scholarly journals PAEDIATRIC AND OBSTETRICS EMERGENCIES TOWARDS THE ACHIEVEMENT OF MILLENNIUM DEVELOPMENT GOAL’S 4, 5, AND 6: THE ROLE OF THE PHYSICIAN ASSISTANT

2016 ◽  
Vol 68 (1) ◽  
pp. 28
Author(s):  
Owusu Agyekum
Keyword(s):  
Rural Areas ◽  
Physician Assistant ◽  
Current Trend ◽  
Maternal Mortality Ratio ◽  
Mortality Rates ◽  
Health Centers ◽  
Live Births ◽  
Mortality Ratio ◽  
Mdg 4

<p>The Physician Assistant (PA) plays a very important role in the rural areas manning clinics and health centers where no doctor is available. Millennium development goal (MDG 4) is targeted at reducing under-five mortality rates by half between 1990 and 2015. However, the current rate of 80 deaths per 1000 live births is far greater than the target rate of 40 per 1000 by 2015. MDG5 is aimed at reducing maternal mortality ratio by 2/3 by 2015. However, the current trend shows maternal death of 451 per 10,000 live births as against 185 by 1000 live births. MDG6 aims at combating HIV/AIDS, malaria, and other diseases such as tuberculosis, diabetes mellitus, and hypertension. There is still the need to reduce the prevalence of these diseases. Therefore, there is a need to increase the knowledge and number of PAs in the rural areas to help solve these problems.</p>

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

Effectiveness of Official Development Assistance in the Health Sector in Africa: A Case Study of Uganda

2020 ◽  
pp. 0272684X2091804
Author(s):  
Cyriaque Rene Sobtafo Nguefack
Keyword(s):  
Infant Mortality ◽  
Maternal Mortality ◽  
Development Assistance ◽  
Maternal Mortality Ratio ◽  
Health Sector ◽  
Health Indicators ◽  
Mortality Rates ◽  
Official Development Assistance ◽  
Mortality Ratio

This qualitative explanatory case study assessed the influence of Official Development Assistance on selected health development indicators in Uganda between 2005 and 2013 by reviewing development partners’ perceptions. Key health indicators included the following: (a) under 5-year-old mortality rates, (b) infant mortality rates, and (c) maternal mortality ratio. Results indicated slow progress in reducing infant mortality and under-5 mortality rates and almost no progress in the maternal mortality ratio despite the disbursement of a yearly average of nearly $400 million USD in the last 7 years to the health sector in Uganda. Five bottlenecks in the influence of development assistance on health indicators were identified: (a) poor governance and accountability framework in the country, (b) ineffective supply chain of health commodities, (c) negative cultural beliefs, (d) insufficient government funding to health care, and (e) insufficient alignment of development assistance to the National Development Plan and noncompliance with the Paris Declaration on Aid Effectiveness.

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.

scholarly journals GAMBARAN ANGKA KEMATIAN IBU DI RSUP. Prof. Dr. R. D. KANDOU MANADO PERIODE JANUARI 2014 – SEPTEMBER 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Ria Mariani Andini ◽  
Joice Sondakh ◽  
Bismarch J. Laihad
Keyword(s):  
Maternal Mortality ◽  
Hemorrhagic Stroke ◽  
Maternal Mortality Ratio ◽  
Sampling Technique ◽  
Complex Problem ◽  
Health Issues ◽  
Maternal Deaths ◽  
Live Births ◽  
Mortality Ratio ◽  
And Child Health

Abstract: Maternal mortality is a complex problem that is caused by a variety of causes that can be distinguished on the determinant of near, intermediate and far. Maternal mortality or maternal death is one indicator to see the progress of the health of a country, especially with regard to maternal and child health issues. The research objective was to determine the description of Maternal Mortality Rate (MMR) in RSUP Prof. Dr. dr. R. D. Kandou Manado period January 2014 - September 2015. Methods: This study is a retrospective descriptive study. The population is all deliveries in RSUP Prof. Dr. dr. R. D. Kandou Manado period January 2014 - September 2015. The samples is 20 persons, sampling with total sampling technique. Results: based on this research, the highest number of births was in 2014 that as many as 3,347 people (70.8%), while in 2015 as many as 1,380 people (29.2%). Maternal Mortality Ratio (MMR) was 298 per 100,000 live births in 2014 and 725 per 100,000 live births in 2015. The number of maternal deaths in the period from January 2014 through September 2015 respectively by 10 people (50%). The most diagnosis entry patients is eclampsia by 10 persons (50.0%) Based on the causes of maternal mortality, that most because of hemorrhagic stroke by 7 people (35.0%).. Conclusion: Maternal Mortality Ratio (MMR) was 298 per 100,000 live births in 2014 and 725 per 100,000 live births in 2015. By entering the patient's diagnosis, most of the patients with the diagnosis of eclampsia and cause most maternal deaths are patients who died because stroke hemorrhagic period January 2014 through September 2015.Keyword: Maternal Mortality RateAbstrak: Kematian ibu merupakan salah satu indikator untuk melihat kemajuan kesehatan suatu negara, khususnya yang berkaitan dengan masalah kesehatan ibu dan anak. Tujuan penelitian adalah mengetahui gambaran Angka Kematian Ibu (AKI) di RSUP. Prof. Dr. R. D. Kandou Manado Periode Januari 2014 – September 2015. Metode: penelitian ini merupakan jenis penelitian deskriptif retrospektif. Populasi yang diambil adalah semua persalinan di RSUP. Prof. Dr. R. D. Kandou Manado Periode Januari 2014 – September 2015. Jumlah sampel adalah 20 orang, penentuan sampel dengan teknik total sampling. Hasil: berdasarkan hasil penelitian, jumlah persalinan terbanyak adalah pada tahun 2014 yaitu sebanyak 3.347 orang (70,8%) sedangkan pada tahun 2015 sebanyak 1.380 orang (29,2%). Rasio Angka Kematian Ibu (AKI) 298 per 100.000 kelahiran hidup pada tahun 2014 dan 725 per 100.000 kelahiran hidup pada tahun 2015.Sedangkan jumlah Jumlah Kematian Ibu pada periode januari 2014 sampai september 2015 masing-masing sebanyak 10 orang (50%). Diagnosa masuk pasien terbanyak yaitu eklamsia sebesar 10 orang (50,0%) Berdasarkan penyebab kematian ibu, yang tebanyak karena stroke hemoragik sebesar 7 orang (35,0%). Kesimpulan: Rasio Angka Kematian Ibu (AKI) adalah 298 per 100.000 kelahiran hidup pada tahun 2014 dan 725 per 100.000 kelahiran hidup pada tahun 2015. Berdasarkan diagnosis masuk pasien, terbanyak adalah pasien dengan diagnosa eklampsia dan penyebab kematian ibu terbanyak adalah pasien yang meninggal karena stroke hemoragik periode januari 2014 sampai september 2015.Kata kunci: Angka Kematian Ibu

scholarly journals A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics

2016 ◽  
Vol 8 (4) ◽  
pp. 261-265
Author(s):  
Smiti Nanda ◽  
Shaveta Yadav
Keyword(s):  
Observational Study ◽  
Maternal Mortality ◽  
Prospective Observational Study ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Mortality Index ◽  
Severe Maternal Outcome ◽  
Mortality Ratio

ABSTRACT Purpose To study the incidence and causes of near-miss cases and maternal deaths (MDs) and also search the level of delay. Materials and methods The prospective observational study was carried out in the Department of Obstetrics and Gynecology for a period of one and a half year (September 2012 to February 2014). For identifying near-miss events, disease-specific criteria were used. Near-miss cases were identified among women with pregnancy-related complications whose diagnoses were meeting the criteria. Detailed information of maternal mortalities and near-miss cases for demographic features, underlying causes, treatment received, and level of delay were also obtained. Results There were 15,170 obstetric admission, 13,851 live births, 184 near-miss cases, and 60 MDs during the study period. The maternal near-miss (MNM) rate was 13.2/1,000 live births and maternal mortality ratio was 433.1/100,000 live births. The mortality index (MD/MNM+MD) was reported as 25%. The maternal mortality to near-miss ratio was 1:3.07. Severe maternal outcome rate (MNM/MNM+MD) was 17.6/1,000 live births. Hemorrhage (54.89%) was the leading cause of nearmiss events followed by hypertension (24.45%) and anemia (13.59%). Hypertension (26.66%) was responsible for most of the MDs followed by anemia (25%), hemorrhage (20%), and puerperal sepsis (10%). The most common level of delay was found on the part of women and/or family to seek help. Conclusion Hypertension, hemorrhage, and anemia are leading causes of maternal morbidity and mortality. Lessons need to be learnt from cases of near-miss, which can serve as a useful tool in making strategies and putting efforts to reduce maternal mortality. How to cite this article Yadav S, Nanda S. A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics. J South Asian Feder Obst Gynae 2016;8(4):261-265.

scholarly journals A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

2022 ◽  
Vol 7 (1) ◽  
pp. e007544
Author(s):  
Megan Norris ◽  
Gonnie Klabbers ◽  
Andrea B Pembe ◽  
Claudia Hanson ◽  
Ulrika Baker ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Rural Areas ◽  
Urban Areas ◽  
Maternal Education ◽  
Health Seeking ◽  
African Countries ◽  
Live Births ◽  
Urban Rural ◽  
Ssa Countries

IntroductionNeonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015–2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.MethodsWe assessed urban–rural NMR disparities among 21 SSA countries with four or more DHS, at least one of which was before 2000, using the DHS StatCompiler. For Tanzania DHS 2015–2016, descriptive statistics were carried out disaggregated by urban and rural areas, followed by bivariate and multivariable logistic regression modelling the association between urban/rural residence and neonatal mortality, adjusting for other risk factors.ResultsAmong 21 countries analysed, Tanzania was the only SSA country where urban NMR (38 per 1000 live births) was significantly higher than rural (20 per 1,000), with largest difference during first week of life. We analysed NMR on the 2015–2016 Tanzania DHS, including live births to 9736 women aged between 15 and 49 years. Several factors were significantly associated with higher NMR, including multiplicity of pregnancy, being the first child, higher maternal education, and male child sex. However, their inclusion did not attenuate the effect of urban–rural differences in NMR. In multivariable models, urban residence remained associated with double the odds of neonatal mortality compared with rural.ConclusionThere is an urgent need to understand the role of quality of facility-based care, including role of infections, and health-seeking behaviour in case of neonatal illness at home. However, additional factors might also be implicated and higher NMR within urban areas of Tanzania may signal a shift in the pattern of neonatal mortality across several other SSA countries.

scholarly journals Impact Evaluation Design for Community Midwife Technicians in Malawi

2016 ◽  
Vol 12 (27) ◽  
pp. 349
Author(s):  
Nathan B.W. Chimbatata ◽  
Chikondi M. Chimbatata
Keyword(s):  
Rural Areas ◽  
Human Resources For Health ◽  
Maternal Mortality Ratio ◽  
Health Sector ◽  
Health Staff ◽  
Community Midwives ◽  
Mortality Ratio ◽  
Training Institutions ◽  
Training Community ◽  
Maternal And Newborn

Maternal Mortality Ratio and neonatal mortality rate are alarmingly high in Malawi. The shortage and poor retention of midwives coupled with poor working conditions have been a major challenge affecting the provision of high-quality maternity care for women. Many women are giving birth without skilled attendants, increasing the risk of maternal and neonatal illness and death. The major driving factor in the shortage of health staff is the limited number of existing training slots and hence the minimum output from the training institutions into service delivery units. Midwifery is a key component of sexual, reproductive, maternal, and newborn healthcare. Responding to the crisis, the Malawi Government has made a commitment in strengthening human resources for health, including accelerating training and recruitment of health professionals to fill all the shortage gaps in the health sector. One mechanism implemented by Malawi Government to increase skilled attendance at birth in rural areas is the introduction of Community midwifery assistants (CMA) training. This program of training community midwives is being piloted and targets the general population of pregnant women and their new born babies in rural areas where the CMAs are deployed. However, there is a great need to have this initiative evaluated and gauge its impact in attaining the desired outcomes.

scholarly journals Temporal Evolution of Maternal Mortality: 1980-2019

2021 ◽  
Vol 43 (09) ◽  
pp. 662-668
Author(s):  
Janete Vettorazzi ◽  
Edimárlei Gonsales Valério ◽  
Maria Alexandrina Zanatta ◽  
Mariana Hollmann Scheffler ◽  
Sergio Hofmeister de Almeida Martins Costa ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Medical Records ◽  
Causes Of Death ◽  
Maternal Mortality Ratio ◽  
Liver Steatosis ◽  
Reproductive Age ◽  
Porto Alegre ◽  
Maternal Deaths ◽  
Live Births ◽  
Mortality Ratio

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Maternal mortality and morbidity

2016 ◽  
Author(s):  
Suni Halder ◽  
Steve Yentis
Keyword(s):  
Maternal Mortality ◽  
Women’S Health ◽  
Women's Health ◽  
Maternal Mortality Ratio ◽  
Developed Countries ◽  
Surveillance Systems ◽  
Maternal Deaths ◽  
Live Births ◽  
The World ◽  
Mortality Ratio

The risk to women’s health is increased during pregnancy, and maternal mortality is used as an indicator of general healthcare provision as well as a target for improving women’s health worldwide. Morbidity is more difficult to define than mortality but may also be used to monitor and improve women’s care during and after pregnancy. Despite international efforts to reduce maternal mortality, there remains a wide disparity between the rate of deaths in developed (maternal mortality ratio less than 10–20 per 100,000 live births) and developing (maternal mortality ratio as high as 1000 or more per 100,000 live births in some countries) areas of the world. Similarly, treatable conditions that cause considerable morbidity in developed countries but uncommonly result in maternal death (e.g. pre-eclampsia (pre-eclamptic toxaemia), haemorrhage, and sepsis) continue to be major causes of mortality in developing countries, where appropriate care is hampered by a lack of resources, skilled staff, education, and infrastructure. Surveillance systems that identify and analyse maternal deaths aim to monitor and improve maternal healthcare through education of staff and politicians; the longest-running and most comprehensive of these, the Confidential Enquiries into Maternal Deaths in the United Kingdom, was halted temporarily after the 2006–2008 report but is now active again. Surveillance of maternal morbidity is more difficult but systems also exist for this. The lessons learnt from such programmes are thought to be important drivers for improved maternal outcomes across the world.

scholarly journals Government Revenue and Child and Maternal Mortality

2020 ◽  
Author(s):  
Stephen Hall ◽  
Janine Illian ◽  
Innocent Makuta ◽  
Kyle McNabb ◽  
Stuart Murray ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Inverse Function ◽  
Mortality Rates ◽  
Government Revenue ◽  
The Sustainable Development ◽  
Poor Access ◽  
Non Linear ◽  
Mortality Ratio ◽  
Per Capita

Abstract Most maternal and child deaths result from inadequate access to the critical determinants of health: clean water, sanitation, education and healthcare, which are also among the Sustainable Development Goals. Reasons for poor access include insufficient government revenue for essential public services. In this paper, we predict the reductions in mortality rates — both child and maternal — that could result from increases in government revenue, using panel data from 191 countries and a two-way fixed-effect linear regression model. The relationship between government revenue per capita and mortality rates is highly non-linear, and the best form of non-linearity we have found is a version of an inverse function. This implies that countries with small per-capita government revenues have a better scope for reducing mortality rates. However, as per-capita revenue rises, the possible gains decline rapidly in a non-linear way. We present the results which show the potential decrease in mortality and lives saved for each of the 191 countries if government revenue increases. For example, a 10% increase in per-capita government revenue in Afghanistan in 2002 ($24.49 million) is associated with a reduction in the under-5 mortality rate by 12.35 deaths per 1000 births and 13,094 lives saved. This increase is associated with a decrease in the maternal mortality ratio of 9.3 deaths per 100,000 live births and 99 maternal deaths averted. Increasing government revenue can directly impact mortality, especially in countries with low per- capita government revenues. The results presented in this study could be used for economic, social and governance reporting by multinational companies and for evidence-based policymaking and advocacy.

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