Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study

Souza, João Paulo; Gülmezoglu, A. Metin; Vogel, Joshua P.; Carroli, Guillermo; Lumbiganon, Pisake; Qureshi, Zahida; Costa, María José; Fawole, Bukola; Mugerwa, Yvonne; Idi, Nafiou; Neves, Isilda; Wolomby-Molondo, Jean José; Bang, Hoang Thi; Cheang, Kannitha; Kang, Chaogui; Jayaratne, Kapila; Jayathilaka, Chandani Anoma; Mazhar, Syeda Batool; Mori, Rintaro; Mustafa, Mir Lais; Pathak, Laxmi; Perera, Deepthi; Rathavy, Tung; Recidoro, Zenaida Dy; Roy, Malabika; Pang, Ruoming; Shrestha, Ninadini; Taneepanichsku, Surasak; Tien, Nguyen Viet; Ganchimeg, Togoobaatar; Wehbe, Mira; Yadamsuren, Buyanjargal; Wang, Yan; Yunis, Khalid; Bataglia, Vicente; Cecatti, José Guilherme; Hernández-Prado, Bernardo; Nardin, Juan Manuel; Cerezo-Narváez, Alberto; Ortíz-Panozo, Eduardo; Pérez‐Cuevas, Ricardo; Valladares, Eliette; Zavaleta, Nelly; Armson, Anthony; Crowther, Caroline A; Hogue, Carol J.; Lindmark, Gunilla; Mittal, Suneeta; Pattinson, Robert Clive; Stanton, Mary Ellen; Campodónico, Liana; Cuesta, Cristina; Giordano, Daniel; Intarut, Nirun; Laopaiboon, Malinee; Bahl, Rajiv; Martines, José; Mathai, Matthews; Merialdi, Mario; Say, Lale

doi:10.1016/s0140-6736(13)60686-8

Cited by 623 publications

(619 citation statements)

References 18 publications

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“…Although the results vary, the frequency of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. 62 We conclude that the evaluation of maternal near miss should be implanted as a routine in the maternity hospitals, using the WHO criteria of greater specificity and adding other criteria according to the capacity of each unit, in increasing sensitivity. It is important to emphasize that it should not only be an aid for the study on maternal mortality, but also for the conditions of maternal morbidity in pregnancy, childbirth and the puerperium.…”

Section: Discussionmentioning

confidence: 88%

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

Silva

Fonseca

Dias

et al. 2018

Rev. Bras. Saude Mater. Infant.

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Section: Discussionmentioning

confidence: 88%

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

Silva

Fonseca

Dias

et al. 2018

Rev. Bras. Saude Mater. Infant.

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“…Furthermore, it may be argued that maternal and neonatal deaths are extreme and rare outcomes. They may still be good indicators for less developed countries, but not sensitive enough for countries with low mortality, in which health professionals are more concerned with morbidity and quality of life as outcome indicators 27, 28, 29. Therefore, the caesarean section rate threshold identified in this analysis is not applicable to outcomes other than mortality.…”

Section: Discussionmentioning

confidence: 92%

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

Zhang

Mikolajczyk

et al. 2015

BJOG

322

277

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ObjectiveCaesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality.DesignEcological study using longitudinal data.SettingWorldwide country‐level data.PopulationA total of 159 countries were included in the analyses, representing 98.0% of global live births (2005).MethodsNationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio‐economic development by means of human development index (HDI) using fractional polynomial regression models.Main outcome measuresMaternal mortality ratio and neonatal mortality rate.ResultsMost countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5–10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%.ConclusionsAlthough caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality.Tweetable abstractThe caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality.

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“…[23] The continuum of care during pregnancy and childbirth is an essential part of every health system and is crucial in the struggle to fight maternal and child mortality,[24,25] even if recently it has been acknowledged that increasing access and availability is not enough. [26] There is also a need to focus on quality of care (QoC). [23,27] It can fairly be assumed that there is a further aggravation of the equity gap if also including QoC, with the better off not only accessing care more frequently, but also receiving better care when doing so.…”

Section: Discussionmentioning

confidence: 99%

Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains

Pun

Raaijmakers

2017

Global Health Action

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Background: Maternal health care utilization is at the core of global public health provision and an area of focus in the now-concluded Millennium Development Goal agenda. Objective: This study aims to examine trends in maternal health care utilization over the last 15 years in Nepal, focusing on coverage and equity. Methods: This paper used data from the Demographic Health Survey (DHS) 2001, 2006 and 2011 and Multiple Indicator Cluster Survey (MICS), 2014. Coverage rates were calculated and logistic regression models used to examine inequity. Results: Impressive gains were found in antenatal care (ANC) attendance, which increased from nearly half of women attending (49%) in 2001 to 88% in 2014, and the rate of facility delivery increased from just 7–44%. This development did not, however, influence the equity gap in ANC and skilled attendance at birth, as women from low socioeconomic backgrounds were six times more likely to deliver without skilled assistance than those from high socioeconomic backgrounds (AdjOR 6.38 CI 95% 4.57–8.90) in 2014. Conclusion: These persistent equity gaps call for targeted interventions focusing on the most disadvantaged and vulnerable women in order to achieve the new Sustainable Development Goal of universal health coverage.

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Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study

Cited by 623 publications

References 18 publications

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains

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