Severe maternal outcomes and their predictors among Pakistani women in the WHO Multicountry Survey on Maternal and Newborn Health

Mazhar, Syeda Batool; Batool, Afshan; Emanuel, Angela; Khan, Arif Tajammal; Bhutta, Shereen

doi:10.1016/j.ijgo.2014.10.017

Cited by 30 publications

(30 citation statements)

References 12 publications

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“…Subsequently, a projection of 260 was made in 2010 using a statistical model [21]. Most recently, an MMR of 299 was estimated using facility-based data from 2011 [22]. The burden of disease analysis projects an MMR of 400/100,000 live births in Pakistan in 2013 [1].…”

Section: Discussionmentioning

confidence: 99%

“…Nisar et al have described a significant increase in the risk of neonatal mortality associated with a lack of parental education in Pakistan during the 2006-07 PDHS [15]. Similarly, the findings of the WHO Multi-country Survey on Maternal and Newborn Health in Pakistan demonstrate the increased risk of poor maternal outcome related to lack of education [22]. Given that vast majority of women in the Pakistani site lack any formal education, the impact of being uneducated is likely to be considerable on both the mother and the child.…”

Section: Discussionmentioning

confidence: 99%

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Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network’s Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism

et al. 2015

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BackgroundDespite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network’s Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries.MethodsUsing data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan.ResultsThe Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies.ConclusionsThe increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.Trial registrationThe study is registered at clinicaltrials.gov [NCT01073475].

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network’s Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism

et al. 2015

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“…For example, research has shown that maternal age of greater than 35 years [7], and multiparous [8] are higher risks for PPH. Moreover, complications during pregnancy, such as pregnant women with diabetes mellitus [9] and pregnant women with chronic anemia [6,10] appear to also increase the risk of PPH. Women with a past history of PPH were more likely to experience PPH than others [11].…”

Section: Introductionmentioning

confidence: 99%

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Prapawichar

Ratinthorn

Utriyaprasit

et al. 2020

BMC Pregnancy Childbirth

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Background: Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. Methods: A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. Results:The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95, 50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6-10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. Conclusions:This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

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“…The maternal mortality ratio, using similar WHO criteria (6) , was higher in Rwanda, Nigeria, and Uganda, with 325/100,000 live births, 503/100,000 live births and 1,088/100,000 live births, respectively (8,(10)(11) . "This high ratio could be attributable to several factors, such as a lack of initial treatment facilities, delayed referral to a higher care center, and underestimation of the severity of the condition and therefore a delay of necessary actions" (12) .…”

Section: Discussionmentioning

confidence: 99%

Comparison between near miss criteria in a maternal intensive care unit

Monte

Teles

Oriá

et al. 2018

Rev. esc. enferm. USP

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Objective: The aim of this study was to compare the incidence of different criteria of maternal near miss in women admitted to an obstetric intensive care unit and their sensitivity and specificity in identifying cases that have evolved to morbidity. Method: A cross-sectional analytical epidemiological study was conducted with women admitted to the intensive care unit of the Maternity School Assis Chateaubriand in Ceará, Brazil. The Chi-square test and odds ratio were used. Results: 560 records were analyzed. The incidence of maternal near miss ranged from 20.7 in the Waterstone criteria to 12.4 in the Geller criteria. The maternal near-miss mortality ratio varied from 4.6:1 to 7.1:1, showing better index in the Waterstone criteria, which encompasses a greater spectrum of severity. The Geller and Mantel criteria, however, presented high sensitivity and low specificity. Except for the Waterstone criteria, there was an association between the three other criteria and maternal death. Conclusion: The high specificity of Geller and Mantel criteria in identifying maternal near miss considering the World Health Organization criteria as a gold standard and a lack of association between the criteria of Waterstone with maternal death.

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Severe maternal outcomes and their predictors among Pakistani women in the WHO Multicountry Survey on Maternal and Newborn Health

Abstract: Improving education, nutrition, and uniform implementation of obstetric care protocols are needed for better maternal and neonatal health in Pakistan.

Cited by 30 publications

References 12 publications

Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network’s Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism

Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network’s Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Comparison between near miss criteria in a maternal intensive care unit

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