Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

被引：39

作者：

Bauserman, Melissa ^{[1
]}

Thorsten, Vanessa R. ^{[2
]}

Nolen, Tracy L. ^{[2
]}

Patterson, Jackie ^{[1
]}

Lokangaka, Adrien ^{[3
]}

Tshefu, Antoinette ^{[3
]}

Patel, Archana B. ^{[4
,5
]}

Hibberd, Patricia L. ^{[6
]}

Garces, Ana L. ^{[7
]}

Figueroa, Lester ^{[7
]}

Krebs, Nancy F. ^{[8
]}

Esamai, Fabian ^{[9
]}

Nyongesa, Paul ^{[9
]}

Liechty, Edward A. ^{[10
]}

Carlo, Waldemar A. ^{[11
]}

Chomba, Elwyn ^{[12
]}

Goudar, Shivaprasad S. ^{[13
]}

Kavi, Avinash ^{[13
]}

Derman, Richard J. ^{[14
]}

Saleem, Sarah ^{[15
]}

Jessani, Saleem ^{[15
]}

Billah, Sk Masum ^{[16
,17
]}

Koso-Thomas, Marion ^{[18
]}

McClure, Elizabeth M. ^{[2
]}

Goldenberg, Robert L. ^{[19
]}

Bose, Carl ^{[1
]}

机构：

[1] Univ N Carolina, Dept Pediat, Sch Med, 101 Manning Dr,CB 7596, Chapel Hill, NC 27599 USA

[2] RTI Int, Durham, NC USA

[3] Kinshasa Sch Publ Hlth, Kinshasa, DEM REP CONGO

[4] Lata Med Res Fdn, Nagpur, Maharashtra, India

[5] Datta Meghe Inst Med Sci, Adjunct Fac Med Res, Sawangi, India

[6] Boston Univ, Sch Publ Hlth, Boston, MA USA

[7] Inst Nutr Ctr Amer & Panama, Guatemala City, Guatemala

[8] Univ Colorado, Sch Med, Denver, CO USA

[9] Moi Univ, Sch Med, Eldoret, Kenya

[10] Univ Indiana, Indiana Sch Med, Indianapolis, IN USA

[11] Univ Alabama Birmingham, Birmingham, AL USA

[12] Univ Teaching Hosp, Lusaka, Zambia

[13] JN Med Coll Belagavi, KLE Acad Higher Educ & Res, Belgaum, Karnataka, India

[14] Thomas Jefferson Univ, Philadelphia, PA 19107 USA

[15] Aga Khan Univ, Karachi, Pakistan

[16] Maternal & Child Hlth Div Icddr B, Dhaka, Bangladesh

[17] Univ Sydney, Sydney Sch Publ Hlth, Sydney, NSW 2006, Australia

[18] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Bethesda, MD USA

[19] Columbia Univ, Dept Obstet & Gynecol, Sch Med, New York, NY USA

来源：

REPRODUCTIVE HEALTH | 2020年 / 17卷 / Suppl 3期

关键词：

Low-resource countries; Maternal mortality; Sustainable development goals; Global network;

D O I：

10.1186/s12978-020-00990-z

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

BackgroundMaternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time.MethodsWe analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time.ResultsWe evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age>35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity >2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites.ConclusionsThe MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030.Trial registrationThe MNHR is registered at NCT01073475.

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