Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

Ahmed, Imran; Ali, Said M.; Amenga‐Etego, Seeba; Ariff, Shabina; Bahl, Rajiv; Baqui, Abdullah H; Begum, Nazma; Bhandari, Nita; Bhatia, Kiran; Bhutta, Zulfiqar A; Biemba, Godfrey; Deb, Saikat; Dhingra, Usha; Dube, Brinda; Dutta, Arup; Edmond, Karen; Esamai, Fabian; Fawzi, Wafaie W.; Ghosh, Amit; Gisore, Peter; Grogan, Caroline; Hamer, Davidson H.; Herlihy, Julie M.; Hurt, Lisa; Ilyas, Muhammad; Jehan, Fyezah; Kalonji, Michel; Kaur, Jasmine; Khanam, Rasheda; Kirkwood, Betty; Kumar, Aarti; Kumar, Alok; Kumar, Vishwajeet; Manu, Alexander; Marete, Irene; Masanja, Honorati; Mazumder, Sarmila; Mehmood, Usma; Mishra, Shambhavi; Mitra, Dipak Kumar; Mlay, Erick; Mohan, Sanjana Brahmawar; Moin, Mamun Ibne; Karim, Muhammad; Muhihi, Alfa; Newton, Samuel S.; Ngaima, Serge; Nguwo, Andre; Nisar, Imran; O’Leary, Maureen; Otomba, John; Patil, Pawankumar; Quaiyum, Md. Abdul; Rahman, Mohammed; Sazawal, Sunil; Semrau, Katherine; Shannon, Caitlin; Smith, Emily R.; Soofi, Sajid Bashir; Soremekun, Seyi; Sunday, Venantius; Taneja, Sunita; Tshefu, Antoinette; Wasan, Yaqub; Yeboah-Antwi, Kojo; Yoshida, Sachiyo; Zaidi, Anita K. M.

doi:10.1016/s2214-109x(18)30385-1

Cited by 237 publications

(207 citation statements)

References 19 publications

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“…Maternal and neonatal mortality remain a global health concern despite different interventions that have been implemented to address this issue [1]. Sub-Saharan Africa (SSA) is by far among the regions with the highest ratios of maternal mortality with 351 per 100 000 live births and high neonatal mortality rates with 20 per 1000 live births [2]. Several studies have shown that 15% of maternal and newborn deaths in SSA are attributed to pregnancy complications that are a result of inadequate pregnancy follow-up [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Nisingizwe

Tuyisenge

Hategeka

et al. 2020

BMC Pregnancy Childbirth

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Background: Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda. Methods: This study is cross-sectional using secondary data from the 2014-15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15-49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.Results: Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results. Conclusion: The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

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Section: Introductionmentioning

confidence: 99%

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Nisingizwe

Tuyisenge

Hategeka

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…[1][2][3] Poor quality of care contributes to morbidity and mortality, and therefore attention has shifted to the quality of care. In low-and middle-income countries (LMIC), the challenge has been the need for balancing coverage with quality.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Poor quality of care contributes to morbidity and mortality, and therefore attention has shifted to the quality of care. 2 A significant contributor to the neonatal mortality rate was birth asphyxia, with only prematurity occurring more frequently. 6 The disease burden is high, particularly in LMIC.…”

Section: Introductionmentioning

confidence: 99%

“…Reductions in maternal and neonatal mortality remain slow. [1][2][3] Poor quality of care contributes to morbidity and mortality, and therefore attention has shifted to the quality of care. 4,5 The effect of improving quality of care during labour and delivery, will reflect in health indicators such as perinatal mortality and birth asphyxia rates.…”

Section: Introductionmentioning

confidence: 99%

“…1 In a study conducted in South Asia and Sub-Saharan Africa, 40-45% of pregnancy-related deaths, stillbirths, and neonatal deaths occurred during labour, delivery, and the 24-hour postpartum period in both regions. 2 A significant contributor to the neonatal mortality rate was birth asphyxia, with only prematurity occurring more frequently. 3,4 It is clear that a multifactorial approach rather than any one single intervention is the key to improving quality of care provided, as so many factors are involved in making the peripartum period a safe one.…”

Section: Introductionmentioning

confidence: 99%

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Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study

Ebenezer

Londhe

Rathore

et al. 2019

BJOG

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Objective To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. Design Retrospective study. Setting Labour and maternity unit of a tertiary centre in South India. Population or sample Women who gave birth between 2000 and 2018. Methods Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re‐organisation, and minor changes in staffing and infrastructure. Main outcome measures Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. Results Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. Conclusion In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. Tweetable abstract Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.

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Estimates of Stillbirths, Neonatal Mortality, and Medically Vulnerable Live Births in Amhara, Ethiopia

et al. 2022

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IMPORTANCEData on birth outcomes and early mortality are scarce, especially in settings with limited resources. Total births, both stillbirths and live births, are often not counted, yet such data are critical to allocate resources and target interventions to improve survival. OBJECTIVE To estimate the prevalence of stillbirths, neonatal deaths, and medically vulnerable phenotypes, such as preterm births, small-for-gestational-age (SGA), large-for-gestational-age (LGA), and low-birth-weight (LBW) births, in a setting where these key indicators remain largely unknown.

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Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

Cited by 237 publications

References 19 publications

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study

Estimates of Stillbirths, Neonatal Mortality, and Medically Vulnerable Live Births in Amhara, Ethiopia

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