Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.
Adult
Africa South of the Sahara
/ epidemiology
Age Distribution
Blood Pressure
Blood Transfusion
/ statistics & numerical data
Developing Countries
/ statistics & numerical data
Female
Haiti
/ epidemiology
Health Personnel
/ education
Healthcare Disparities
Heart Rate
Humans
Hypertension, Pregnancy-Induced
/ mortality
Incidence
India
/ epidemiology
Intensive Care Units
/ supply & distribution
Maternal Mortality
Postpartum Period
Sepsis
/ mortality
Time Factors
Uterine Hemorrhage
/ mortality
Young Adult
Epidemiology
low and middle resource
maternal mortality
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
accepted:
22
04
2020
pubmed:
10
5
2020
medline:
27
10
2020
entrez:
9
5
2020
Statut:
ppublish
Résumé
The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources. This is a secondary analysis of a stepped-wedge cluster randomised controlled trial. This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti. Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion. Pregnancy-related deaths were collected prospectively from routine data sources and active case searching. Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome. Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death. The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists. Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability.
Identifiants
pubmed: 32383337
doi: 10.1111/1471-0528.16309
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1082-1089Subventions
Organisme : Department of Health
ID : RP-2014-05-019
Pays : United Kingdom
Organisme : Medical Research Council, Department of Biotechnology India and Department of International Development joint fund
ID : MR/N006240/1
Pays : International
Investigateurs
Doreen Bukani
(D)
Grace Makonyola
(G)
Paul Toussaint
(P)
Adeline Vixama
(A)
Grace Greene
(G)
Carwyn Hill
(C)
Emily Nakirijja
(E)
Doreen Birungi
(D)
Noela Kalyowa
(N)
Dorothy Namakula
(D)
Josaphat Byamugisha
(J)
Nathan Mackayi Odeke
(NM)
James Ditai
(J)
Julius Wandabwa
(J)
Fatmata Momodou
(F)
Margaret Sesay
(M)
Patricia Sandi
(P)
Jeneba Conteh
(J)
Jesse Kamara
(J)
Matthew Clarke
(M)
Rebecca Best
(R)
Josaphine Miti
(J)
Martina Chima
(M)
Mercy Kopeka
(M)
Christene Jere
(C)
Thokozile Musonda
(T)
Violet Mambo
(V)
Yonas Guchale
(Y)
Feiruz Surur
(F)
Geetanjali M Mungarwadi
(GM)
Sphoorthi S Mastiholi
(SS)
Chandrappa C Karadiguddi
(CC)
Natasha Hezelgrave
(N)
Kate E Duhig
(KE)
Monice Kachinjika
(M)
Jane Makwakwa
(J)
Hannah Nathan
(H)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
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