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1.
Front Public Health ; 9: 664659, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34746071

RESUMO

Background: Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3). Methods: Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed. Results: From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: N = 19, 61.3%, Massachusetts: N = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% (n = 17) of national policies and 68.8% (n = 11) of Massachusetts with positive impact on health equity. Conclusions: There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.


Assuntos
Afro-Americanos , Saúde Materna , Feminino , Política de Saúde , Humanos , Massachusetts , Mortalidade Materna , Gravidez , Estados Unidos
2.
Artigo em Inglês | MEDLINE | ID: mdl-34770029

RESUMO

Accomplishing unremitting favorable health outcomes, especially reducing maternal mortality, remains a challenge for South Asian countries. This study explores the relationship between health expenditure and maternal mortality by using data set consisting of 18 years from 2000 to 2017. Fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) models were employed for the empirical analysis. The outcomes revealed that a 1% rise in health expenditure increased the maternal mortality rate by 1.95% in the case of FMOLS estimator and 0.16% in the case of DOLS estimator. This reflects that the prevailing health care system is not adequate for reducing maternal mortality. Moreover, the meager system and the priorities established by an elitist system in which the powerless and poor are not considered may also lead to worsen the situation. In addition, the study also added population, economic growth, sanitation, and clean fuel technology in the empirical model. The findings revealed that population growth has a significant long-term effect on maternal mortality-an increase of 40% in the case of FMOLS and 10% in the case of DOLS-and infers that an increase in population growth has also dampened efforts towards reducing maternal mortality in the South Asian panel. Further, the results in the case of economic growth, sanitation, and clean fuel technologies showed significant long-term negative effects on maternal mortality by 94%, 7.2%, and 11%, respectively, in the case of the FMOLS estimator, and 18%, 1.9%, and 5%, respectively, in the case of the DOLS estimator. The findings imply that GDP and access to sanitation and clean fuel technologies are more nuanced in declining maternal mortality. In conclusion, the verdict shows that policymakers should formulate policies considering the fundamental South Asian aspects warranted to reduce maternal mortality.


Assuntos
Gastos em Saúde , Mortalidade Materna , Dióxido de Carbono , Desenvolvimento Econômico , Política de Saúde
3.
J Glob Health ; 11: 04048, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34737857

RESUMO

Background: Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods: We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease - 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words "maternal mortality", "maternal death", "pregnancy-related death", "reproductive age mortality" and "causes" as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results: We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions: Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.


Assuntos
Morte Materna , Mortalidade Materna , África ao Sul do Saara/epidemiologia , Feminino , Humanos , Gravidez , Publicações , Estudos Retrospectivos
4.
J Glob Health ; 11: 04057, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34737858

RESUMO

Background: Since 2014, iterative technical work has captured stakeholder demand and channeled it toward improving maternal health measurement, to support SDG 3.1. Strategies toward Ending Preventable Maternal Mortality (EPMM) (2015) turned a broad lens on upstream systemic determinants of maternal health and survival highlighted in 11 Key Themes. A monitoring framework was developed to help countries track progress across these domains. This process yielded requests for additional indicators where stakeholders identified gaps for tracking EPMM Key Themes. In response, two technical consultations aimed at affirming the measurement gaps, specifying the constructs for measurement, and fully elaborating the metadata to allow them to be monitored. Methods: Measures for development were prioritized based on multi-stakeholder dialogues in five countries, and data collected from government officials and UN partners in twenty countries on perceived need for proposed additional indicators. Sixty-one participants representing expertise in measure development and the topical areas covered took part across both consultations. Measures were developed through two simultaneous participatory online consultations stratified by focus area, comprising videos, discussion forums, polls, and live Zoom meetings. Results: Eight candidate indicators relevant to priority recommendations in the EPMM Strategies are presented. Each includes a definition, numerator and denominator (if applicable), method of estimation, disaggregation factors, preferred data source(s), and expected periodicity. Four address gaps in measures of fundamental rights-related determinants of maternal health at national and subnational level, including women's reproductive autonomy; participative accountability for maternal health outcomes; and Respectful Maternity Care. Four strengthen the ability to count, track, and link births and maternal deaths and causes of death. Conclusions: The proposed indicators correspond to specific EPMM Key Themes, filling gaps identified by multiple stakeholders, and respond to calls for a broadened approach to measurement and for indicators that track the social and health-systems determinants of maternal health. They reflect inputs and aspirations of numerous stakeholders, gathered over time and across various platforms. The iterative, discursive exploration of the concepts for measurement and the need for metrics to track them responds to recent calls for measure development to be carried out in more inclusive ways, and to be primarily concept- and user-driven.


Assuntos
Morte Materna , Serviços de Saúde Materna , Feminino , Humanos , Saúde Materna , Mortalidade Materna , Gravidez , Encaminhamento e Consulta
5.
J Glob Health ; 11: 04063, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34737863

RESUMO

Background: Ethiopia and other countries continue to experience high rates of maternal mortality and neonatal deaths. Interventions are needed to increase utilization of antenatal care (ANC) and facility delivery services to improve outcomes. Methods: A cluster-randomized trial was conducted in the Amhara Region of Ethiopia, with 6 communities randomly assigned to receive the intervention and 12 communities monitored as controls. Intervention teams provided outreach to pregnant women and their families. Registry data were used to measure utilization of services provided at health centers in intervention and control communities.The intervention consisted of trained pairs of community health workers and Ethiopian Orthodox priests who worked together to promote health messages around safe delivery. The pairs visited pregnant women and their families in their homes to provide counseling, discuss concerns, and answer questions about ANC and facility deliveries. Intervention impact was measured using facility-level data on monthly number of ANC visits and facility deliveries at the health centers that served the intervention and control communities. Intervention effect was measured using difference-in-difference analyses estimated by generalized estimating equation models. Results: During the 12-month intervention period, intervention facilities (n = 6) recorded 14% more ANC1 visits (relative risk RR = 1.14; 95% confidence interval (CI) = 1.09-1.19; P < 0.001) and 26% more ANC4 visits (RR = 1.26; 95%CI = 1.18, 1.34; P < 0.001) compared to control health centers (n = 12). The intervention health centers experienced a 10% increase in facility deliveries over what would have been expected had the intervention not occurred (RR = 1.10; 95% CI = 1.05-1.16; P < 0.001). Conclusions: Promotion of safe delivery through home visits by community health workers paired with Ethiopian Orthodox priests increased utilization of ANC and facility delivery services. This approach could leverage the influential role of faith leaders and increase the impact of community health workers in Ethiopia. Trial registration: NCT04039932.


Assuntos
Agentes Comunitários de Saúde , Cuidado Pré-Natal , Etiópia , Feminino , Promoção da Saúde , Humanos , Recém-Nascido , Mortalidade Materna , Gravidez
6.
Cien Saude Colet ; 26(10): 4397-4409, 2021 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34730631

RESUMO

This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.


Assuntos
Aborto Induzido , Aborto Espontâneo , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Mortalidade Materna , Gravidez , Desenvolvimento Sustentável , Adulto Jovem
7.
Int J Equity Health ; 20(1): 228, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666762

RESUMO

BACKGROUND: Community mobilization (CM) is recommended as a best practice intervention for low resource settings to reduce maternal mortality. Measurement of process outcomes are lacking and little is known about how CM impacts individuals or how community members perceive its function. Given the complex and recursive nature of CM interventions, research that describes the CM process at multiple levels is needed. This study examines change in CM domains at baseline and endline in rural Zambia. METHODS: This secondary analysis uses data from a large maternity waiting homes intervention in rural Zambia that employed CM over 3 years as part of a package of interventions. A 19-item CM survey was collected from three groups (women with babies < 1, health workers, community members; n = 1202) with focus groups (n = 76) at two timepoints from ten intervention and ten comparison sites. Factor analysis refined factors used to assess temporal change through multivariable regression. Independent covariates included time (baseline vs endline), intervention vs comparison site, group (women with babies, healthworkers, community members), and demographic variables. Interaction effects were checked for time and group for each factor. RESULTS: Final analyses included 1202 individuals from two districts in Zambia. Factor analysis maintained domains of governance, collective efficacy, self-efficacy, and power in relationships. CM domains of self-efficacy, power in relationships, and governance showed significant change over time in multivariable models. All increases in the self-efficacy factor were isolated within intervention communities (b = 0.34, p < 0.001) at endline. Between groups comparison showed the women with babies groups consistently had lower factor scores than the healthworkers or community member groups. CONCLUSIONS: Community mobilization interventions increase participation in communities to address health as a human right as called for in the 1978 Alma Ata Declaration. Grounded in empowerment, CM addresses socially prescribed power imbalances and health equity through a capacity building approach. These data reflect CM interventions function and have impact in different ways for different groups within the same community. Engaging directly with marginalized groups, using the community action cycle, and simultaneous quality improvement at the facility level may increase benefit for all groups, yet requires further testing in rural Zambia.


Assuntos
Serviços de Saúde Materna , Feminino , Grupos Focais , Humanos , Mortalidade Materna , Gravidez , População Rural , Zâmbia
8.
Bull World Health Organ ; 99(10): 693-707F, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34621087

RESUMO

Objective: To describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health Organization's (WHO) maternal near-miss tool and to evaluate its applicability in these settings. Methods: We did a systematic review of studies on maternal near misses in middle-income countries published over 2009-2020. We extracted data on number of live births, number of maternal near misses, major causes of maternal near miss and most frequent organ dysfunction. We extracted, or calculated, the maternal near-miss ratio, maternal mortality ratio and mortality index. We also noted descriptions of researchers' experiences and modifications of the WHO tool for local use. Findings: We included 69 studies from 26 countries (12 lower-middle- and 14 upper-middle-income countries). Studies reported a total of 50 552 maternal near misses out of 10 450 482 live births. Median number of cases of maternal near miss per 1000 live births was 15.9 (interquartile range, IQR: 8.9-34.7) in lower-middle- and 7.8 (IQR: 5.0-9.6) in upper-middle-income countries, with considerable variation between and within countries. The most frequent causes of near miss were obstetric haemorrhage in 19/40 studies in lower-middle-income countries and hypertensive disorders in 15/29 studies in upper-middle-income countries. Around half the studies recommended adaptations to the laboratory and management criteria to avoid underestimation of cases of near miss, as well as clearer guidance to avoid different interpretations of the tool. Conclusion: In several countries, adaptations of the WHO near-miss tool to the local context were suggested, possibly hampering international comparisons, but facilitating locally relevant audits to learn lessons.


Assuntos
Near Miss , Complicações na Gravidez , Países em Desenvolvimento , Feminino , Humanos , Nascido Vivo , Mortalidade Materna , Gravidez , Complicações na Gravidez/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34639806

RESUMO

It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence-itself from 15 to 20 years ago-suggests that 6-7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70-150 deaths per year. I then offer some evidence suggesting that a substantial proportion of these are attributable to spontaneous abortion. To reduce maternal mortality by large margins, emergency obstetric care should be prioritised, which will also save women from complications of induced and spontaneous abortion.


Assuntos
Aborto Induzido , Aborto Espontâneo , Aborto Induzido/efeitos adversos , Aborto Espontâneo/epidemiologia , Feminino , Humanos , Malaui/epidemiologia , Mortalidade Materna , Gravidez
10.
BMC Public Health ; 21(1): 1842, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641846

RESUMO

BACKGROUND: Public health recognizes that health conditions depend on factors related to the development patterns income distribution, degree of poverty, working conditions, among other social determinants. The objective of this study was to analyze the association of maternal mortality with the Human Development Index (HDI), Gini Index, Income per capita, and the Social Vulnerability. METHOD: The study analyzed the relationship between MMR and socioeconomic indicators in the 26 federative units and the Federal District of Brazil, in 2017. The socioeconomic indicators used in the study were: HDI, Gini Index, Income per capita, and SVI. Crude and adjusted linear regression were performed between maternal mortality and socioeconomic indicators. RESULTS: When analyzing which socioeconomic determinants that are related to maternal mortality ratio rates, a higher per capita income positive effect was observed for lower MMR (ß = - 150.8; CI 95% -289.9 to - 11.7; r2 = 0.17; p = 0.035), as well as a trend of higher MMR in relation to the SVI (ß = 97.7; CI 95% -12.2 to 207.6; r2 = 0.12; p = 0.079). In model found by the stepwise forward selections, only the per capita income was um index related to less RMM (ß = - 0.02; CI 95% -0.05 to - 0.002; r2 = 0.15; p = 0.028). CONCLUSION: The findings showed that the per capita income has a negative association MMR in the different states of Brazil, but seems canceled because of the other socioeconomic determinants related to the poor live conditions.


Assuntos
Renda , Mortalidade Materna , Brasil/epidemiologia , Humanos , Saúde Pública , Fatores Socioeconômicos
11.
Artigo em Inglês | MEDLINE | ID: mdl-34682468

RESUMO

Reducing the maternal mortality ratio (MMR) in low- and middle-income countries (LMICs) remains a huge challenge. Maternal mortality is mostly attributed to low coverage of maternal health services. This study investigated the trajectories and predictors of skilled birth attendant (SBA) service utilisation in LMIC over the past two decades. The data was sourced from standard demographic and health surveys which included four surveys on women with livebirth/s from selected countries from two regions with a pooled sample of 56,606 Indonesian and 63,924 Nigerian respondents. Generalised linear models with quasibinomial family of distributions were fitted to investigate the association between SBA utilisation and sociodemographic factors. Despite a significant improvement in the last two decades in both countries, the change was slower than hope for, and inconsistent. Women who received antenatal care were more likely to use an SBA service. SBA service utilisation was significantly more prevalent amongst literate women in Indonesia (AOR = 1.39, 95% CI: 1.24-1.54) and Nigeria (AOR = 1.41, 95% CI: 1.31-1.53) than their counterparts. The disparity based on geographic region and social factors remained significant over time. Given the significant disparities in SBA utilisation, there is a strong need to focus on community- and district-level interventions that aim at increasing SBA utilisation.


Assuntos
Serviços de Saúde Materna , Tocologia , Parto Obstétrico , Países em Desenvolvimento , Feminino , Humanos , Renda , Mortalidade Materna , Gravidez , Cuidado Pré-Natal , Fatores Socioeconômicos
13.
BMJ Open ; 11(9): e047660, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593489

RESUMO

OBJECTIVE: Few studies have analysed accidental maternal deaths. This study analysed the basic situation and classification of maternal accidental deaths and compared the differences between urban and rural areas. DESIGN: A cross-sectional study on accidental deaths during pregnancy and puerperium from 2009 to 2019 in Hunan Province. SETTING: Hunan Province, with a population of 74 million, has an area of 210 000 km2 and 123 counties/districts. PARTICIPANTS: A collection of 239 cases of accidental death during pregnancy and puerperium in Hunan Province from 2009 to 2019, including 181 cases of rural pregnancy and puerperium and 58 cases of urban pregnancy and puerperium. MAIN OUTCOME MEASURE: Classification of accidental mortality of pregnant women. RESULTS: A total of 239 accidental deaths occurred in Hunan Province, with an accidental mortality rate of 2.8 per 100 000 live births. The accidental mortality rate in rural areas (3.2 per 100 000 live births) was higher than in urban areas (2.0 per 100 000 live births). The proportion of accidental deaths among pregnancy-related deaths showed an upward trend. The main types of accidental deaths were suicide (1.0 per 100 000 live births), traffic accidents (0.8 per 100 000 live births), accidental poisoning/overdose and assault/homicide (0.2 per 100 000 live births), and other accidents (0.6 per 100 000 live births). Maternal accidental deaths were mainly concentrated in low-income families, in rural areas and in those with low level of education. 74.5% of accidental deaths occurred before childbirth. 49.2% of pregnant women gave birth by caesarean section. CONCLUSION: In response to the different causes of accidental maternal death, public health programmes and policy interventions should pay special attention to maternal suicide and traffic injuries.


Assuntos
Cesárea , Mortalidade Materna , Causas de Morte , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Nascido Vivo , Período Pós-Parto , Gravidez
14.
Health Aff (Millwood) ; 40(10): 1551-1559, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34606354

RESUMO

Each year approximately 700 people die in the United States from pregnancy-related complications. We describe the characteristics of pregnancy-related deaths due to mental health conditions, including substance use disorders, and identify opportunities for prevention based on recommendations from fourteen state Maternal Mortality Review Committees (MMRCs) from the period 2008-17. Among 421 pregnancy-related deaths with an MMRC-determined underlying cause of death, 11 percent were due to mental health conditions. Pregnancy-related mental health deaths were more likely than deaths from other causes to be determined by an MMRC to be preventable (100 percent versus 64 percent), to occur among non-Hispanic White people (86 percent versus 45 percent), and to occur 43-365 days postpartum (63 percent versus 18 percent). Sixty-three percent of pregnancy-related mental health deaths were by suicide. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use. MMRC recommendations can be used to prioritize interventions and can inform strategies to enable screening, care coordination, and continuation of care throughout pregnancy and the year postpartum.


Assuntos
Complicações na Gravidez , Suicídio , Comitês Consultivos , Causas de Morte , Feminino , Humanos , Mortalidade Materna , Saúde Mental , Gravidez , Complicações na Gravidez/prevenção & controle , Suicídio/prevenção & controle , Estados Unidos
15.
J Nepal Health Res Counc ; 19(2): 264-269, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601514

RESUMO

BACKGROUND: Maternal Near Miss cases have similarities with those dying from such complications and so present an important opportunity to improve practice. This study was conducted to assess the prevalence of Maternal Near Miss events and identify the delays experienced. METHODS: This was a facility-based cross-sectional study conducted in three tertiary referral hospitals from three provinces of Nepal. All the women surviving a near miss event during six months data collection period were included in the study. RESULTS: There were 67 near miss cases, 7 maternal deaths, and 9158 live births in the study hospitals during the data collection period. This resulted in Maternal Near Miss ratio of 7.31/1000 live births and facility-based Maternal Mortality Ratio of 76/100,000 live births. Severe obstetric haemorrhage (54%) was the most frequent clinical cause of near miss, followed by hypertensive disorders (43%). At least one type of delay was experienced by 85% women. First delay occurred in 63% (42 of 67) cases, second delay occurred in 52% (33 of 62) cases and third delay occurred in 55% (37 of 67) cases. CONCLUSIONS: This study found out that all three delays were common among women experiencing maternal near miss event. Raising awareness regarding dangers signs, improving referral system and strengthening ability of health workers can help in reducing these delays.


Assuntos
Near Miss , Estudos Transversais , Feminino , Humanos , Masculino , Mortalidade Materna , Nepal/epidemiologia , Gravidez , Centros de Atenção Terciária
17.
BMC Public Health ; 21(1): 1792, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34610806

RESUMO

BACKGROUND: China was one of the few countries to achieve the Millennium Development Goals 5. China had taken many effective measures to reduce maternal mortality ratio (MMR) and has achieved encouraging progress. These measures were worth sharing for other countries to reduce the MMR, but the introduction of these measures from the national perspective was too grand, and the measures implemented in a city and the results achieved were more valuable. However, there were few studies on the prevalence and trends of prolonged maternal mortality in a city. In this study, we mainly introduced the prevalence of the MMR in Jinan,China from 1991 to 2020, analyzed the causes of trends and put forward some solutions to the difficulty existing in the process of reducing the MMR,hoping to serve as a model for some developing cities to reduce MMR. METHODS: We collected maternal mortality data from paper records, electronic files and network platforms. The time trend of MMR was tested by Cochran-Armitage Test (CAT). We divided the study period into three stages with 10 years as a stage and the Chi-square test or Fisher's exact test was used to test the difference in MMR of different periods. RESULTS: From 1991 to 2020, We counted 1,804,162 live births and 323 maternal deaths, and the MMR was 17.93 per 100,000 live births. The MMR declined from 44.06 per 100,000 live births in 1991 to 5.94 per 100,000 live births in 2020, with a total decline of 86.52% and an annual decline of 2.89%. The MMR declined by 88.54% in rural areas, with an average annual decline 2.95%, faster than that in urban areas (82.06, 2.73%). From 1991 to 2020, the top five causes of maternal deaths were obstetric haemorrhage (4.55 per 100,000 live births), amniotic fluid embolism (3.27 per 100,000 live births), pregnancy-induced hypertension (2.61 per 100,000 live births), heart disease (2.33 per 100,000 live births) and other medical complications (2.05 per 100,000 live births). Postpartum hemorrhage, amniotic fluid embolism, pregnancy-induced hypertension showed a downward trend (P < 0.05) and other medical complications showed an upward trend (P < 0.05). CONCLUSIONS: Subsidy for hospitalized delivery of rural women, free prenatal check-ups for pregnant women and rapid referral system between hospitals have contributed to reducing MMR in Jinan. However, it was still necessary to strengthen the treatment of obstetric hemorrhage by ensuring blood supply, reduce the MMR due to medical complications by improving the skills of obstetricians to deal with medical diseases, and reduce the MMR by strengthening the allocation of emergency equipment in county hospitals and the skills training of doctors.


Assuntos
Hemorragia Pós-Parto , Complicações na Gravidez , China/epidemiologia , Feminino , Humanos , Nascido Vivo , Mortalidade Materna , Hemorragia Pós-Parto/epidemiologia , Gravidez
18.
Pan Afr Med J ; 39: 263, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34707764

RESUMO

The lack of health infrastructure in developing countries to provide women with modern obstetric care and universal access to maternal and child health services has largely contributed to the existing high maternal and infant deaths. Access to basic obstetric care for pregnant women and their unborn babies is a key to reducing maternal and infants´ deaths, especially at the community-level. This calls for the strengthening of primary health care systems in all developing countries, including Ghana. Financial access and utilization of maternal and child health care services need action at the community-level across rural Ghana to avoid preventable deaths. Financial access and usage of maternal and child health services in rural Ghana is poor. Lack of financial access is a strong barrier to the use of maternal and child health services, particularly in rural Ghana. The sustainability of the national health insurance scheme is vital in ensuring full access to care in remote communities.


Assuntos
Serviços de Saúde da Criança/organização & administração , Mortalidade Infantil , Serviços de Saúde Materna/organização & administração , Mortalidade Materna , Serviços de Saúde da Criança/economia , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Países em Desenvolvimento , Feminino , Gana , Acesso aos Serviços de Saúde/economia , Humanos , Lactente , Morte do Lactente/prevenção & controle , Recém-Nascido , Morte Materna/prevenção & controle , Serviços de Saúde Materna/economia , Programas Nacionais de Saúde/economia , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/organização & administração , População Rural
20.
Glob Health Action ; 14(1): 1978662, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34586033

RESUMO

Burnout rates among sub-Saharan African healthcare providers are high. In particular, obstetric providers experience unique stressors surrounding poor neonatal and maternal outcomes. This study explores predictors of burnout among obstetric providers at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. A survey was electronically distributed to midwives, house officers, and Obstetrician Gynecologists (OBGYNs) at KATH in Ghana. Demographic and clinical practice information was collected. Burnout was assessed using a 4-point Likert scale. To evaluate perceived agency caring for critically ill obstetric patients, participants responded to three statements and responses were summed to create an Agency Scale. Logistic regression was used to evaluate predictors of burnout. Marginal effects were calculated for factors significantly associated with burnout. Participants were 48 physicians and 222 midwives. Mean age was 32.4 years, mean years in practice was 6.5 years, and 83% had completed their medical training. Nearly half (49.6%) have personal experience with maternal mortality and 28.3% manage more than 5 maternal mortalities annually. The majority of participants (n = 152, 62%) reported feeling burned out from their work. After adjusting for role, number of annual maternal mortalities managed, and personal experience with maternal mortality, participants with more years in practice were 15.8% more likely to report being burned out (marginal effect = 0.158). Even after adjusting for years in practice, participants who scored higher on the Agency Scale had a significantly lower likelihood of reporting burnout (OR 0.76, 95% CI 0.66-0.88, p < 0.001). For each step up the Agency Scale, participants were 6.4% less likely to report they felt burned out. Rates of burnout are high among obstetric providers, particularly among providers who have practiced longer. Supporting provider agency to manage critically ill patients may reduce burnout rates.


Assuntos
Pessoal de Saúde , Mortalidade Materna , Adulto , Esgotamento Psicológico , Feminino , Gana/epidemiologia , Humanos , Recém-Nascido , Gravidez , Inquéritos e Questionários
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