A comparison of approaches to measuring maternal mortality in Bangladesh, Mozambique, and Bolivia

Background Many low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality. Objective The objective is to inform on potential options for measuring maternal mortality. Methods This paper uses a case study approach to compare methodologies and estimates of pregnancy-related mortality ratio (PRMR)/maternal mortality ratio (MMR) obtained from four different data sources from similar time periods in Bangladesh, Mozambique, and Bolivia—national population census; post-census mortality survey; household sample survey; and sample vital registration system (SVRS). Results For Bangladesh, PRMR from the 2011 census falls closely in line with the 2010 household survey and SVRS estimates, while SVRS’ MMR estimates are closer to the PRMR estimates obtained from the household survey. Mozambique's PRMR from household survey method is comparable and shows an upward trend between 1994 and 2011, whereas the post-census mortality survey estimated a higher MMR for 2007. Bolivia's DHS and post-census mortality survey also estimated comparable MMR during 1998–2003. Conclusions Overall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia. It also outlines recommendations to estimate maternal mortality based on the advantages and disadvantages of several approaches. Contribution Recommendations in this paper can help health administrators and policy planners in prioritizing investment for collecting reliable and contemporaneous estimates of maternal mortality while progressing toward a complete civil registration system.

PERBANDINGAN MODEL REGRESI BINOMIAL NEGATIF BIVARIAT DENGAN MODEL GEOGRAPHICALLY WEIGHTED NEGATIVE BINOMIAL BIVARIAT REGRESSION (GWNBBR) PADA KASUS ANGKA KEMATIAN BAYI DAN KEMATIAN IBU DI JAWA TENGAH

Infant mortality (0-11 months) and maternal mortality (during pregnancy, childbirth, and postpartum) are significant indicators in determining the level of public health. Central Java Province which has 35 regencies/cities is included in the top five regions with the highest number of infant and maternal mortality in Indonesia. The data characteristics of the number of infants and maternal mortality are count data. Therefore, the Poisson Regression method can be used to analyze the factors that influence the number of infants and maternal mortality. In Poisson regression analysis, there must be a fulfilled assumption, called equidispersion. Frequently, the variance of count data is greater than the mean, which is known as the overdispersion. The research, binomial negative bivariate regression is used as a solutions to overcome the problem of overdispersion in poisson regression. This method produce a global model. In reality, the geographical, socio-cultural, and economic conditions of each region will be different. This illustrates the effect of spatial heterogeneity, so it needs to be developed into Geographically Weighted Negative Binomial Bivariate Regression (GWNBBR). The model of GWNBBR provides weighting based on the position or distance from one observation area to another. Significant variables for modeling infant mortality cases included the percentage of obstetric complications treated (X1), the percentage of infants who were exclusively breastfed (X3), and the percentage of poor people (X5). Significant variable for modeling maternal mortality cases is the percentage of poor people (X5). Based on the AIC value, GWNBBR model is better than binomial negatif bivariat regression model because it has a smaller AIC value.

Optimal Ambulatory Vital Sign Targets in Pulmonary Hypertension Pregnant Women via Time-Dependent Survival Analysis

Background: Pulmonary hypertension (PH) can cause complications in pregnant women due to significant hemodynamic fluctuation or right heart failure as well as death during pregnancy and postpartum. Those in critical condition would be sent to the intensive care unit (ICU) for observation and treatment. However, evidence to suggest the safe target vital signs is limited and none specific to pregnancy with PH.Methods: This retrospective study of consecutive obstetric patients with PH admitted to ICU of the First Affiliated Hospital of Air Force Military Medical University of China, from January 2011 to May 2020, consisted of 92 cases analyzed using time-dependent Cox regression to consider the dynamic features of vital signs. Results: 7/92 maternal deaths occurred. Most of these deaths occurred within the first three days of admission to the ICU. The vital signs for survival were stable and normal compared to death. Three vital signs were identified as risk factors in the maternal in-hospital mortality model via backward selection: SpO2（HR，0.93；95%CI，0.88-0.97；P=0.003）, heart rate（HR，0.94；95%CI，0.90-0.99；P=0.027）, and mean arterial pressure (MAP) （HR，1.09；95%CI，1.00-1.18；P=0.045）. Log of relative hazard ratios of mortality is linearly negatively related to SpO2 value with a U-shaped correlation with heart rate and MAP (both lower and higher values were associated with high mortality). The optimal range of SpO2 <73%, MAP was 65–95 mmHg, and heart rate was 59–125 beats per minute (bpm). Further exploration showed that the cumulative and the longest consecutive time of abnormal vital signs also affect the outcome. For example, SpO2<73% accumulated for 5 h or continuously up to 2 h increases mortality.Conclusions: Pregnant women with PH who died in the hospital experienced long-term abnormal fluctuations in MAP, heart rate, and SpO2 during ICU stay. Maintaining SpO2>73%, MAP at 65–95mmHg, and heart rate at 59–125 bpm can significantly reduce in-hospital maternal mortality. The effects of the abnormal SpO2, heart rate, and MAP on in-hospital maternal mortality should be combined with the cumulative time and the longest duration.Trial Registry: ChiCTR2100046637.

Black maternal mortality in the media: How journalists cover a deadly racial disparity

Through semi-structured interviews with four women news journalists, this study explores how journalists who specialize in women’s issues and health cover Black maternal mortality. Discussions include the role of advocacy in journalism and the struggle of covering the complex, long-standing systemic issue of maternal mortality associated with race in American society. Six themes consider the inclusion of race in healthcare coverage, a need for in-depth, nuanced coverage, the role of advocacy in journalism, complications of reporting on race, the importance of citing sources of color, and celebrity influence. Findings show the need for media advocacy in public health crises, and how journalistic norms can pressure journalists into citing inappropriate sources or diluting the story.

Knowledge, Attitude and Practice on Maternal Sepsis Among Mothers in Kuantan, Pahang, Malaysia

Maternal sepsis is one of the main contributors to maternal mortality worldwide. Malaysia has the least number of cases associated with maternal sepsis in 2015. However, the number of cases has increase by eight cases in 2017 as stated by the Family Health Development Division Ministry of Health Malaysia. Hence, this study aimed to investigate the knowledge, attitude and practice on maternal sepsis and its associated factors among mothers in Kuantan,Pahang. A cross sectional study design with convenience sampling were applied to 100 respondents among mothers based on specific criteria. From the findings, the majority of the mothers in Kuantan has good level of knowledge (52%), whereas the level of attitude was moderate (85%). In addition, the finding shows that the level of practice among mothers in Kuantan was excellent (76%). Maternal knowledge significantly associated with the age of the mother with p = 0.007. There was a significant correlation between knowledge and attitude (r = 0.433, p = less than 0.001) and knowledge with practice (r = 0.236, p = 0.018). While attitude and practice (r = 0.194, p = 0.053) showed no significant correlation. This study shows that the mothers in Kuantan, Pahang had good level of knowledge, moderate attitude towards maternal sepsis and excellent practice in preventing maternal sepsis. Continues education on maternal sepsis and other risk factors of maternal mortality should be done especially to young mothers in order to control and reduce the the rates of maternal mortality. Furthermore, this can be a benchmark initiative to achieve the targets in reducing maternal mortality rate in Malaysia as outlined under sustainable development goals 3 (SDG3).

Regulating Midwives: Foreclosing Alternatives in the Policymaking Process in West Java, Indonesia

Promotion of “skilled birth attendants” (SBAs) in global maternal health policy has prompted a range of policy responses to “traditional birth attendants” (TBAs). In Indonesia the response has been to develop a national policy of partnership between SBAs (bidan) and TBAs (dukun bayi). This policy aims to ensure the presence of an SBA at every birth yet offers a role for TBAs. In this chapter I examine the development of a district regulation on partnership, promoted within the context of decentralization policies enacted in Indonesia from 1999. The district regulation aimed to strengthen the national policy in a location in West Java where TBAs remain popular. Drawing on 10 months of fieldwork from 2012 to 2013 at a district health office and on observations of its outreach programs, I elucidate how the regulation on partnership was promoted through the policy entrepreneurship of certain key figures in the district health office. They argued that the partnership regulation was the fastest means to improve maternal health. But casting a spotlight on the relationship between SBAs and TBAs diverted attention away from other health system challenges including under-resourced medical facilities and a weak referral system. Three contexts played into this process of bringing the partnership issue to the fore: global policies promoting SBAs and sidelining TBAs; pressure to achieve the Millennium Development Goal (MDG) on maternal mortality; and the limited financial power and decision space afforded to districts under decentralization in Indonesia. In this context, the regulation offered a viable path for demonstrating commitment to improving maternal health outcomes, yet one that failed to address broader constraints in the health system that contribute to persistent high maternal mortality rates.