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Maternal Morbidity And Mortality Patterns in Uttar Pradesh
Nandan Deoke,Saxena Badri N
Indian Journal of Community Medicine , 1997,
Abstract: Research question: What is the extent of maternal morbidity and mortality in the community? Objectives: To know the extent and pattern of maternal mortality in the community. Study area: The districts of Uttar Pradesh namely Agra and Farrukhabad, covering 206 villages in 15 blocks. Sample Size: 51, 186 households and 292,496 population. Participants: Married women in reproductive age group. Setting: Rural community Development Blocks. Study variables: Menstrual problems, gynaecological problems, general morbidity and maternal deaths. Outcome variables: Maternal morbidity and mortality. Study Design: Community based cross- sectional study. Analysis: Simple proportions. Results: Over 47.5% of women reported excessive discharge, 15-16% complained of foul smelling discharge besides other problems like urinary infections, incontinence, prolapse, vesico-vaginal fistula etc. Around 22-27% of women suffered general morbidity, predominant being fever/cough/cold, malaria, diarrhoea and anemiaa€ s. Overall, high level of (703 per 100,000) maternal mortality was reported in the area. Respective fingers for Agra and Farrukhabad being 582 and 992 per lakh live births. Over 50% of these deaths occurred at home, 22% in government hospitals, 12% in private hospitals and 15% in transit. Leading causes of maternal mortality were; haemorrhage, retained placenta, sepsis, anemia, jaundice and tetanus.
Understanding the Trends of Maternal and Neonatal Mortality in Bangladesh in the Context of South Asia  [PDF]
Halima Akhter, Md. Mahbubur Rahman Alam
Advances in Anthropology (AA) , 2019, DOI: 10.4236/aa.2019.91004
Abstract: Introduction: This article is presenting the overall situation of maternal and neonatal health in Bangladesh in comparison to other South Asian countries. Bringing down the maternal mortality ratio from 569 to 143 was the target for Bangladesh which was achieved up to 176 per 100,000 live births by 2015 but the target as per the Millennium Development Goal 5 was not fulfilled yet and remained as a challenge. Besides, the improvement in reducing the neonatal mortality rate during 1993-2014 shows a national level decline from 52 to 28 per 1000 live births, which is almost half during this period with a percentage change of about 46% and so more care is needed here also. Objectives and Methods: The manuscript has three objectives: to present the trends of maternal and neonatal mortality, to explain the maternal and neonatal mortality rate by background characteristics and the causes of maternal and neonatal deaths in Bangladesh on the basis of South Asian perspective. The main source of data collection and analysis was the secondary sources, from different journals and project reports published between the years 2001 to May 2018. Main Text: In Bangladesh, 35% maternal deaths occurred as indirect causes and 9% causes of deaths are still remaining unidentified. In addition, hemorrhage (31%) and pre-eclampsia-eclampsia (20%) are found two vital causes of maternal deaths with two more causes which are due to obstructed labor (7%), and termination of pregnancy (1%). It is found that Bangladesh has shown a great improvement in maternal mortality ratio by reducing maternal mortality to 176 in 2015 from 569 deaths per 100,000 live births in 1990, with an increase of 69% as progress. On the other hand, it is found that 43% of neonatal deaths in Bangladesh occurred due to birth asphyxia, 24% due to neonatal pneumonia, 22% due to prematurity, 5% due to sepsis, 0.2% due to meningitis and encephalitis, 0.1% due to congenital malformation and 5% causes are still remain undetermined. While comparing the situation to other South Asian countries, it is seen that the causes of neonatal deaths by prematurity are in the highest position that causes 29.7%, 43.8%, 30.8% and 39.3% deaths and birth asphyxia is in the second highest position that causes 22.9%, 18.9%, 23.4% and 20.9% deaths in Bangladesh, India, Nepal and Pakistan respectively. Conclusion: This paper will support health researchers and medical anthropologist for further studies and specifically for
Maternal, Perinatal and Neonatal Mortality in South-East Asia Region  [PDF]
Gaurav Sharma
Asian Journal of Epidemiology , 2012,
Abstract: South East Asia Region (SEAR) is one of the most populous world regions and also bears a disproportionate burden of mortality compared to other world regions. The purpose of this article was to analyze the situation of maternal, neonatal and perinatal health in SEAR to inform public health practitioners, program managers and policy makers about the situation in this world region. A secondary review of policy and programmatic documents published by ministries of health in SEAR countries, WHO, other UN agencies and peer reviewed journal articles in the area of maternal, child, neonatal and perinatal health published in the last five years was conducted. This article discusses the current situation of maternal, perinatal and neonatal health in SEAR countries, highlights some of the key challenges and provides recommendations to countries on the way forward for improving perinatal and maternal health. Key issues are discussed under the broad themes of improving maternal and perinatal health information systems, improving quality of care and human resource management. The article concludes that Health Systems Strengthening, Scaling up of Skilled Human Resource, Investing in information systems and improving the quality of maternal and neonatal care services are essential for future progress in countries but these are long term processes which need sustained commitment and ownership at all levels.
Care seeking at time of childbirth, and maternal and perinatal mortality in Matlab, Bangladesh
Ronsmans,Carine; Chowdhury,Mahbub Elahi; Koblinsky,Marge; Ahmed,Anisuddin;
Bulletin of the World Health Organization , 2010, DOI: 10.1590/S0042-96862010000400015
Abstract: objective: to examine the nature of the relationship between the use of skilled attendance around the time of delivery and maternal and perinatal mortality. methods: we analysed health and demographic surveillance system data collected between 1987 and 2005 by the international centre for diarrhoeal disease research, bangladesh (icddr,b) in matlab, bangladesh. findings: the study recorded 59 165 pregnancies, 173 maternal deaths, 1661 stillbirths and 1418 early neonatal deaths in its service area over the study period. during that time, the use of skilled attendance during childbirth increased from 5.2% to 52.6%. more than half (57.8%) of the women who died and one-third (33.7%) of those who experienced a perinatal death (i.e. a stillbirth or early neonatal death) had sought skilled attendance. maternal mortality was low among women who did not seek skilled care (160 per 100 000 pregnancies) and was nearly 32 times higher (adjusted odds ratio, or: 31.66; 95% confidence interval, ci: 22.03-45.48) among women who came into contact with comprehensive emergency obstetric care. over time, the strength of the association between skilled obstetric care and maternal mortality declined as more women sought such care. perinatal death rates were also higher for those who sought skilled care than for those who did not, although the strength of association was much weaker. conclusion: given the high maternal mortality ratio and perinatal mortality rate among women who sought obstetric care, more work is needed to ensure that women and their neonates receive timely and effective obstetric care. reductions in perinatal mortality will require strategies such as early detection and management of health problems during pregnancy.
Study Of Some Maternal Risk Factors Influencing Early Neonatal Mortality  [cached]
Chatterjee Chitra,Das K.B,Bhattacharya S.K,Ram Rama
Indian Journal of Community Medicine , 1998,
Abstract: Research question: What is the extent of early neonatal mortality (0-7 days) amongst neonates delivered in a city hospital and its association with maternal factors. Objectives: 1. To find out the extent of early neonatal mortality amongst the neonates delivered in a city hospital of Calcutta. 2. To identify the maternal and biosocial factors influencing the early neonatal mortality. Setting :Obstetric and nursery wards of Eden Hospital of Medical college, Calcutta. Study design: Case-control study. Sample Size: 139 a€ casea€ mothers whose neonates died within 7 days of delivery and 215 a€ controla€ mothers who delivered well neonates on the same dates as those of case group. Study Variables: Maternal age, parity, literacy, place of residence, utilization of antenatal care, toxaemia of pregnancy, ante-partumhaemorrhage etc. Statistical analysis: Odds ratio and Chi-square test. Results: Overall early neonatal mortality rate was 55.33 per 1000 live births. Although there was no association of early neonatal mortality with parity and maternal age, but it was found to be significantly higher among illiterate mothers (odds ratio 3.9), those living in rural and slum areas (odds ratio 3 and 2.8) and those who did not receive complete antenatal care(odds ratio 28), The risk of early neonatal mortality was significantly high particularly in presence of two complications during pregnancy e.g. toxaemia (odds ratios 7.48) and antepartum haemorrhage (odds ratio 8.16). Conclusion: Increasing literacy status of mothers will improve their receptivity for antenatal care, which by way of ensuring proper management of pregnancy and its complications will prevent early neonatal deaths to a significant extent.
Reexamining the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality
Cande V Ananth, Robert W Platt
BMC Pregnancy and Childbirth , 2004, DOI: 10.1186/1471-2393-4-22
Abstract: We derived data on over 10 million singleton live births delivered at ≥ 24 weeks from the 1998–2000 U.S. natality data files. Nonparametric multivariable logistic regression based on generalized additive models was used to examine neonatal mortality (deaths within the first 28 days) in relation to fetal growth (gestational age-specific standardized birth weight), gestational age, and number of cigarettes smoked per day. All analyses were further adjusted for the confounding effects due to maternal age and gravidity.The relationship between standardized birth weight and neonatal mortality is nonlinear; mortality is high at low z-score birth weights, drops precipitously with increasing z-score birth weight, and begins to flatten for heavier infants. Gestational age is also strongly associated with mortality, with patterns similar to those of z-score birth weight. Although the direct effect of smoking on neonatal mortality is weak, its effects (on mortality) appear to be largely mediated through reduced fetal growth and, to a lesser extent, through shortened gestation. In fact, the association between smoking and reduced fetal growth gets stronger as pregnancies approach term.Our study provides important insights regarding the combined effects of fetal growth, gestational age, and smoking on neonatal mortality. The findings suggest that the effect of maternal smoking on neonatal mortality is largely mediated through reduced fetal growth.Birth weight is arguably one of the strongest predictors of infant survival, yet its role as a causal predictor of mortality is poorly understood [1]. This is at least partly because low birth weight (<2,500 g) is a construct of two intricately intertwined components: preterm delivery and reduced fetal growth, or both. Our lack of understanding of the complex relationship among birth weight, gestational age and perinatal mortality stems from mixing etiologically distinct pathways to mortality, namely effects chiefly due to fetal maturit
The impact of economic recession on maternal and infant mortality: lessons from history
Tim Ensor, Stephanie Cooper, Lisa Davidson, Ann Fitzmaurice, Wendy J Graham
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-727
Abstract: We utilise 20th century time series data from 14 high and middle income countries to investigate associations between previous economic recession and boom periods on maternal and infant outcomes (1936 to 2005). A first difference logarithmic model is used to investigate the association between short run fluctuations in GDP per capita (individual incomes) and changes in health outcomes. Separate models are estimated for four separate time periods.The results suggest a modest but significant association between maternal and infant mortality and economic growth for early periods (1936 to 1965) but not more recent periods. Individual country data display markedly different patterns of response to economic changes. Japan and Canada were vulnerable to economic shocks in the post war period. In contrast, mortality rates in countries such as the UK and Italy and particularly the US appear little affected by economic fluctuations.The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mechanisms that protect vulnerable populations from the effects of fluctuating national income.What effect is the current worldwide recession likely to have on the health of populations, particularly those in the least wealthy countries? This key question has featured strongly in international meetings such as the G8, and as a focus of several initiatives, including the High Level Taskforce for Innovative Financing [1]. Prior to the present economic slump there was already considerable concern that many countries were failing to have a substantial impact on basic health outcomes [2]. In particular, many of the
Mortalidad materna y perinatal en adolescentes Maternal and perinatal mortality in adolescents  [cached]
Evelio Cabezas Cruz
Revista Cubana de Obstetricia y Ginecolog?-a , 2002,
Abstract: Se analizan las tasas de mortalidad materna y perinatal, durante la adolescencia, comparándola con lo planteado en la literatura internacional mediante los datos que aparecen en la Oficina Nacional de Estadísticas y en los Anuarios de la Dirección Nacional de Estadísticas del MINSAP. Se estudiaron 1 559 398 nacimientos ocurridos en 10 a os, de los cuales el 16,2 % fueron en mujeres menores de 20 a os; se indica que este porcentaje es más bajo que en los países latinoamericanos comprendidos en el estudio de Demographic and Health Surveys. La tasa de mortalidad materna fue inferior en las adolescentes que en el grupo de mujeres de todas las edades. Igualmente la tasa de mortalidad perinatal I se mostró ligeramente inferior al grupo de mujeres de todas las edades, en contraposición con lo que se plantea en la literatura internacional, lo cual evidencia la atención especial que recibe la adolescente en Cuba. The maternal and perinatal mortality rates during adolescence are analyzed and compared with what is published in the international literature. Data registered in the National Statistics Office and in the Yearbooks of the National Statistics Division of the Ministry of Public Health are also reviewed. 1 559 338 births occurred in ten years were analyzed. l6.2 % of them corresponded to women under 20. It is stressed that this percentage is lower than in the Latin American countries included in the study of Demographic and Health Surveys. The maternal mortality rate was lower in the adolescents than in the group of women of all ages. The perinatal mortality rate I was slightly lower than that of the group of women of all ages, contrary to what is stated in international literature. This shows the special attention received by the female adolescents in Cuba.
Maternal Tetanus Toxoid Vaccination and Neonatal Mortality in Rural North India  [PDF]
Abhishek Singh, Saseendran Pallikadavath, Reuben Ogollah, William Stones
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048891
Abstract: Objectives Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. Methods and Findings Using the third round of the Indian National Family Health Survey (NFHS) 2005–06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. Conclusions Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose.
Correlation of Cesarean rates to maternal and infant mortality rates: an ecologic study of official international data
Volpe,Fernando Madalena;
Revista Panamericana de Salud Pública , 2011, DOI: 10.1590/S1020-49892011000500001
Abstract: objective: to correlate international official data on cesarean delivery rates to infant and maternal mortality rates and low weight-at-birth rates; and to test the hypothesis that cesarean rates greater than 15% correlate to higher maternal and infant mortality rates. methods: analyses were based on the most recent official data (2000-2009) available for 193 countries. exponential models were compared to quadratic models to regress infant mortality rates, neonatal mortality rates, maternal mortality rates, and low weight-at-birth rates to cesarean rates. separate regressions were performed for countries with cesarean rates greater than 15%. results: in countries with cesarean rates less than 15%, higher cesarean rates were associated to lower infant, neonatal, and maternal mortality rates, and to lower rates of low weightat-birth. in countries with cesarean rates greater than 15%, cesarean rates were not significantly associated with infant or maternal mortality rates. conclusions: there is an inverse exponential relation between countries' rates of cesarean deliveries and infant or maternal mortality rates. very low cesarean rates (less than 15%) are associated with poorer maternal and child outcomes. cesarean rates greater than 15% were neither correlated to higher maternal nor child mortality, nor to low weight-at-birth.
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