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.

scholarly journals Identification of factors associated with stillbirth in Zimbabwe – a cross sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kushupika Dube ◽  
Tina Lavender ◽  
Kieran Blaikie ◽  
Christopher J. Sutton ◽  
Alexander E. P. Heazell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antenatal Care ◽  
Cross Sectional Study ◽  
Model Specification ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Increased Risk ◽  
Low And Middle Income

Abstract Introduction 98% of the 2.6 million stillbirths per annum occur in low and middle income countries. However, understanding of risk factors for stillbirth in these settings is incomplete, hampering efforts to develop effective strategies to prevent deaths. Methods A cross-sectional study of eligible women on the postnatal ward at Mpilo Hospital, Zimbabwe was undertaken between 01/08/2018 and 31/03/2019 (n = 1779). Data were collected from birth records for maternal characteristics, obstetric and past medical history, antenatal care and pregnancy outcome. A directed acyclic graph was constructed with multivariable logistic regression performed to fit the corresponding model specification to data comprising singleton pregnancies, excluding neonatal deaths (n = 1734), using multiple imputation for missing data. Where possible, findings were validated against all women with births recorded in the hospital birth register (n = 1847). Results Risk factors for stillbirth included: previous stillbirth (29/1691 (2%) of livebirths and 39/43 (91%) of stillbirths, adjusted Odds Ratio (aOR) 2628.9, 95% CI 342.8 to 20,163.0), antenatal care (aOR 44.49 no antenatal care vs. > 4 antenatal care visits, 95% CI 6.80 to 291.19), maternal medical complications (aOR 7.33, 95% CI 1.99 to 26.92) and season of birth (Cold season vs. Mild aOR 14.29, 95% CI 3.09 to 66.08; Hot season vs. Mild aOR 3.39, 95% CI 0.86 to 13.27). Women who had recurrent stillbirth had a lower educational and health status (18.2% had no education vs. 10.0%) and were less likely to receive antenatal care (20.5% had no antenatal care vs. 6.6%) than women without recurrent stillbirth. Conclusion The increased risk in women who have a history of stillbirth is a novel finding in Low and Middle Income Countries (LMICs) and is in agreement with findings from High Income Countries (HICs), although the estimated effect size is much greater (OR in HICs ~ 5). Developing antenatal care for this group of women offers an important opportunity for stillbirth prevention.

Prevalence and Risk Factors for Maternal Mortality at a Tertiary Care Centre in Eastern Nepal- Retrospective Cross Sectional Study

2021 ◽  
Author(s):  
Sarita Sitaula ◽  
Tulasa Basnet ◽  
Ajay Agrawal ◽  
Tara Manandhar ◽  
Dipti Das ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Type I ◽  
Maternal Deaths ◽  
Live Births ◽  
Contributory Factors ◽  
Mortality Ratio

Abstract Background:Maternal mortality ratio is an important public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and to identify the various risk factors and causes of maternal mortality.Methods: This is a retrospective study conducted in a tertiary care center of Eastern Nepal from 16th July,2015 to 15th July 2020. Maternal mortality ratio per 100,000 live-births over 5 years of study period was calculated. The causes of death, delays of maternal mortality and different sociodemographic profiles were analyzed by descriptive statistics.Results:There were total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in year 2015 to 2020. The mean age and gestational age of women having maternal deaths were 24.69 ±5.99 years and 36.15± 4.38 weeks of gestation respectively. The common causes of maternal deaths were obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis. The leading contributory factors to the death were delay in seeking health care and delay in reaching health care facility (type I delay:40.84%).Conclusions:Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors were due to delay in seeking care and delayed referral from other health facilities. Contributory factors related to maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and puerperium.

scholarly journals 492. High Prevalence of Colonization with Carbapenem-Resistant Enterobacteriaceae Among Patients Admitted to Vietnamese Hospitals: Risk Factors and Burden of Disease

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S240-S240
Author(s):  
Dien M Tran ◽  
Mattias Larsson ◽  
Linus Olson ◽  
Ngoc TB Hoang ◽  
Le Kien Ngai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Infection Prevention And Control ◽  
Middle Income ◽  
Peripheral Venous Catheter ◽  
Middle Income Countries ◽  
Carbapenem Resistant ◽  
Increased Risk ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Low And Middle Income

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) is an increasing problem worldwide, but particularly problematic in low- and middle-income countries (LMIC) due to limitations of resources for surveillance of CRE and infection prevention and control (IPC). Methods A point prevalence survey (PPS) with screening for colonization with CRE was conducted on 2233 patients admitted to neonatal, pediatric and adult care at 12 Vietnamese hospitals located in northern, central and southern Vietnam during 2017 and 2018. CRE colonisation was determined by culturing of fecal specimens on selective agar for CRE. Risk factors for CRE colonisation were evaluated. A CRE admission and discharge screening sub-study was conducted among one of the most vulnerable patient groups; infants treated at an 80-bed Neonatal ICU from March throughout June 2017 to assess CRE acquisition, hospital-acquired infection (HAI) and treatment outcome. Results A total of 1165 (52%) patients were colonized with CRE, most commonly Klebsiella pneumoniae (n = 805), Escherichia coli (n = 682) and Enterobacter spp. (n = 61). Duration of hospital stay, HAI, intubation, peripheral venous catheter and treatment with a carbapenem were independent risk factors for CRE colonization. The PPS showed that the prevalence of CRE colonization increased on average 4.2% per day and mean CRE colonisation rates increased from 13% on the day of admission to 89% at day 15 of hospital stay. At the NICU CRE colonisation increased from 32% at admission to 87% at discharge, mortality was significantly associated (OR 5·5, P < 0·01) with CRE colonisation and HAI on admission. Conclusion These data indicate that there is an epidemic spread of CRE in Vietnamese hospitals with rapid transmission to hospitalized patients. CRE colonization places a major burden on the healthcare system due to the increased risk of HAI caused by CRE and associated increased mortality. This study shows that large-scale epidemiological surveillance of CRE using affordable methods is possible in low- and middle-income countries. Disclosures All authors: No reported disclosures.

scholarly journals Neonatal deaths in infants born weighing ≥ 2500 g in low and middle-income countries

2020 ◽  
Vol 17 (S2) ◽  
Author(s):  
Sarah Saleem ◽  
Farnaz Naqvi ◽  
Elizabeth M. McClure ◽  
Kayla J. Nowak ◽  
Shiyam Sunder Tikmani ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Neonatal Mortality ◽  
Global Network ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Live Births ◽  
Middle Income Countries ◽  
High Resource ◽  
Low Middle Income Countries ◽  
Increased Risk

Abstract Background Babies born weighing ≥ 2500 g account for more than 80% of the births in most resource-limited locations and for nearly 50% of the 28-day neonatal deaths. In contrast, in high-resource settings, 28-day neonatal mortality among this group represents only a small fraction of the neonatal deaths. Yet mortality risks for birth weight of ≥ 2500 g is limited. Knowledge regarding the factors associated with mortality in these babies will help in identifying interventions that can reduce mortality. Methods The Global Network’s Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities that has been conducted in research sites in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya and Zambia). Study staff enroll all pregnant women as early as possible during pregnancy and conduct follow-up visits to ascertain delivery and 28-day neonatal outcomes. We analyzed the neonatal mortality rates (NMR) and risk factors for deaths by 28 days among all live-born babies with a birthweight ≥ 2500 g from 2010 to 2018 across the Global Network sites. Results Babies born in the Global Network sites from 2010 to 2018 with a birthweight ≥ 2500 g accounted for 84.8% of the births and 45.4% of the 28-day neonatal deaths. Among this group, the overall NMR was 13.1/1000 live births. The overall 28-day NMR for ongoing clusters was highest in Pakistan (29.7/1000 live births) and lowest in the Zambian/Kenyan sites (9.3/1000) for ≥ 2500 g infants. ≥ 2500 g NMRs declined for Zambia/Kenya and India. For Pakistan and Guatemala, the NMR remained almost unchanged over the period. The ≥ 2500 g risks related to maternal, delivery and newborn characteristics varied by site. Maternal factors that increased risk and were common for all sites included nulliparity, hypertensive disease, previous stillbirth, maternal death, obstructed labor, severe postpartum hemorrhage, and abnormal fetal presentation. Neonatal characteristics including resuscitation, hospitalization, congenital anomalies and male sex, as well as lower gestational ages and birthweights were also associated with increased mortality. Conclusions Nearly half of neonatal deaths in the Global Network sites occurred in infants born weighing ≥ 2500 g. The NMR for those infants was 13.1 per 1000 live births, much higher than rates usually seen in high-income countries. The changes in NMR over time varied across the sites. Even among babies born ≥ 2500 g, lower gestational age and birthweight were largely associated with increased risk of mortality. Since many of these deaths should be preventable, attention to preventing mortality in these infants should have an important impact on overall NMR. Trial registration: https://ClinicalTrials.gov Identifier: NCT01073475

scholarly journals Triage and resuscitation tools for low and middle income countries: how to catch the killer?

2021 ◽  
pp. edpract-2021-321981
Author(s):  
Indumathy Santhanam ◽  
Prinetha Moodley ◽  
Balaji Jayaraman ◽  
Adriana Yock-Corrales ◽  
Baljit Cheema ◽  
...  
Keyword(s):  
Emergency Care ◽  
Middle Income ◽  
Primary Survey ◽  
Multiorgan Dysfunction ◽  
Middle Income Countries ◽  
Risk Of Death ◽  
Resource Limited ◽  
Increased Risk ◽  
Key Steps ◽  
Low And Middle Income

Under-5 mortality rates in low and middle-income countries (LMIC) remain high. One major contributing factor is the failure to recognise critically unwell children when they first present to hospital. This leads to delayed or inadequate resuscitation and an increased risk of death.Triage is a key skill in this setting to sort the queue and prioritise patients, even when staff and equipment are scarce. In LMIC, children generally present late in their illness and often have progressed to some degree of multiorgan dysfunction.Following triage, a structured systematic primary survey is critical to ensure the detection of subtle signs of multiorgan dysfunction. Repeated physiological assessments of the child guide subsequent resuscitation management decisions, which depend somewhat on the resources available.It is possible to achieve significant improvements in survival of critically unwell children presenting for emergency care in the resource-limited setting. The three key steps in the patient’s journey that we can influence in emergency care are triage, primary survey and initial stabilisation. Resources that address these steps have been developed for all settings. However, these resources were developed in a specific clinical context, and must therefore be adapted to local structures and processes. A systematic approach to triage and resuscitation saves lives.

scholarly journals The power of marginal gains in obstetric anaesthesia

2020 ◽  
pp. 176-182
Author(s):  
DN Lucas ◽  
A Ezihe-Ejiofor ◽  
MC Mushambi
Keyword(s):  
Maternal Mortality ◽  
Pathological Condition ◽  
Valuable Insight ◽  
Maternal Deaths ◽  
Middle Income ◽  
Obstetric Anaesthesia ◽  
Middle Income Countries ◽  
The Usa ◽  
Underlying Causes

The crucial role of anaesthesia in improving outcomes in obstetrics has received renewed attention over the last few years. In 2016, Sobhy and colleagues presented the first systematic review of anaesthesia-related maternal mortality in lowincome and middle-income countries (LMICs).1 They found that anaesthesia contributed to 2.8% of all maternal deaths in LMICs. This is a relatively small percentage and may be superficially reassuring to anaesthesia providers; however, the overall frequency of anaesthesia-related maternal death was 300-fold higher for neuraxial anaesthesia and 900-fold higher for general anaesthesia than that reported for the USA.2 In contrast to other causes of maternal mortality, anaesthesia does not represent a disease or pathological condition; deaths related to anaesthesia are iatrogenic. The underlying causes of death in the study by Sobhy and colleagues included airway-related complications (45%), pulmonary aspiration (31%) and staff competencies and equipment issues (27%). It therefore behoves all anaesthesia providers who care for obstetric patients to scrutinise practice and seek ways to reduce anaesthesia-related morbidity and mortality. This edition of SAJAA features four articles of direct relevance to obstetric anaesthesia that provide valuable insight into aspects of care and strategies for quality improvement.

Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries:  A Series of 180 Patients

2020 ◽  
Author(s):  
Larrey Kamabu ◽  
Hervé Monka Lekuya ◽  
Bienvenu Muhindo Kasusula ◽  
Nicole Kavugho Mutimani ◽  
Louange Maha Kathaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

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

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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