Incidence and characteristics of pregnancy‐related death across ten low‐ and middle‐income geographical regions: secondary analysis of a cluster randomised controlled trial

Objective The aim of this article is to describe the incidence and characteristics of pregnancy‐related death in low‐ and middle‐resource settings, in relation to the availability of key obstetric resources. Design This is a secondary analysis of a stepped‐wedge cluster randomised controlled trial....

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Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 127; no. 9; pp. 1082 - 1089
Main Authors:	Vousden, N, Holmes, E, Seed, PT, Gidiri, MF, Goudar, S, Sandall, J, Chinkoyo, S, Kumsa, LY, Brown, A, Charantimath, U, Bellad, M, Nakimuli, A, Vwalika, B, Chappell, LC, Shennan, AH, Bukani, Doreen, Makonyola, Grace, Toussaint, Paul, Vixama, Adeline, Greene, Grace, Hill, Carwyn, Nakirijja, Emily, Birungi, Doreen, Kalyowa, Noela, Namakula, Dorothy, Byamugisha, Josaphat, Odeke, Nathan Mackayi, Ditai, James, Wandabwa, Julius, Momodou, Fatmata, Sesay, Margaret, Sandi, Patricia, Conteh, Jeneba, Kamara, Jesse, Clarke, Matthew, Best, Rebecca, Miti, Josaphine, Chima, Martina, Kopeka, Mercy, Jere, Christene, Musonda, Thokozile, Mambo, Violet, Guchale, Yonas, Surur, Feiruz, Mungarwadi, Geetanjali M, Mastiholi, Sphoorthi S, Karadiguddi, Chandrappa C, Hezelgrave, Natasha, Duhig, Kate E., Kachinjika, Monice, Makwakwa, Jane, Nathan, Hannah
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-08-2020
Subjects:	Adult Africa South of the Sahara - epidemiology Age Distribution Blood Pressure Blood Transfusion - statistics & numerical data Death Developing Countries - statistics & numerical data Epidemiology Female Haiti - epidemiology Health Personnel - education Healthcare Disparities Heart Rate Hemorrhage Humans Hypertension, Pregnancy-Induced - mortality Incidence India - epidemiology Intensive Care Units - supply & distribution low and middle resource Maternal Mortality Neonates Obstetrics Postpartum Period Pregnancy Resource availability Sepsis Sepsis - mortality Time Factors Uterine Hemorrhage - mortality Young Adult Africa South of the Sahara Haiti India Epidemiology maternal mortality low and middle resource
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Summary:	Objective The aim of this article is to describe the incidence and characteristics of pregnancy‐related death in low‐ and middle‐resource settings, in relation to the availability of key obstetric resources. Design This is a secondary analysis of a stepped‐wedge cluster randomised controlled trial. Setting This trial was undertaken at ten sites across eight low‐ and middle‐income countries in sub‐Saharan Africa, India and Haiti. Population Institutional‐level consent was obtained and all women presenting for maternity care were eligible for inclusion. Methods Pregnancy‐related deaths were collected prospectively from routine data sources and active case searching. Main outcome measures Pregnancy‐related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome. Results Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000–630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20–29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30–39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy‐related death. Conclusions The large variation in the rate of pregnancy‐related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists. Tweetable Inequality and inequity in pregnancy‐related death persists globally, irrespective of resource availability. Tweetable Inequality and inequity in pregnancy‐related death persists globally, irrespective of resource availability.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1470-0328 1471-0528
DOI:	10.1111/1471-0528.16309