Obstetric hemorrhage and safe blood for transfusion in Ethiopia: the challenges of bridging the gap

Makuria, Addisalem Taye; Gebremichael, Daniel; Demoz, Habtemariam; Hadush, Azmach; Abdella, Yetmgeta; Berhane, Yemane; Kamani, Naynesh

doi:10.1111/trf.14219

Cited by 15 publications

(16 citation statements)

References 20 publications

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“…Haemorrhage, the leading cause of death, is typically linked to a lack of resources [ 1 , 10 ]. It is associated with unskilled delivery assistance, delivery in ill-equipped facilities, and a shortage of essential obstetric care materials such as transfusion blood [ 1 , 56 ]. These challenges are endemic in SSA, where delivery at home and in unequipped primary care facilities is typical.…”

Section: Discussionmentioning

confidence: 99%

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

et al. 2021

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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 – 10 th 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 s...

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Section: Discussionmentioning

confidence: 99%

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

et al. 2021

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“…5 Blood transfusions are also used for supportive care in cardiovascular and transplant surgery, massive trauma, and therapy for solid and hematological malignancies and treating pregnancy-related complications. 6 The collection of blood only from low-risk voluntary non-remunerated donors 7 and good laboratory practice 1 minimizes the risk of transfusion reactions. However, each blood product carries a risk of transfusion reactions.…”

Section: Introductionmentioning

confidence: 99%

<p>Proportion of Acute Transfusion Reaction and Associated Factors Among Adult Transfused Patients at Felege Hiwot Compressive Referral Hospital, Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study</p>

Gelaw¹,

Woldu²,

Melku³

2020

JBM

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Introduction: Acute transfusion reactions are adverse events occurring within 24 hrs of transfusion and cause simple-to-severe complications. They may vary with the blood component transfused and recipient factors. In Ethiopia, there is a limited evidence about the incidence and associated factors of transfusion reactions. Objective: To determine the proportion of acute transfusion reactions and associated factors among adult transfused patients. Methods: A total of 384 study participants were included in the study. Structured questionnaires were used for socio-demographic and past medical history data collection. Vital signs were measured as a baseline for every study participants and monitored and followed for 24 hrs. Laboratory tests like complete blood count, direct anti-human globulin test and urine hemoglobin were done as a baseline for suspected patients. Cross-match, blood grouping, and blood culture for patients and donors sample were also done for suspected patients. Descriptive statistics, bivariable and multivariable binary logistic regression were analyzed using SPSS version 20. P-value of <0.05 in the multivariable model was considered as statistically significant. Results: Acute transfusion reactions were observed in 5.2% of patients. Of total cases of acute transfusion reaction, the majority developed allergic reactions (65%) and febrile non-hemolytic transfusion reaction (30%). It was significantly associated with transfusion history (AOR=3.4; 95% CI: 1.2-9.7), abortion history (AOR=5.0; 95% CI: 1.5-16.4), longer blood storage time (AOR=5.1; 95% CI: 1.7-15.2) and receiving three or more unit of blood (AOR= 4.1; 95% CI: 1.5-11.2). Conclusion: Acute transfusion reactions were observed in 5.2% of patients (allergic reactions (65%), febrile non-hemolytic transfusion reaction (30%) and alloimmunization (5%)). Patients with a history of transfusion, abortion, transfused with blood stored ≥14 days and multi-transfused patients should be closely monitored.

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“…Despite the presence of maternal waiting shelters in health facilities, women continue to experience significant first, second and third delays from various controllable factors, such as long distances to the nearest health facility and significant delays in getting transport to referral centres, coupled with human resource and commodity challenges at the referral centres. Efforts to reduce unskilled deliveries at home and ill-equipped primary-care facilities, improve emergency transport and increase access to the right care should continue [ 59 – 63 ]. Diagnosis and treatment of hypertensive diseases in pregnancy must also be prioritised as NCDs increase in SSA [ 49 , 50 , 64 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys

et al. 2022

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Background Reducing maternal mortality is a priority of Sustainable Development Goal 3.1 which requires frequent epidemiological analysis of trends and patterns of the causes of maternal deaths. We conducted two reproductive age mortality surveys to analyse the epidemiology of maternal mortality in Zimbabwe and analysed the changes in the causes of deaths between 2007-08 and 2018-19. Methods We performed a before and after analysis of the causes of death among women of reproductive ages (WRAs) (12-49 years), and pregnant women from the two surveys implemented in 11 districts, selected using multi-stage cluster sampling from each province of Zimbabwe (n=10); an additional district selected from Harare. We calculated mortality incidence rates and incidence rate ratios per 10000 WRAs and pregnant women (with 95% confidence intervals), in international classification of disease groups, using negative binomial models, and compared them between the two surveys. We also calculated maternal mortality ratios, per 100 000 live births, for selected causes of pregnancy-related deaths. Results We identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in the WRAs decreased by 82% in diseases of the respiratory system and 81% in certain infectious or parasitic diseases' groups, which include HIV/AIDS and malaria. Pregnancy-related deaths decreased by 84% in the indirect causes group and by 61% in the direct causes group, and HIV/AIDS-related deaths decreased by 91% in pregnant women. Direct causes of death still had a three-fold MMR than indirect causes (151 vs. 51 deaths per 100 000) in 2018-19. Conclusion Zimbabwe experienced a decline in both direct and indirect causes of pregnancy-related deaths. Deaths from indirect causes declined mainly due to a reduction in HIV/AIDS-related and malaria mortality, while deaths from direct causes declined because of a reduction in obstetric haemorrhage and pregnancy-related infections. Ongoing interventions ought to improve the coverage and quality of maternal care in Zimbabwe, to further reduce deaths from direct causes.

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Obstetric hemorrhage and safe blood for transfusion in Ethiopia: the challenges of bridging the gap

Cited by 15 publications

References 20 publications

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

<p>Proportion of Acute Transfusion Reaction and Associated Factors Among Adult Transfused Patients at Felege Hiwot Compressive Referral Hospital, Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study</p>

Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys

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