the whole period from first trimester to puerperium. The clinical data were collected via the hospital electronic medical record system. Single-factor regression and multivariate logistic regression were implemented to analyze the risk factors for maternal sepsis.Results: The incidence of maternal sepsis was 0.099%, the maternal mortality ratio was 0.004% and the fetal mortality ratio was 0.007%. For clinical manifestations, septic shock was associated with a higher severity of patient illness. All of the poor outcomes (maternal or fetal death) occurred during pregnancy. Postpartum sepsis had the longest onset period, and postpartum sepsis was associated with the premature rupture of fetal membranes and preeclampsia.Conclusions: Maternal sepsis is an important cause of both maternal and fetal mortality. Here we described an epidemiological study that evaluated the disease incidence, development and prognosis of local maternal sepsis. Furthermore, the characteristics of maternal sepsis is likely due to unknown pathological mechanisms, and patients would benefit from the identification of more effective treatments for maternal sepsis.

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Sustainable Development Goal 3 and Maternal Health in Nigeria

Advances in Healthcare Information Systems and Administration - Human Rights, Public Values, and Leadership in Healthcare Policy ◽

10.4018/978-1-5225-6133-0.ch012 ◽

2019 ◽

pp. 247-271

Author(s):

Idongesit Eshiet

Keyword(s):

Sustainable Development ◽

Maternal Health ◽

Postnatal Care ◽

Maternal Mortality Ratio ◽

Sustainable Development Goal ◽

Maternal Deaths ◽

Development Goal ◽

Live Births ◽

Mortality Ratio ◽

The Government

This chapter addresses the feasibility of Nigeria achieving Target 3.1 of Sustainable Development Goal 3, which aims at reducing maternal deaths to less than 70 per 100,000 live births by 2030. Maternal deaths occur due to lack of access to maternal healthcare, which encompasses the healthcare dimensions of family planning, preconception, prenatal, and postnatal care for women. Nigeria is presently the second largest contributor to maternal deaths globally, having a maternal mortality ratio of 814 per 100,000 live births. Will Nigeria achieve this goal by 2030? This chapter assesses the maternal health landscape of Nigeria and the measures taken by the government to address maternal health from the perspective of the feasibility of achieving SDG 3, Target 3.1 by 2030.

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Sustainable Development Goal 3 and Maternal Health in Nigeria

Innovations in Global Maternal Health ◽

10.4018/978-1-7998-2351-3.ch011 ◽

2020 ◽

pp. 247-271

Author(s):

Idongesit Eshiet

Keyword(s):

Sustainable Development ◽

Maternal Health ◽

Postnatal Care ◽

Maternal Mortality Ratio ◽

Sustainable Development Goal ◽

Maternal Deaths ◽

Development Goal ◽

Live Births ◽

Mortality Ratio ◽

The Government

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Strategies to improve the maternal health programmes under NHM towards MDG-5: maternal mortality in Karnataka

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20171329 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1087

Author(s):

R. R. Kularni ◽

D Venkatesh

Keyword(s):

Maternal Health ◽

Maternal Mortality ◽

Program Implementation ◽

Maternal Mortality Ratio ◽

Exact Result ◽

Health Programs ◽

Financial Resources ◽

Maternal Deaths ◽

Mortality Ratio ◽

Health Programmes

Background: Since from the inception of safe mother hood programs in India during 1982-1990, there is no enough maternal health initiative and financial resource for funding public health activities. So number of maternal deaths is more in India, presently which is accounted 20% of the world total maternal deaths. The global and national importance has been given during 1990 by forming millennium development goal -5 (MDG) to improve maternal health programs. During these days MMR was high and there has been recognition for Maternal Health Programs since from 1997, when RCH-I, in the year 2005. National rural health mission (NRHM) was launched with the primary and main objective was to reduce infant and maternal mortality rate as per goal and target fixed by the 12th five year plan (NHM) and MDG -5. Under NHM enough financial resources envelop has been allotted to states of India as per program implementation plan (PIP), so effective utilization of these strategic and financial resources to reduce MMR. Hence this study needs to form strategies to improve the maternal health programs to reduce maternal mortality ratio as per NHM and MDG. Methods: We used the range of methods, like analytical methods to generate the strategies to reduce maternal deaths due to the particular cause by introducing the maternal health programmes with the strategies. Results: Maternal mortality ratio reduced from an estimated level of 437 in 1990 to 178 in 2010–12.The all India and Karnataka target for 2015 was 109 so far not reached. It has to be reached at least by 2017. Conclusions: Optimal using of resources with the implementation of proper strategies, it will give the exact result for achievement of planned goal. This study is also revealed that all the aspects of maternal health programmes and MMR.

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Designed to Fail? Revisiting Uganda’s Maternal Health Policies to Understand Policy Design Issues Underpinning missed Targets for Reduction of Maternal Mortality Ratio (MMR): 2000-2015

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.127 ◽

2021 ◽

Author(s):

Moses Mukuru ◽

Jonathan Gorry ◽

Suzanne N. Kiwanuka ◽

Linda Gibson ◽

David Musoke ◽

...

Keyword(s):

Maternal Health ◽

Maternal Mortality ◽

Policy Design ◽

Maternal Mortality Ratio ◽

Policy Instruments ◽

Delay Model ◽

Design Issues ◽

Maternal Deaths ◽

Mortality Ratio ◽

Three Delays

Background: Despite Uganda and other Sub-Saharan African countries missing their Maternal Mortality Ratio (MMR) targets for Millenium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions designed to reduce maternal deaths in Uganda and identified particular policy design issues that underpinned MDG 5 performance. We suggest a novel prescriptive and analytical (re)conceptualization of policy in terms of its fidelity to ‘3Cs’ (coherence of design, comprehensiveness of coverage and consistency in application) that could have implications for future healthcare programming. Methods: We conducted a retrospective study. Sixteen Ugandan maternal health policy documents and twenty-one national programme performance reports were examined, and six key informant interviews conducted with national stakeholders managing maternal health programmes during the reference period 2000-2015. We applied the analytical framework of the ‘three delay model’ combined with a broader literature on ‘policy mixing’. Results: Despite introducing fourteen separate policy instruments over 15 years with the goal of reducing maternal mortality. By the end of the MDG period in 2015, only 87.5% of the interventions for the three delays were covered with a notable lack of coherence and consistency evident among the instruments. The three delays persisted at the frontline with 70% of deaths by 2014 attributed to failures in referral policies while 67% of maternal deaths were due to inadequacies in healthcare facilities and trained personnel in the same period. By 2015, 37.3% of deaths were due to transportation issues. Conclusions: The piecemeal introduction of additional policy instruments frequently distorted existing synergies among policies resulting in persistence of the three delays and missed MDG 5 target. Future policy reforms should address the ‘three delays’ but also ensure fidelity of policy design to coherence, comprehensiveness and consistency.

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Maternal Mortality: Paradigm Shift in Nepal

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v7i2.11132 ◽

2014 ◽

Vol 7 (2) ◽

pp. 3-8 ◽

Cited By ~ 4

Author(s):

TR Bhadari ◽

G Dangal

Keyword(s):

Maternal Health ◽

Maternal Mortality ◽

Maternal Mortality Ratio ◽

Health Indicators ◽

Millennium Development Goal ◽

Care Providers ◽

Continuous Assessment ◽

Development Goal ◽

Quality Health ◽

Mortality Ratio

Achieving Millennium Development Goal (MDG) 5 still remains a challenge to Nepal. It is necessary to collect reliable evidence on maternal health for tackling MDG 5 with limited resources. A continuous assessment of maternal mortality is required to assure the progress towards the MDG 5. This study aims to assess the results of the different studies on maternal mortality in Nepal.The results published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2012 have been utilized to prepare this paper. In spite of the low proportion of births attended by skilled persons and institutional delivery, the maternal mortality ratio (MMR) in Nepal has declined drastically between the years 1990 and 2011, from 850 to 229 deaths per 100,000 live births. In recent years, Nepal is also reaching progress in different maternal health indicators such as mothers receiving antenatal care from skilled providers (60%- up from 24% in 1996). More than one-third births in the past five years have been assisted by skilled care providers. Nearly, 45% of women received postnatal care for their last birth in the first two days after delivery, 38% of women is aware of abortion which has been legalized since 2003.Though maternal health is a priority agenda of Nepal among the policy makers and the country is likely to achieve Millennium Development Goal 5 by the year 2015, there is still a wide gap between policies and charted targets, and the real accessibility and availability of the quality health services. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11132 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 3-8

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Maternal near miss review: a brief appraisal

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171928 ◽

2017 ◽

Vol 6 (5) ◽

pp. 1703 ◽

Cited By ~ 1

Author(s):

Sheeba Marwah ◽

Manjula Sharma

Keyword(s):

Health Care ◽

Maternal Health ◽

Maternal Mortality ◽

Maternal Morbidity ◽

Health Care Services ◽

Maternal Mortality Ratio ◽

Near Miss ◽

Maternal Near Miss ◽

Care Services ◽

Mortality Ratio

Recuperation of maternal health is mandatory for realms signatory to millennium declaration, as MDG 5A aims at reduction in maternal mortality ratio by three quarters between 1990 and 2015. MM is frequently described as “Just the Tip of The Iceberg” with a vast base of maternal morbidity that still remains largely undescribed. Hence, the concept of maternal near miss (MNM) or severe acute maternal Morbidity (SAMM) was instituted in maternal health care to complement information acquired from MDR. Here we present a succinct review to enlighten and update the readers about the concept of maternal near miss and its advantage in providing the modern-day obstetricians and the administrators an edge over maternal mortality in gauging the quality of health care delivered at each facility. This would thus be instrumental in helping them formulating policies to enhance the health care services at each level across the nation.

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