Journal ArticleDOI
Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study
João Paulo Souza,Ahmet Metin Gülmezoglu,Joshua P. Vogel,Guillermo Carroli,Pisake Lumbiganon,Zahida Qureshi,Maria José Costa,Bukola Fawole,Yvonne Mugerwa,Idi Nafiou,Isilda Neves,Jean José Wolomby-Molondo,Hoang Thi Bang,Kannitha Cheang,Kang Chuyun,Kapila Jayaratne,Chandani Anoma Jayathilaka,Syeda Batool Mazhar,Rintaro Mori,Mir Lais Mustafa,Laxmi Raj Pathak,Deepthi Perera,Tung Rathavy,Zenaida Dy Recidoro,Malabika Roy,P. Ruyan,N Shrestha,Surasak Taneepanichsku,Nguyen Viet Tien,Togoobaatar Ganchimeg,Mira A. Wehbe,Buyanjargal Yadamsuren,Wang Yan,Khalid Yunis,Vicente Bataglia,José Guilherme Cecatti,Bernardo Hernández-Prado,Juan Manuel Nardin,Alberto Narváez,Eduardo Ortiz-Panozo,Ricardo Pérez-Cuevas,Eliette Valladares,Nelly Zavaleta,Anthony Armson,Caroline A Crowther,Carol J. R. Hogue,Gunilla Lindmark,Suneeta Mittal,Robert Clive Pattinson,Mary Ellen Stanton,Liana Campodonico,Cristina Beatriz Cuesta,Daniel Giordano,N. Intarut,Malinee Laopaiboon,Rajiv Bahl,Jose Martines,Matthews Mathai,Mario Merialdi,Lale Say +59 more
TLDR
In this article, the authors report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities.Abstract:
Summary Background We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. Methods In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. Results From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23 015 (7·3%) women had potentially life-threatening disorders and 3024 (1·0%) developed an SMO. 808 (26·7%) women with an SMO had post-partum haemorrhage and 784 (25·9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0·826 [95% CI 0·802–0·851]). Interpretation High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.read more
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Journal ArticleDOI
Global causes of maternal death: a WHO systematic analysis
Lale Say,Doris Chou,Alison Gemmill,Alison Gemmill,Özge Tunçalp,Ann Beth Moller,Jane P Daniels,A Metin Gülmezoglu,Marleen Temmerman,Leontine Alkema +9 more
TL;DR: Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide, and more than a quarter of deaths were attributable to indirect causes.
Journal ArticleDOI
Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group
Leontine Alkema,Doris Chou,Daniel R Hogan,Sanqian Zhang,Ann Beth Moller,Alison Gemmill,Doris Ma Fat,Ties Boerma,Marleen Temmerman,Colin Mathers,Lale Say +10 more
TL;DR: Based on MMR estimates for 2015, scenario-based projections are constructed to highlight the accelerations needed to accomplish the Sustainable Development Goal (SDG) global target of less than 70 maternal deaths per 100,000 live births globally by 2030.
Journal ArticleDOI
Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study
Togoobaatar Ganchimeg,Erika Ota,Naho Morisaki,Malinee Laopaiboon,Pisake Lumbiganon,Jian Zhang,B Yamdamsuren,Marleen Temmerman,Lale Say,Ö Tunçalp,Joshua P. Vogel,Joshua P. Vogel,João Paulo Souza,Rintaro Mori +13 more
TL;DR: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries, a large number of countries and territories are considered to be at risk.
Journal ArticleDOI
Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two who multicountry surveys
Joshua P. Vogel,Joshua P. Vogel,Ana Pilar Betrán,Nadia Vindevoghel,João Paulo Souza,Maria Regina Torloni,Jun Zhang,Özge Tunçalp,Rintaro Mori,Naho Morisaki,Eduardo Ortiz-Panozo,Bernardo Hernández,Ricardo Pérez-Cuevas,Zahida Qureshi,A Metin Gülmezoglu,Marleen Temmerman +15 more
TL;DR: The contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities, is analyzed.
Improvement of maternal and newborn health through midwifery (Journal article)
TL;DR: In this article, the authors look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce.