Performance of Ashas in ANC and Birth Planning in Uttar Pradesh, India

ASHAs were introduced in UP through NRHM in 2005, the first major task of ASHAs was to focus on maternal and child health to reduce Maternal Mortality Ratio and Infant Mortality Rate in the state of UP. Their primary activity was to visit homes of pregnant women. The first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all pregnancies to decipher messages on ANC and birth planning is an integral part of the work of ASHAs across the state of UP. The current study explores variables like the average visits of each of the ASHAs to pregnant women in absolute numbers in four districts of UP. Further, the study sees the percentage of the ASHAs that give messages on ANC like TT injections, BP and abdominal examination, IFA tablets and provision of 3 ANCs to pregnant women. In addition to that, the percentage of ASHAs giving messages on birth planning like identification of place of delivery, birth attendant, arranging money, arranging transport and identification of blood donor. Information on JSY was also a part of the message. These activities were done by the ASHAs in the last 3 months prior to the survey. The relevance of the study assumes significance as data on the details of targeted messages done by ASHAs through home visits are never discussed in detail and further there is no comparison to their performance visa vis the inputs they received through capacity building. A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study. The numbers of pregnant women visited by each of the ASHAs in the 4 districts in their catchment area in the 3 months were in the range of 4-6. Among the messages on ANC, IFA tablets consumption and TT injections were given by most of the ASHAs in the 4 districts. Among the birth planning messages, identification of place and birth attendant were given by most of the ASHAs in the 4 districts. This reflected that the focus of messages were neither prioritized nor covered by all the ASHAs.

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Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

BMC Public Health ◽

10.1186/s12889-021-11325-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nina Mendez-Dominguez ◽

Karen Santos-Zaldívar ◽

Salvador Gomez-Carro ◽

Sudip Datta-Banik ◽

Genny Carrillo

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Maternal Mortality ◽

Respiratory Distress ◽

Pregnant Women ◽

Distress Syndrome ◽

Maternal Mortality Ratio ◽

Maternal Deaths ◽

Immune Impairment ◽

Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

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Temporal evolution and spatial distribution of maternal death

Revista de Saúde Pública ◽

10.1590/s0034-8910.2014048005220 ◽

2014 ◽

Vol 48 (4) ◽

pp. 662-670 ◽

Cited By ~ 7

Author(s):

Ioná Carreno ◽

Ana Lúcia de Lourenzi Bonilha ◽

Juvenal Soares Dias da Costa

Keyword(s):

Spatial Distribution ◽

Maternal Mortality ◽

Maternal Death ◽

Temporal Evolution ◽

Maternal Mortality Ratio ◽

Rio Grande ◽

The State ◽

Rio Grande Do Sul ◽

Maternal Risk ◽

Mortality Ratio

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution.METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008.RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding.CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

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Análisis de la mortalidad materna de los años 2013 a 2015 en el estado de Yucatán

REVISTA BIOMÉDICA ◽

10.32776/revbiomed.v1i30.635 ◽

2018 ◽

Vol 30 (1) ◽

Author(s):

Rodrigo Gaspar Díaz Novelo ◽

Luis Orlando Bobadilla Rosado ◽

Lizbeth Sabrina Fajardo Ruiz ◽

Nina Méndez Domínguez ◽

Salvador Gómez Carro

Keyword(s):

Maternal Mortality ◽

Preventive Measures ◽

Maternal Mortality Ratio ◽

National Average ◽

The State ◽

Hypertensive Disorders ◽

Mortality Ratio ◽

The Caribbean ◽

America Latina

ResumenIntroducción: La mortalidad materna se considera un indicador significativo de la calidad de los servicios de salud, así, se conoce que aproximadamente un 95% de estas muertes en América Latina y el Caribe son prevenibles.Objetivos: Determinar si la Razón de Muerte Materna (RMM) en Yucatán es mayor a la media nacional durante los años 2013 a 2015.Material y Métodos: Estudio transversal observacional en mujeres embarazadas que fallecieron por causas directas relacionadas con el embarazo durante los años 2013 a 2015 en el estado de Yucatán. Se utilizaron datos del Instituto Nacional de Estadística y Geografía (INEGI).Resultados: En el 2013 se encontró que la RMM en Yucatán fue 38,11% mayor en comparación con la nacional, en el 2014 la RMM en este mismo estado fue 34,68% mayor en comparación con la del país y en el 2015 la RMM fue 21,14% mayor que la mexicana. Las principales causas de muerte en el estado concuerdan con lo expuesto en la bibliografía, siendo éstas los desórdenes hipertensivos y las hemorragias.Conclusiones: La RMM durante los años 2013 a 2015 en el estado de Yucatán fue mayor a la media nacional. Es importante implementar medidas preventivas que permitan reducir esta disparidad en términos de mortalidad materna en el estado de Yucatán.Palabras clave: Muerte Materna, Salud Pública, Prevención Secundaria, Salud MaternaTítulo corto: Análisis de la mortalidad materna en Yucatán. ABSTRACT.Introduction. Maternal Mortality is considered a significant indicator of the quality of the health services in any country. It is known that approximately 95% of these deaths in Latin America and the Caribbean are preventable.Objectives. Our objective is to determine whether or not the Maternal Mortality Ratio (MMR) in Yucatan is higher than the national mean during the years 2013 to 2015.Materials and methods. Transversal-observational study in pregnant women who died from direct causes related to pregnancy during the years 2013 to 2015 in Yucatan. Data from the National Institute of Statistics and Geography (INEGI) were used.Results. In 2013 the MMR in Yucatan was 38,11% higher than the national mean, in 2014 the MMR of this state was 34,68% higher in comparison to the national mean and in 2015 the MMR was 21,14% higher than the national mean. The main causes of dead in the state of Yucatan are in agreement with the national causes which are hypertensive disorders and hemorrhagic disorders.Conclusions. The MMR during the years 2013 to 2015 in the state of Yucatan was higher than the national average. It is important to implement preventive measures to reduce this disparity in terms of maternal mortality in the state of Yucatán.Keywords: Maternal Mortality, Public Health, Secondary Prevention, Maternal Health.

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Knowledge in Tracking Danger Signs in Newborns and their Referrals by ASHA in Uttar Pradesh, India

International Journal of Contemporary Research and Review ◽

10.15520/ijcrr.v10i12.768 ◽

2019 ◽

Vol 10 (12) ◽

pp. 20762-20765

Author(s):

Dr. Tridibesh Tripathy

Keyword(s):

Health Care ◽

Primary Health Care ◽

High Risk ◽

Child Survival ◽

Uttar Pradesh ◽

Structured Interview ◽

Interview Schedule ◽

Danger Signs ◽

Primary Health ◽

Depth Interviews

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP. The current study explores some of the crucial variables of the danger signs in newborns and their subsequent referrals by the ASHAs in four districts of UP. Through this profile, the knowledge of ASHAs on these danger signs and the action that they take after identification is detailed out. The relevance of the study assumes significance as data on the details of targeted activities on high risk newborns done by ASHAs in comparison to their performance are usually not available in various studies. A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study.

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Scaling the Maternal and Newborn Survival Initiative (MANSI)

Innovations in Global Maternal Health ◽

10.4018/978-1-7998-2351-3.ch010 ◽

2020 ◽

pp. 224-246

Author(s):

Deepa Fernandes Prabhu ◽

Richard C. Larson

Keyword(s):

System Analysis ◽

Maternal Mortality Ratio ◽

Infant Mortality Rate ◽

Rural India ◽

Public And Private ◽

System Analysis Approach ◽

Mortality Ratio ◽

Hospital Births ◽

The Village ◽

Maternal And Newborn

The infant mortality rate (IMR) and maternal mortality ratio (MMR) are unacceptably high in many parts of rural India. This article focuses on a system analysis approach to the best practices for scaling and replicating of maternal and newborn survival initiative (MANSI), a field-tested pilot program for addressing high IMRs and MMRs. A system dynamics model of the village birthing system is used to understand the resources needed for the viability of scaling or replication, is constructed and incorporated in the analysis. The MANSI program is a public and private partnership between a few key players. Implemented in the Seraikela area of India's Jharkhand state, the program has achieved a 32.7% reduction in neonatal mortality, a 26.5% reduction in IMR, and a 50% increase in hospital births, which tend to have better health outcomes for women and newborns. The authors conclude with a discussion of the prospects for and difficulties of replicating MANSI in other resource-constrained areas, not only in India but in other developing countries as well.

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Primary health care among rural pregnant women in China: achievements and challenges in maternal mortality ratio

Primary Health Care Research & Development ◽

10.1017/s1463423619000306 ◽

2019 ◽

Vol 20 ◽

Author(s):

Le Yang ◽

Hongman Wang

Keyword(s):

Health Care ◽

Primary Health Care ◽

Maternal Mortality ◽

Pregnant Women ◽

Rural Areas ◽

Maternal Mortality Ratio ◽

Chinese Government ◽

Primary Health ◽

Mortality Ratio ◽

The Government

Abstract Background: The maternal mortality ratio (MMR) is not only an important indicator of maternal and infant safety, but also a sign of the development of economy, education, and medical care in a country. In the last 60 years, the Chinese government has implemented various strategies and policies to reduce the MMR, especially in the rural areas. Aim: This study aimed to discuss the strategies developed by the Chinese government, showing the successful experience of Chinese intervention programs and highlighting the challenges to the government in the context of current economic and social status. Method: This study probed into the Chinese government’s efforts and achievements in the MMR reducing by reviewing the relevant health policies, extracting the data from China Health Statistics Yearbook of 2015, analyzing the reduction of maternal death in rural areas and the major causes from 1991 to 2015, comparing the MMR trend in urban and rural areas, and discussing the changes of the situation in China. Finding: Although it seems that Chinese government’s efforts have brought evangel to the rural pregnant women and significantly reduced rural maternal mortality, the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care for the rural-to-urban migration in China.

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A study on knowledge, attitude and practices regarding antenatal care among pregnant women attending antenatal clinic at a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211148 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1621

Author(s):

Rajvir Kaur ◽

Poonam Taneja ◽

Isha Nandal

Keyword(s):

Maternal Health ◽

Antenatal Care ◽

Pregnant Women ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Antenatal Clinic ◽

Infant Mortality Rate ◽

Safe Motherhood ◽

Care Hospital

Background: The maternal health level of Indian women was noticed to be inferior as compared to other developed countries. Antenatal care is the clinical assessment of both mother and foetus, during the period of pregnancy. Safe motherhood by providing good antenatal care (ANC) is very crucial to reduce maternal mortality ratio and infant mortality rate and to achieve millennium development goals. The objectives of this study aimed to assess the level of knowledge, attitude, and practice on ANC among pregnant women attending the antenatal clinic and their association with several sociodemographic factors.Methods: A cross-sectional study was undertaken among 200 pregnant women in their 3rd trimester attending the OPD in a Tertiary Care Hospital of Gurugram, Haryana. Predesigned questionnaire was used for collecting data by interview after obtaining informed consent.Results: This study revealed that about 55% women had adequate knowledge regarding ANC. It was found that almost all the variables such as age, parity, level of education, occupation and type of family had a significant association with awareness about ANC. 90% women were having a positive attitude towards ANC. Around 70%, women were practicing this adequately.Conclusions: These results can be used to design a Health Intervention Program targeting to upgrade the maternal health practices and ultimately progress the health status of the women.

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A study to assess the occurrence and factors of maternal near-miss among women admitted in maternal unit in selected hospitals of Kolkata, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214338 ◽

2021 ◽

Vol 10 (11) ◽

pp. 4236

Author(s):

Dipti Das ◽

Sujata Mitra ◽

Saraswati Barui

Keyword(s):

Maternal Education ◽

Family Income ◽

Maternal Mortality Ratio ◽

Structured Interview ◽

Near Miss ◽

Maternal Near Miss ◽

Maternity Unit ◽

Tertiary Hospitals ◽

Mortality Ratio ◽

Descriptive Survey

Background: Assessment of the occurrence of maternal near-miss (an event in which a woman comes close to maternal death, but survive), identify the factors of maternal near-miss and to find out the association between determining factors and selected sample characteristics of maternal near-miss women.Methods: A descriptive survey is carried out among purposively selected women admitted in the maternity unit of two tertiary hospitals of Kolkata. Data are collected by face-to-face interview using valid and reliable semi-structured interview schedule to identify factors of maternal near-miss. WHO selected maternal near-miss proforma (2011) is used for assessment of occurrence of maternal near-miss by using record analysis.Results: The occurrence of maternal near-miss is identified as 100 out of 1669 women admitted in maternity unit. Eclampsia occurred maximum (27%) followed by severe pre-eclampsia (19%), severe PPH (6%) among potentially life-threatening conditions. Multigravida (65%), multipara (54%), non-booked cases (5%), duration of labour more than 18 hours (65%), caesarean section (78%), referred cases (79%), maternal type 1 delay (53%) and type 2 delay (67%) all are the factors mainly responsible for developing maternal near-miss. Significant association present between reproductive and obstetrical factors and maternal education, marital age (p<0.01). Significant association is also present between maternal delay factors and residence, maternal education, monthly family income, marital age (p<0.01).Conclusions: Exploring the factors of maternal near-miss may help to identify the factors early, which in turn will prevent the condition. Lesson can be learned from cases of near-miss which can serve as a useful tool in reducing maternal mortality ratio.

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A Study on Maternal Mortality in Baba Raghav Das Medical College, Gorakhpur

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1437 ◽

2016 ◽

Vol 8 (4) ◽

pp. 294-298

Author(s):

Reena Shrivastava ◽

Harish C Tiwari ◽

Renu Sangal

Keyword(s):

Maternal Mortality ◽

Maternal Mortality Ratio ◽

Regional Distribution ◽

Uttar Pradesh ◽

Study Data ◽

Maternal Deaths ◽

Medical College ◽

Mortality Ratio ◽

Interval Condition ◽

Determinants Of Maternal Mortality

ABSTRACT Introduction Prevention of maternal deaths is one of our foremost goals to provide safety to motherhood and to avoid loss to the family, society, and the nation. Maternal mortality ratio (MMR) of Uttar Pradesh is very high as compared to national average. Within the state, there is wide variation in MMR. The explanations and answers to these regional variations are complex. This study was planned with the objectives to explore each and every maternal death that had occurred in Baba Raghav Das Medical College in the last 4 years (2011—2014). Materials and methods In this study, data were collected from records of all maternal deaths that had occurred in the Department of Obstetrics and Gynecology, Baba Raghav Das Medical College, Gorakhpur from March 2011 to December 2014. Records of all maternal deaths during this period were scrutinized for socio-demographic profile, obstetric history, antenatal care history, causes of maternal mortality, time trend, geographical or regional distribution, admission and death interval, condition of patients on admission, outcome of pregnancy, and reasons for delay. Records of number of maternal deaths and live births were also collected for previous 11 years (2004—2014). Results Maternal mortality ratio has dropped almost six times in the last 11 years. Early age at marriage, illiteracy, poor socioeconomic status, and multiparity were found to be important determinants of maternal mortality and can act as risk factors. The pattern of causes of maternal deaths in this institute (preeclampsia) is different from that found in the community (postpartum hemorrhage). Delay in seeking care because of unawareness and illiteracy and ignorance was found to be the major contributing factor for most of the maternal deaths. How to cite this article Shrivastava R, Tiwari HC, Sangal R. A Study on Maternal Mortality in Baba Raghav Das Medical College, Gorakhpur. J South Asian Feder Obst Gynae 2016;8(4):294-298.

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