Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana.

Despite the fact that about 94% of pregnant women attend ANC, 95% deliver at health facilities and 99% deliveries are assisted by skilled birth attendants in Botswana, the national Maternal Mortality Rate is still high. OBJECTIVES: To determine the trend of MMR at Princess Marina and Nyangabwe referral hospitals before and after EMOC training. METHODS: Retrospective longitudinal quantitative study design was used to collect data on maternal deaths. Demographic characteristics, maternal death causes, gestation at ANC registration and pregnancy risks were collected for the period before EMOC training and after training, analysed and compared. Descriptive statistics and frequency tables were used. FINDINGS: Maternal deaths were 33 and 41 before and after EMOC training respectively. Majority of the maternal deaths, 78.8% and 70.7% before and after EMOC training respectively occurred among young women in the reproductive ages. Eclampsia was the commonest cause of maternal death before EMOC between training & and 58% and 66% of maternal deaths before and after EMOC training respectively occurred among women who had attended ANC services four or more times. CONCLUSION: Maternal deaths at the hospitals remained similar during the two periods. Qualitative studies are needed to determine why EMOC training has not resulted in significant reduction in MMR in Botswana.

Desaceleración en la reducción de la mortalidad materna en Chile impide alcanzar el 5° Objetivo de Desarrollo del Milenio / Slowdown in reducing maternal mortality in Chile prevents reach the 5th Millennium Development Goal

Antecedentes: en Chile, a pesar de la importante reducción de la mortalidad materna en la década de los 90, los avances distan de los objetivos comprometidos. Objetivos: analizar la tendencia de la razón de mortalidad materna (RMM) en Chile desde 1990 al 2015 y de factores epidemiológicos que afectan el cumplimiento del 5° Objetivo del Mileno (5°OM). Métodos: estudio observacional a nivel nacional. Analizamos la tendencia del cambio porcentual anual promedio (CPAP) y puntos de inflexión de la RMM junto con la evolución de los nacimientos, muertes maternas y sus causas. Además, analizamos los nacimientos por edad y la distribución de la razón de mortalidad materna por edad y por causa de muerte materna. Resultados: en Chile la RMM se redujo un 61% entre 1990 y 2015, con una inflexión desde el 2001 (IC 95% 1997 a 2004) demostrando dos periodos: 1990-2001 (CPAP -6,97%; IC 95% -8,63 a -5,29) y 2001-2015 (CPAP -0,66%; IC 95% -2,40 a 1,10). En el segundo período la tasa de natalidad disminuyó con menor pendiente, los nacimientos de madres de 15-29 años disminuyeron, mientras que en los otros estratos de edad los nacimientos aumentaron. En ambos períodos las primeras causas de muerte fueron hipertensión arterial, enfermedades concurrentes y aborto. En el segundo período la muerte materna por hipertensión arterial y aborto se redujo, mientras que por enfermedades concurrentes aumentó. Conclusiones: en Chile la RMM es estacionaria desde el 2001 y se asocia a cambios en la distribución en la edad materna y causas de muerte. (AU)

Background: in Chile, despite the significant reduction in maternal mortality in the 1990s, the advances are far from the committed objectives. Aim: To analyze trends of the maternal mortality ratio (MMR) in Chile from 1990 to 2015 and epidemiologic factors that threaten the5th Millennium Goal. Methods: an observational study at the country level. We performed a trend analysis of the average annual percent change (AAPC) and models for joint point analyses for MMR, births, maternal deaths and their causes. In addition, we assessed the Odds Ratios for births by maternal age and the distribution of the maternal mortality rate by maternal age and main death causes. Results: in Chile, a reduction of 61% in MMR was observed from 1990 to 2015 with a trend join point in 2001 (CI 95% 1997 to 2004) indicating two periods: 1990-2001 (AAPC -6.97%; 95% CI -8.63 to -5.29) and 2001-2015 (AAPC - 0.66%; 95% CI -2.4 to 1.10). In the second period the birth rate decreased with a lower slope, the births of mothers in the age group 15-29 decreased, while in the other age groups the births increased. In both periods, main maternal death causes were hypertension, concurrent illness, and abortion. In the second period, maternal deaths associated to hypertension and abortion decreased, whereas deaths associated to concurrent illness increased. Conclusions: in Chile, MMR has been stationary since 2001 and is associated with changes in the distribution of maternal age and causes of death.(AU)

Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: exploring pathways for maternal mortality reduction / Transición obstétrica en la Encuesta Global de la Organización Mundial de la Salud sobre Salud Materna y Neonatal: exploración de las vías de reducción de la mortalidad materna

OBJECTIVE: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. METHODS: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. RESULTS: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. CONCLUSIONS: This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.

RESUMEN OBJETIVO: Evaluar si las características propuestas del Modelo de Transición Obstétrica, un marco teórico que puede explicar los cambios graduales que experimentan los países a medida que eliminan la mortalidad materna evitable, se pueden observar en una amplia base de datos de salud materna y perinatal de varios países; y tratar sobre el proceso dinámico de reducción de la mortalidad materna utilizando este modelo como marco teórico. MÉTODOS: Este estudio consistió en un análisis secundario de un estudio transversal realizado por la Organización Mundial de la Salud que recopiló información sobre más de 300 000 mujeres que dieron a luz en 359 establecimientos de salud de 29 países de África, Asia, América Latina y Oriente Medio, durante un período de 2 a 4 meses en el 2010 y el 2011. Se calcularon los índices de afecciones potencialmente mortales, resultados maternos graves, morbilidad materna extremadamente grave, y muerte materna, y se estratificaron según las etapas de transición obstétrica. Se definen las características de cada etapa. RESULTADOS: Los datos de 314 623 mujeres indicaron que la fecundidad femenina, calculada indirectamente por el número de partos, fue mayor en los países que se hallaban en las primeras etapas de la transición obstétrica, desde un promedio de 3 hijos en el estadio II a 1,8 en el estadio IV. El nivel de medicalización de los establecimientos de salud de los países participantes, definido por el número de partos por cesárea y el número de partos inducidos, tuvo tendencia a aumentar según avanzaba la etapa de transición obstétrica. En el estadio IV, las mujeres tuvieron 2,4 veces más partos por cesárea (15,3% en el estadio II y 36,7% en el estadio IV) y 2,6 veces más inducciones de parto (7,1% en el estadio II y 18,8% en el estadio IV) que las mujeres en el estadio II. A medida que avanzaban las etapas de transición obstétrica, también se incrementaba la media de edad de las mujeres primíparas. La ocurrencia de rotura uterina mostraba una tendencia descendente, y se reducía 5,2 veces, de 178 a 34 casos por 100 000 nacidos vivos, a medida que un país efectuaba la transición del estadio II al IV. CONCLUSIONES: Este análisis apoya el concepto de transición obstétrica utilizando datos de varios países. El Modelo de Transición Obstétrica podría justificar la adaptación de las estrategias para reducir la mortalidad materna según la etapa de transición obstétrica en que se halla un país.

Trends in maternal mortality in Tamale Teaching Hospital, Ghana.

OBJECTIVE: To determine the yearly maternal mortality ratio over the period 2006-2010 and trends in the causes of 139 audited maternal deaths from 2008-2010 at the Tamale Teaching Hospital in Ghana STUDY DESIGN: Retrospective descriptive review of maternal deaths SETTING: Department of Obstetrics and Gynaecology, Tamale Teaching Hospital METHODS: Data on maternal deaths that occurred over the review period were obtained from the patient folders, departmental monthly reports, midwifery monthly returns, audit reports, theatre, intensive care unit, maternity, gynaecology and the labour ward records. RESULTS: There were 280 maternal deaths from 1(st) January 2006 to 31(st) December 2010. The maternal mortality ratio dropped from 1870 per 100,000 live births in 2006 to 493 per 100,000 live births in 2010, a fall of nearly 74%. Using 2008 as the baseline, maternal mortality ratio dropped from 842 per 100,000 live births in 2008 to 493 per 100,000 live births in 2010, a fall of 41.4%. The main causes of 139 audited maternal deaths from 2008 to 2010 were sepsis (19.8%) hypertensive disorders(18.6%), haemorrhage (15.8%), unsafe abortion (11.5%), obstructed labour (5.7%), anaemia (8.7%), sickle cell disease (5.7%) and malaria (5.0%). The ages of the 139 audited maternal deaths ranged from 14-48 years; with mean age of 26.5 ± 4.6 years. Nearly 50% of the maternal deaths were aged 20-29 years and about 10% were 14-19 years. Eighteen(13%) of the maternal deaths were from towns over 150 km from Tamale. CONCLUSION: There has been significant reduction in maternal mortality at the Tamale Teaching Hospital, it is however still unacceptably high.