scholarly journals Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

2020 ◽  
Author(s):  
Ayele Geleto Bali ◽  
Catherine Chojenta ◽  
Tefera Taddele ◽  
Deborah Loxton

Abstract Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. Results The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 live births. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 live births in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. Conclusions At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ayele Geleto ◽  
Catherine Chojenta ◽  
Tefera Taddele ◽  
Deborah Loxton

Abstract Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. Results The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 livebirths. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 livebirths in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. Conclusions At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.


2018 ◽  
Vol 3 (1) ◽  
pp. 16
Author(s):  
Yona Desni Sagita

Abstrak: Berdasarkan data WHO tahun 2015 Rasio kematian ibu (MMR) selama kehamilan dan melahirkan berkisar antara 102/100.000 Kelahiran Hidup. Berdasarkan SDKI Tahun 2013 bahwa Angka Kematian Ibu di Indonesia sebesar 359 per 100.000 kelahiran hidup. Provinsi Lampung memiliki 130 kasus kematian ibu pada saat hamil, melahirkan dan nifas. Studi pendahuluan di Ruang Bersalin RSIA Anugerah Medical Center Kota Metro tahun 2016 bulan November sebanyak 22 ibu dengan perpanjangan kala II. Tujuan penelitian ini untuk mengetahui hubungan tingkat kecemasan terhadap lama persalinan kala II pada ibu bersalin di RSIA Anugerah Medical Center Kota Metro Tahun 2017.Jenis penelitian kualitatif dengan desain analitik dan pendekatan cross sectional. Populasi pada penelitian ini adalah semua seluruh ibu bersalin di RSIA Anugerah Medical Center Kota Metro sebanyak 50 ibu, sedangkan sampel diambil dengan tehnik total sampling sebanyak 50 ibu. Analisis yang digunakan adalah univariat dengan distribusi frekuensi dan bivariat menggunakan uji chi square.Hasil penelitian diketahui bahwa tingkat kecemasan ibu bersalin sebagian besar dengan tingkat kecemasan sedang sebanyak 17 ibu (34%). lama persalinan kala II yang tidak normal sebanyak 22 ibu (44%). Ada hubungan antara tingkat kecemasan dengan lama persalinan kala II pada ibu bersalin dengan nilai p value: 0,009. Kesimpulan penelitian ada hubungan tingkat kecemasan terhadap lama persalinan kala II pada ibu bersalin di RSIA Anugerah Medical Center Kota Metro Tahun 2017, sehingga disarankan kepada tenaga kesehatan untuk meningkatkan berperan aktif dalam mengurangi tingkat kecemasan ibu selama proses persalinan karena berkaitan dengan gangguan pada proses persalinan. Abstract:  The maternal mortality ratio (MMR) during pregnancy and childbirth ranges based on WHO data 2015 estimated from 102 / 100,000 live births. IDHS in 2013 estimated that the Maternal Mortality Rate in Indonesia amounted to 359 per 100,000 live births. Lampung province has 130 cases of maternal mortality during pregnancy, childbirth and childbirth. Preliminary study at the Maternity Room of RSIA Anugerah Medical Center Metro City in 2016 November as many as 22 mothers with second stage extension. The purpose of this study to determine the relationship of anxiety level to the second stage of labor delivery to the maternal mother at RSIA Anugerah Medical Center Metro City Year 2017.This was a quantitative research, analytic survey design with cross sectional approach. The population was whole mother of maternity in RSIA Anugerah Medical Center Metro City that consisted of 50 mother, while sample taken with total sampling technique that consisted of 50 mother. The analysis used univariate with frequency distribution and bivariate using chi square test.The result showed frequency distribution of maternal anxiety level was mostly with moderate anxiety level of 17 mothers (34%). An abnormal second stage of labor during childbirth was 22 mothers (44%). There is no relationship between the level of anxiety with the duration of labor of stage II on maternal mothers with value p value: 0.009.  Conclusion of research there is correlation of anxiety level to the duration of labor of second stage at mother of maternity in RSIA Anugerah Medical Center of Metro City Year 2017. The suggestion for to health worker to increase active role in reducing mother's anxiety level during delivery process because related to disruption at delivery process.


2017 ◽  
Vol 7 (3) ◽  
pp. 410-425
Author(s):  
Manoj Kumar Rau ◽  
Ananta Basudev Sahub

In India, Civil registration was initiated under the registration of births and deaths act,1969 to give reliable estimates of fertility and mortality situation for the nation up to the lowest administrative levels, but due to its inadequate and underreporting, still the Sample Registration System is used to generate reliable indicators of fertility and mortality. In this paper, an attempt is made to compute certain indicators from the civil registration system for the period of 2001-14 in the State of Rajasthan, India. The major SDG indicators of goal 3 of ensuring healthy lives and promoting well-being for all at all ages; targets 3.1 (By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births) and 3.2 (By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births) with indicators of Under-five Mortality Rate (indicator 3.2.1) and Maternal Mortality Ratio (indicator 3.1.1) and other fertility and mortality indicators can be computed, if certain denominator bases are available every year. As the civil registration data has not been classified by the place of residence, it is not strictly comparable to SRS figures. But it has been presented here so as to serve as an indication and for the improvement of the system for generation of reliable vital rates at subnational levels using civil registration data, which is the need of the day for planning purposes for programme managers and policy makers.


2021 ◽  
pp. 097206342199498
Author(s):  
Rajesh Kumar

Background: Since independence, life expectancy has increased substantially in India, but the goal of health-for-all has not been achieved yet. Hence, National Rural Health Mission was launched in 2005, and several strategies were implemented to strengthen the health system. Impact evaluation of the mission was done to learn lessons for future health planning. Materials and Methods: Logical evaluation framework was used to examine input, output and impact indicators systematically using time series data from Health Management Information System, National Family Health Surveys, National Sample Surveys and Sample Registration Scheme. Findings: After launch of the mission, fund allocation has increased nearly five times. The number of auxiliary nurse midwives has doubled, and the number of nurses has trebled. The number of accredited social health activists has increased to about one million. Institutional deliveries have increased from 38.7% in 2005–2006 to 78.9% in 2015–2016. Full immunisation coverage has increased from 43.5% to 62%. Oral rehydration solution (ORS) use in childhood diarrhoea has increased from 26% to 51%. Infant mortality rate has declined from 58 in 2005 to 33 per 1,000 live births in 2017 and maternal mortality ratio has also registered a decline from 254 in 2004–2006 to 122/100000 live births in 2015–2017. However, out-of-pocket health expenditure continues to be fairly high (69.3% of the total expenditure on health). Conclusions: Though National Health Mission has made a significant impact, the goal of universal care coverage is not yet fully achieved. Hence, capacity of health system needs to be trebled by a substantial increase in fund allocation.


Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat

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.


2019 ◽  
Vol 4 (5) ◽  
pp. e001605 ◽  
Author(s):  
Hampus Holmer ◽  
Michael M Kamara ◽  
Håkon Angell Bolkan ◽  
Alex van Duinen ◽  
Sulaiman Conteh ◽  
...  

IntroductionSierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.MethodsWe conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality.ResultsIn 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed.ConclusionsThe caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.


2018 ◽  
Vol 6 (6) ◽  
pp. 1153-1158 ◽  
Author(s):  
Thomas U. Agan ◽  
Emmanuel Monjok ◽  
Ubong B. Akpan ◽  
Ogban E. Omoronyia ◽  
John E. Ekabua

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.


e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Ria Mariani Andini ◽  
Joice Sondakh ◽  
Bismarch J. Laihad

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


2016 ◽  
Vol 8 (4) ◽  
pp. 261-265
Author(s):  
Smiti Nanda ◽  
Shaveta Yadav

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.


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