ZERO-INFLATED POISSON REGRESSION TO DETERMINE  THE FACTORS THAT INFLUENCE  THE MATERNAL MORTALITY RATE IN BANDUNG 2016

In Indonesia, especially Bandung, there are still many cases of maternal deaths during pregnancy, birth, and postpartum which can increase the Maternal Mortality Rate (MMR). Cases of maternal deaths are mostly due to exsanguination, infection, anemia, and the other causes that related to pregnancy. To reduce the MMR of Bandung, we can analyze to determine the factors that influence the MMR in order to maximize the maternal health care programs so as to prevent the possibility of death. The analysis is using Zero-Inflated Poisson (ZIP) regression because maternal mortality data is the result of counting that allows overdispersion due to excess zeros. Regression parameter estimation use expectation maximization algorithm followed by the Newton-Raphson iteration method. The analysis result showed that of the five suspected factors to affect the MMR -such as the first tetanus toxoid immunization (TT1), the provision of 90 Fe tablets (Fe3), postpartum care, pregnancy complications, and the first antenatal care (K1)- only TT1 and postpartum care are significantly affect the MMR.

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PERBANDINGAN REGRESI ZERO INFLATED POISSON (ZIP) DAN REGRESI ZERO INFLATED NEGATIVE BINOMIAL (ZINB) PADA DATA OVERDISPERSION (Studi Kasus: Angka Kematian Ibu di Provinsi Bali)

E-Jurnal Matematika ◽

10.24843/mtk.2016.v05.i04.p132 ◽

2016 ◽

Vol 5 (4) ◽

pp. 133

Author(s):

NI PUTU PREMA DEWANTI ◽

MADE SUSILAWATI ◽

I GUSTI AYU MADE SRINADI

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Regression Models ◽

Negative Binomial ◽

Mean Value ◽

Response Variable ◽

Maternal Mortality Rate ◽

Excess Zeros ◽

Zero Values ◽

Independent Variable

Poisson regression is a nonlinear regression which is often used for count data and has equidispersion assumption (variance value equal to mean value). However in practice, equidispersion assumption is often violated. One of it violations is overdispersion (variance value greater than the mean value). One of the causes of overdipersion is excessive number of zero values on the response variable (excess zeros). There are many methods to handle overdispersion because of excess zeros. Two of them are Zero Inflated Poisson (ZIP) regression and Zero Inflated Negative Binomial (ZINB) regression. The purpose of this research is to determine which regression models is better in handling overdispersion data. The data that can be analyzed using the ZIP and ZINB regression is maternal mortality rate in the Province of Bali. Maternal mortality rate data has proportion of zeros value more than 50% on the response variable. In this research, ZINB regression better than ZIP regression for modeling maternal mortality rate. The independent variable that affects the number of maternal mortality rate in the Province of Bali is the percentage of mothers who carry a pregnancy visit, with ZINB regression models and .

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182336 ◽

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.

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Mengenal Tanda-Tanda Bahaya Kehamilan di Puskesmas Pakuan Baru Kota Jambi

Jurnal Abdimas Kesehatan (JAK) ◽

10.36565/jak.v3i1.150 ◽

2021 ◽

Vol 3 (1) ◽

pp. 52

Author(s):

Ria Febrina

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Pregnant Women ◽

Community Service ◽

Health Workers ◽

Obstetric Complications ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Live Births ◽

Danger Signs

Maternal Mortality Rate (MMR) in Indonesia is still high compared to other ASEAN countries. MMR in Indonesia according to the 2017 Indonesian Demographic and Health Survey (IDHS) is 305 per 100,000 live births. The global target of SDGs (Suitainable Development Goals) is to reduce the Maternal Mortality Rate (MMR) to 70 per 100,000 live births. While in Jambi Province in 2017 recorded maternal deaths were 29 cases. Maternal deaths that occur during 90% of pregnancy are caused by obstetric complications. Direct obstetric complications are bleeding, infection and eclampsia. Indirectly maternal mortality is also influenced by delays at the family level in recognizing danger signs of pregnancy and making decisions to immediately seek help. Delay in reaching health facilities and assistance in health service facilities. Pregnancy danger signs must be recognized and detected early so that they can be handled properly because any danger signs of pregnancy can lead to pregnancy complications. Therefore it is necessary to provide counseling to improve the knowledge of pregnant women about the danger signs of pregnancy. This community service activity was carried out by Pakuan Baru Kota Jambi Public Health Center. The time of implementation in April 2020. The target is pregnant women. Community service methods include a survey and lecture approach. The results obtained are pregnant women able to understand the danger signs of pregnancy. It is recommended for health workers to continue to provide education related to pregnancy to pregnant women

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Mapping maternal mortality rate via spatial zero-inflated models for count data: A case study of facility-based maternal deaths from Mozambique

PLoS ONE ◽

10.1371/journal.pone.0202186 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0202186 ◽

Cited By ~ 2

Author(s):

Osvaldo Loquiha ◽

Niel Hens ◽

Leonardo Chavane ◽

Marleen Temmerman ◽

Nafissa Osman ◽

...

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Count Data ◽

Maternal Deaths ◽

Maternal Mortality Rate

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A study of maternal mortality and midwifery on the Isle of Man, 1882 to 1961

Medical History ◽

10.1017/s0025727300060981 ◽

1996 ◽

Vol 40 (2) ◽

pp. 141-172 ◽

Cited By ~ 7

Author(s):

C G Pantin

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Maternal Deaths ◽

Family Doctors ◽

Maternal Mortality Rate ◽

Isle Of Man ◽

The Family ◽

Labour Room ◽

Maternity Home ◽

Skilled Staff

The living conditions and the health of Manx mothers continued to improve from 1881 to 1961. Against this background they were at first delivered conservatively and mostly by midwives. During this conservative phase the proportion of mothers surviving childbirth increased as their health improved: by the quinquennium 1907–1911 the maternal mortality rate on the Island was half what it had been twenty years earlier. Between 1912 and 1927 maternal mortality rose and during the quinquennium 1922–1926 the MD/BR was again at the level it had been thirty years before. Some of the maternal deaths during the quinquennium were among women who were subjected to intervention during childbirth by doctors in the unfavourable surroundings of their homes; conditions more suited to delivery by the conservative methods of kindly and patient handywomen. Following the opening of a small maternity home on 6 May 1927 the family doctors began to send their difficult deliveries into the Home where they were looked after by skilled staff and delivered in a well–equipped labour room. Throughout the subsequent decade the MD/BR remained at a level below that in 1907–1911.

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Maternal mortality assessment in a tertiary care hospital in Uttar Pradesh, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203862 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3814

Author(s):

Urvashi Barman Singh ◽

Shakti Jain ◽

Yashi Srivastava ◽

Manisha Gupta ◽

Meena Dayal

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Post Partum ◽

Tertiary Care ◽

Uttar Pradesh ◽

Care Hospital ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Medical College ◽

Time Period

Background: Objective of this study was to calculate the maternal mortality rate in our hospital and to assess the epidemiological aspects and causes of maternal mortality to further analyse ways to reduce the maternal mortality rate (MMR).Methods: This was a retrospective analytical study done in the department of obstetrics and gynecology, MLN Medical College and District Women Hospital, Prayagraj over a time period of 10 years i.e., October 2009 to October 2019. Retrospective analysis and evaluation of the medical records and statistics was done to find out and collect specific causes of maternal deaths in the give time period.Results: There were 357 maternal deaths from October 2009 to October 2019. Maternal mortality rate in the study was calculated to be 498.42 per 1 lakh live births. Maximum deaths were in 21-30 years age group with multipara, unbooked and illiterate cases. Majority of the deaths reported were from direct causes of maternal mortality i.e., hemorrhage, hypertensive disorders and sepsis.Conclusions: In the selected hospitals, the mean maternal mortality rate in the study period was 498.42/100000 births. 71.4% had direct cause and 21.56% had indirect cause of maternal mortality several factors like regular antenatal visits, early identification of high-risk cases, timely referral, institutional deliveries, adequate post-partum care and follow-up can contribute to decrease the maternal mortality rate effectively.

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Gambaran Determinan Kematian Ibu di Kota Surabaya Tahun 2015-2017

Jurnal Biometrika dan Kependudukan ◽

10.20473/jbk.v7i2.2018.178-187 ◽

2019 ◽

Vol 7 (2) ◽

pp. 178

Author(s):

Hazar Rochmatin

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Health Workers ◽

Early Recognition ◽

Secondary Data ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Second Child ◽

History Of ◽

High Level

Maternal mortality rate is one of indicator in assessing the welfare of the community in a region. The high level of Maternal Mortality Rate is a low level signals of public health. Data on maternal mortality in the city of Surabaya shows a decrease in the last 6 years from 144.66 in 2012 to 79.40 in 2017. Although it has shown a decline in progress, this figure still puts Surabaya as the second largest contributor to maternal deaths in East Java in 2017. The study aims to describe the determinants of maternal mortality in Surabaya based on contextual, intermediate and proxy determinants for 2015-2017. This research is descriptive by using secondary data in the form of recapitulation of Maternal Verbal Autopsy (OVM) data on maternal deaths at Surabaya City Health Office The results showed that based on education, the majority of mothers who died had secondary education of 52.29% (57 people). Based on work, the majority of mothers have jobs as housewives of 68.81% (75 people). Based on the age of the mother, the majority of deaths occurred in women aged 20-34 years with a percentage of 66.97% (73 people). According to parity, the majority of mothers who died occurred during pregnancy of the second child by 31.19% (34 people). Based on the period of death, the majority occurred in the puerperium with a percentage of 66.97% (70 people). According to the cause of single death, the majority of maternal deaths were caused by pre-eclampsia/eclampsia with a percentage of 26.61% (29 people). This study recommends the need for early recognition of mothers about antenatal care and danger during pregnancy, childbirth and the puerperium period and increased alertness of health workers to complications of pregnancy, especially in mothers with a history of disease.

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Maternal Mortality Rate at East Ogan Komering Ulu (East OKU) Regional Public Hospital Over a Four Year Period: Trends, Its Associated Factors and Neonatal Outcome

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v7i2.980 ◽

2019 ◽

pp. 97-100

Author(s):

Cindy Kesty ◽

Hendra S Saputra

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Associated Factors ◽

Public Hospital ◽

Neonatal Outcome ◽

Downward Trend ◽

Hypertensive Disorder ◽

Childbearing Age ◽

Maternal Deaths ◽

Maternal Mortality Rate

Objective: To determine the MMR trends, its associated factors, and neonatal outcome at East OKU Regional Public Hospital from 2013 until 2016. Methods: This descriptive study was performed from January 2013 until December 2016 in maternity ward and Intensive Care Unit (ICU) of East OKU Regional Public Hospital, South Sumatera. Data was collected from medical records. There were 17 maternal deaths, but 1 data was excluded due to lack of data. Results: We recorded 2,191 pregnancies and 17 maternal deaths. Over 4 years, the lowest MMR occurred in 2013 (229/100,000) and achieved its peak in 2014 (1,306/100,000). Then, MMR followed downward trend dropping from 1,087/100,000 in 2015 until 588/100,000 in 2016. Most of deceased were childbearing age women (50.0%), multigravida (62.5%), but nulliparous (50.0%), and aterm (87.5%). The major etiology of maternal deaths were hypertensive disorder (37.5%), followed by hypertensive disorder + hemorrhage and hypertensive disorder + infection in the same proportion. MMR were higher in inborn cases (87.5%), born via C-section (87.5%), and treated for less than 48 hours (93.75%). Alive neonatal were born in most cases (62.5%). Conclusion: MMR trends in our hospital were fluctuating with a downward trend, but still much higher than the MDGs target in 2015 (102/100,000). Hypertensive disorder plays significant role in maternal deaths. In addition, most of neonates were born alive. We hope that this study can be a feedback for hospital to do maternal and perinatal audit. Keywords: Factors, Maternal mortality rate, Neonatal outcome, Regional public hospital, Trends Tujuan: Untuk menentukan pola, faktor yang berkaitan, dan luaran neonatus di RSUD OKU Timur dari 2013 hingga 2016. Metode: Studi deskriptif dilakukan dari Januari 2013 hingga Desember 2016 di bangsal kebidanan dan unit perawatan intensif RSUD OKU Timur, Sumatera Selatan. Data dikumpulkan dari rekam medik. Terdapat 17 kematian ibu, tetapi 1 data dieksklusi karena data yang kurang lengkap. Hasil: Terdapat 2.191 kehamilan, dan 17 kematian ibu. Selama 4 tahun, AKI terendah terjadi pada 2013 (229/100.000) dan mencapai puncaknya pada 2014 (1.306/100.000). Kemudian, AKI mengalami penurunan dari 1.087/100.000 pada 2015 hingga 588/100.000 pada 2016. Mayoritas sampel berusia reproduktif (50,0%), multigravida (62,5%) dan nulipara (50,0%), serta aterm (87,5%). Mayoritas kematian ibu disebabkan oleh hipertensi dalam kehamilan (HDK) (37,5%), diikuti oleh HDK + perdarahan dan HDK + infeksi dalam jumlah yang sama. AKI lebih tinggi pada ibu yang melahirkan di RS (87,5%), melahirkan melalui sectio caesaria (87,5%), dan dirawat selama kurang dari 48 jam (93,75%). Mayoritas neonatus dilahirkan hidup (62,5%). Kesimpulan: Pola AKI di RSUD berfluktuasi dengan pola menurun, tetapi masih jauh lebih tinggi dari target MDGs pada tahun 2015 (102/100,000). Hipertensi dalam kehamilan berperan signifikan terhadap kematian ibu. Mayoritas neonatus dilahirkan hidup. Studi ini diharapkan dapat menjadi masukan bagi rumah sakit untuk melakukan audit maternal dan perinatal. Kata kunci: Angka kematian ibu, Faktor, Luaran neonatus, Pola, Rumah sakit umum daerah

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Maternal mortality rate in Bao'an district, Shenzhen, China, 1999-2018

10.21203/rs.3.rs-76739/v1 ◽

2020 ◽

Author(s):

yuanfang zhu ◽

Yali Luo ◽

Wei Wang ◽

Liling Wang ◽

Yuli Cheng ◽

...

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Health Management ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Targeted Interventions ◽

Live Births ◽

Fast Decline ◽

Rate Of Decline ◽

Substantial Heterogeneity

Abstract Background China had achieved impressive success in reducing maternal mortality rate (MMR), while substantial heterogeneity still existed, and reports from Shenzhen region remained a blank. This study aiming to use all available data sources to evaluate the MMR from 1999 to 2018 in Bao’an district, Shenzhen, China. Methods Data on maternal deaths and key health-service-related indicators were obtained from registration forms and Shenzhen Maternal and Child Health Management System. The levels and trends of MMR, profiles and leading causes of death, as well as results from the maternal mortality review committee were analyzed. Results The MMR in Bao’an district declined from 95.31 per 100,000 live births in 1999 to zero in 2018, with an annualized rate of decline of 12.03% per year. A significant declining trend of MMR was observed over 5-year intervals (from 82.61 to 5.22 per 100,000 live births). MMR was higher among migrant population, women aged ≥ 35 years or those who given birth outside the hospital. The first three causes of maternal death included hemorrhage (27.69%), amniotic fluid embolism (22.31%) and internal medical disease complications (15.38%). Nearly ninety percent (86.78%) of maternal deaths were determined to be preventable. Conclusions Bao’an district had experienced a fast decline in MMR for a two-decade period, its experience in lowering MMR could provide a guideline for other regions to focus on those who needed particular attention and take targeted interventions to reduce maternal deaths.

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Maternal mortality: A 10-year study at Nishtar Hospital Multan

Annals of King Edward Medical University ◽

10.21649/akemu.v11i4.1057 ◽

2016 ◽

Vol 11 (4) ◽

Author(s):

Huma Quddusi ◽

Sajjad Masood ◽

Sobia Mazhar ◽

Samee Akhtar

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Causes Of Death ◽

Age Group ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Live Births ◽

Causative Factors ◽

Management Of Complications ◽

Age Range

Objective: To analyse causes of maternal deaths and to identify preventable causes leading to this tragedy in our setup. Design: An analytical, hospital-based study. Place and duration of study: Department of Obstetric and Gynaecology, Nishter Hospital Multan from June-August 2005. Patients and methods: During the study period retrospective data was collected for period of 10 year from January 1995 to December 2004. This data was analyzed in order to determine the Maternal Mortality Rate (MMR), causes of death and characteristics of the mothers who died including her age, parity and whether they were booked or unbooked. Results: A total numbers of 30031 deliveries took place during the study period and there were 178 maternal deaths with maternal mortality rate of 593/100,000 LB (live births). 7(3.9%) patients were below the age of 20, 74(41.5%) were in the age group of 21-30 and 82(46%) in 31-40 years age range. 15(8.42%) were above the age of 40. Most of them (69%) were grand multiparas (Parity >5). The major causative factors were haemorrhage 63(35.4%), eclampsia 41(23.03%), sepsis 25(14.04%), anaemia 18(10.1%), hepatic encephalopathy 14(7.9%), abortion 11(6.2%). Majority of the patients were unbooked and presented in the hospital very late. Conclusion: A high proportion of potentially preventable maternal deaths indicate the need for improvements in education for both patient and health care provider. The provision of skilled care and timely management of complications can lower maternal mortality in our setup.

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