Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends.
Child
Delivery, Obstetric
/ methods
Developing Countries
Female
Global Health
/ statistics & numerical data
Humans
Infant, Newborn
Maternal Death
/ etiology
Maternal Health
/ statistics & numerical data
Maternal Mortality
/ ethnology
Pregnancy
Pregnancy Complications
/ epidemiology
Pregnancy Outcome
/ epidemiology
Puerperal Disorders
/ epidemiology
Risk Factors
Sustainable Development
Global network
Low-resource countries
Maternal mortality
Sustainable development goals
Journal
Reproductive health
ISSN: 1742-4755
Titre abrégé: Reprod Health
Pays: England
ID NLM: 101224380
Informations de publication
Date de publication:
17 Dec 2020
17 Dec 2020
Historique:
received:
28
08
2020
accepted:
02
09
2020
entrez:
18
12
2020
pubmed:
19
12
2020
medline:
16
6
2021
Statut:
epublish
Résumé
Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. The MNHR is registered at NCT01073475 .
Sections du résumé
BACKGROUND
BACKGROUND
Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time.
METHODS
METHODS
We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time.
RESULTS
RESULTS
We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites.
CONCLUSIONS
CONCLUSIONS
The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030.
TRIAL REGISTRATION
BACKGROUND
The MNHR is registered at NCT01073475 .
Identifiants
pubmed: 33334343
doi: 10.1186/s12978-020-00990-z
pii: 10.1186/s12978-020-00990-z
pmc: PMC7745363
doi:
Banques de données
ClinicalTrials.gov
['NCT01073475']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
173Subventions
Organisme : NICHD NIH HHS
ID : UG1 HD076461
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD078439
Pays : United States
Organisme : National Institute of Child Health and Human Development
ID : U10HD076465
Organisme : NICHD NIH HHS
ID : UG1 HD076465
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD076474
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD078438
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD076457
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD076474
Pays : United States
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