Assessment and validation of the Community Maternal Danger Score algorithm

Abstract

Background High rates of maternal mortality in low-and-middle-income countries (LMICs) are associated with the lack of skilled birth attendants (SBAs) at delivery. Risk analysis tools may be useful to identify pregnant women who are at risk of mortality in LMICs. We sought to develop and validate a low-cost maternal risk tool, the Community Maternal Danger Score (CMDS), which is designed to identify pregnant women who need an SBA at delivery. Methods To design the CMDS algorithm, an initial scoping review was conducted to identify predictors of the need for an SBA. Medical records of women who delivered at the Federal Medical Centre in Makurdi, Nigeria (2019–2020) were examined for predictors identified from the literature review. Outcomes associated with the need for an SBA were recorded: caesarean section, postpartum hemorrhage, eclampsia, and sepsis. A maternal mortality ratio (MMR) was determined. Multivariate logistic regression analysis and area under the curve (AUC) were used to assess the predictive ability of the CMDS algorithm. Results Seven factors from the literature predicted the need for an SBA: age (under 20 years of age or 35 and older), parity (nulliparity or grand-multiparity), BMI (underweight or overweight), fundal height (less than 35 cm or 40 cm and over), adverse obstetrical history, signs of pre-eclampsia, and co-existing medical conditions. These factors were recorded in 589 women of whom 67% required an SBA (n = 396) and 1% died (n = 7). The MMR was 1189 per 100,000 (95% CI 478–2449). Signs of pre-eclampsia, obstetrical history, and co-existing conditions were associated with the need for an SBA. Age was found to interact with parity, suggesting that the CMDS requires adjustment to indicate higher risk among younger multigravida and older primigravida women. The CMDS algorithm had an AUC of 0.73 (95% CI 0.69–0.77) for predicting whether women required an SBA, and an AUC of 0.85 (95% CI 0.67–1.00) for in-hospital mortality. Conclusions The CMDS is a low-cost evidence-based tool that uses 7 risk factors assessed on 589 women from Makurdi. Non-specialist health workers can use the CMDS to standardize assessment and encourage pregnant women to seek an SBA in preparation for delivery, thus improving care in countries with high rates of maternal mortality.

Influence of Cultural Beliefs on the Utilization of Integrated Maternal, Newborn, and Child Health Services in Benue State, Nigeria

“…This can be attributed to the various successful maternal health interventions by government and non-government agencies that have been implemented in these facilities in a bid to reduce the high MMR of Benue state [ 17 , 18 ]. Recent reports have shown that the maternal mortality ratio (MMR) in Benue State is as high as 1189 per 100,000 population, making the state one of the highest contributors to the national average of 576 deaths per 100,000 [ 17 , 19 ]. As a result of this, several strategies have been implemented by government and non-government agencies (including Meta) to contain the menace [ 17 , 18 , 20 ].…”

Identification and mitigation of high-risk pregnancy with the Community Maternal Danger Score Mobile Application in Gboko, Nigeria

“…Records from the World Health Organization indicate that sub-Saharan Africa accounts for 66% of global maternal deaths, with a maternal mortality ratio of 546 per 100,000 live births [ 1 ]. The Nigerian maternal mortality ratio is 512 per 100,000 live births [ 2 ], while we report a maternal mortality ratio for Benue State, one of Nigeria’s 36 states, of 1,189 per 100,000 live births [ 3 ]. The National Demographic and Health Survey reveals that Nigeria constitutes approximately 1% of the world population yet accounts for 10% of the world maternal mortality [ 2 ].…”

“…Analysis of routinely collected maternal data can identify pregnant women who are at risk of mortality or morbidity [ 3 ]. The Community Maternal Danger Score (CMDS) is a low-cost, evidence-based maternal risk analysis tool that was validated in Makurdi, Nigeria to predict the need for skilled birth attendance and identify high risk for maternal death [ 3 ]. The CMDS has been developed into a scoring tool that is available as an Android application to encourage pregnant women to deliver with SBAs.…”

“…The total score out of 10 points provides the midwives and the pregnant women with a quantitative measurement of their risk. A CMDS score of 3 out of 10 or higher is suggested to be the threshold of high risk for pregnant women [ 3 ].…”