Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths

Abstract

Pakistan is the sixth most populous country in the world & is ranked 53 rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Nonmedical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.

Measuring spatial inequalities in maternal and child mortalities in Pakistan: evidence from geographically weighted regression

“…Despite being the most developed province in terms of healthcare facilities and literacy, Punjab has the highest child mortality due to its high population density and the highest birth rate [63]. Maternal mortality and overall DMI scores were highest in Baluchistan as compared to other provinces, showing heterogeneity in health outcomes across the districts of Pakistan [19]. The highest and lowest district mortality indexed districts were traced in the province of Baluchistan, which proves Baluchistan to be a heterogeneous outlier of DMI.…”

“…Despite a significant improvement in maternal and child mortality, there are substantial disparities in health outcomes across the districts of Pakistan [16,17]. These huge disparities across different geographical boundaries tend to lead researchers and public health workers to highlight the epidemiology, risk factors, and associated causes that are responsible for differences in mortalities in Pakistan [18][19][20][21].…”