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Syairaji M, Nurdiati DS, Wiratama BS, Prüst ZD, Bloemenkamp KWM, Verschueren KJC. Trends and causes of maternal mortality in Indonesia: a systematic review. BMC Pregnancy Childbirth 2024; 24:515. [PMID: 39080562 PMCID: PMC11290122 DOI: 10.1186/s12884-024-06687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The maternal mortality ratio (MMR) in Indonesia is among the highest in Southeast Asia. We aim to describe trends in the MMR and causes of maternal deaths in Indonesia over the past decades, regionally and nationally. METHODS We performed a systematic review and conducted a search using PubMed, Embase, Global Health, CINAHL, Cochrane, Portal Garuda, and Google Scholar from the inception of the database to April 2023. We included all studies on the incidence and/or the causes of maternal deaths in Indonesia. The MMR was defined as the number of maternal deaths per 100,000 live births. Maternal death causes were assessed and reclassified according to the WHO International Classification of Disease Maternal Mortality (ICD-MM). RESULTS We included 63 studies that reported the MMR (54 studies) and/or the causes of maternal deaths (44 studies) in Indonesia from 1970 to 2022, with a total of 254,796 maternal deaths. The national MMR declined from 450 to 249 (45%) between 1990 and 2020. Great differences in MMR exist across the country, with the lowest in Java-Bali and the highest (more than twice the national MMR) in Sulawesi and Eastern Indonesia. Between 1990 and 2022, the proportion of deaths due to hemorrhage and sepsis decreased, respectively from 48 to 18% and 15-5%, while the share of deaths due to hypertensive disorders and non-obstetric causes increased, respectively from 8 to 19% and 10-49%. CONCLUSION Despite the steady decline of maternal deaths in Indonesia, it remains one of the highest in Southeast Asia, with enormous disparities within the country. Hypertensive disorders and non-communicable diseases make up a growing share of maternal deaths, making maternal death reduction strategies increasingly challenging. National Maternal Death Surveillance and Response needs to be prioritized to eliminate preventable maternal deaths in Indonesia. REGISTRATION OF SYSTEMATIC REVIEWS PROSPERO, CRD42022320213.
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Affiliation(s)
- M Syairaji
- Department of Health Information and Services, Vocational College, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Detty Siti Nurdiati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Bayu Satria Wiratama
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Zita D Prüst
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kim J C Verschueren
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Women and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
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Alipour J, Payandeh A, Karimi A. Prevalence of maternal mortality causes based on ICD-MM: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:821. [PMID: 38017449 PMCID: PMC10683107 DOI: 10.1186/s12884-023-06142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Maternal mortality is a universal public health challenge. ICD-Maternal Mortality (ICD-MM) was introduced in 2012 to facilitate the gathering, analysis, and interpretation of data on maternal deaths worldwide. The present study aimed to estimate the global prevalence of maternal death causes through a systematic review and meta-analysis. METHODS A systematic literature search was conducted using various databases, including Web of Science, PubMed, Scopus, ScienceDirect, Cochrane Library, as well as Persian databases such as MagIran and Scientific Information Database (SID). The search encompassed articles published until August 21, 2022. Thirty-four eligible articles were included in the final analysis. Analysis was performed using a meta-analysis approach. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, and random effects models with Mantel-Haenszel methods were employed using the STATA software version 14.2. RESULTS The most prevalent causes of maternal deaths, listed in descending order from highest to lowest prevalence, were non-obstetric complications (48.32%), obstetric hemorrhage (17.63%), hypertensive disorders of pregnancy, childbirth, and the puerperium (14.01%), other obstetric complications (7.11%), pregnancy with abortive outcome (5.41%), pregnancy-related infection (5.26%), unanticipated complications of management (2.25%), unknown/undetermined causes (2.01%), and coincidental causes (1.59%), respectively. CONCLUSION Non-obstetric complications, obstetric hemorrhage, and hypertensive disorders of pregnancy, childbirth, and puerperium were the most common causes of maternal deaths. To reduce the burden of maternal mortality causes, increasing awareness and promoting self-care management among women of reproductive age, and implementing effective screening mechanisms for high-risk mothers during pregnancy, childbirth, and the puerperium can play a significant role. ICD-MM enables the uniform collection and comparison of maternal death information at different levels (local, national, and international) by facilitating the consistent collection, analysis, and interpretation of data on maternal deaths. Our findings can be utilized by policymakers and managers at various levels to facilitate necessary planning aimed at reducing the burden of maternal mortality causes.
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Affiliation(s)
- Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Payandeh
- Department of Biostatistics and Epidemiology, Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Afsaneh Karimi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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de Vries PLM, van den Akker T, Bloemenkamp KWM, Grossetti E, Rigouzzo A, Saucedo M, Verspyck E, Zwart J, Deneux-Tharaux C. Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care. Int J Gynaecol Obstet 2023; 162:1077-1085. [PMID: 37177815 DOI: 10.1002/ijgo.14829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. METHODS In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. RESULTS For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. CONCLUSION A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.
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Affiliation(s)
- P L M de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Grossetti
- Department of Obstetrics, Hospital group du Havre, Le Havre, France
| | - A Rigouzzo
- Department of Anesthesiology, Armand Trousseau Children's Hospital, Paris, France
| | - M Saucedo
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| | - E Verspyck
- Department of Obstetrics and Gynaecology, University Hospital of Rouen, Rouen, France
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - C Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
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Wang W, Zhu Y, Cheng Y, Chen X, Luo Y. Levels and trends of maternal death in Baoan district, Shenzhen, China, 1999-2022. Front Public Health 2023; 11:1051717. [PMID: 37139359 PMCID: PMC10149838 DOI: 10.3389/fpubh.2023.1051717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Background China had achieved impressive success in improving maternal health, while the progress of reducing maternal mortality ratio (MMR) varied across regions. Some studies had reported maternal mortality from national or provincial perspective, but researches of the MMR on long-term period at the city or county level rare been reported. Shenzhen has experienced significant socioeconomic and health changes, reflecting the typical development of China's coastal city. This study mainly introduced the levels and trends of maternal death in Baoan district, Shenzhen from 1999 to 2022. Methods Maternal mortality data were extracted from registration forms and the Shenzhen Maternal and Child Health Management System. Linear-by-Linear Association tests were used to evaluate the trends of MMR among different groups. The study periods were divided into three stages by 8-year interval and χ2 test or Fisher's test was used to test the difference in maternal deaths of different periods. Results During 1999-2022, a total of 137 maternal deaths occurred in Baoan, the overall MMR was 15.91 per 100,000 live births, declined by 89.31% with an annualized rate of 9.26%. The MMR declined by 68.15% in migrant population, with an annualized rate of 5.07%, faster than that in permanent population (48.73%, 2.86%). The MMR due to direct and indirect obstetric causes shown a downward trend (P<0.001) and the gap between them narrowed to 14.29% during 2015-2022. The major causes of maternal deaths were obstetric hemorrhage (4.41 per 100,000 live births), amniotic fluid embolism (3.37 per 100,000 live births), medical complications (2.44 per 100,000 live births) and pregnancy-induced hypertension (1.97 per 100,000 live births), the MMR due to the above causes all shown decreasing trends (P < 0.01), pregnancy-induced hypertension became the leading cause of deaths during 2015-2022. The constituent ratio of maternal deaths with advanced age significantly increased by 57.78% in 2015-2022 compared with in 1999-2006. Conclusions Baoan district had made encouraging progress in improving maternal survival, especially in migrant population. To further reduce the MMR, strengthening professional training to improve the capacity of obstetricians and physicians, increasing the awareness and ability of self-help health care among elderly pregnant women were in urgent need.
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Affiliation(s)
- Wei Wang
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
| | - Yuanfang Zhu
- Office of Hospital Director, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
| | - Yuli Cheng
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
| | - Xu Chen
- Office of Hospital Director, Shenzhen Baoan People's Hospital, Shenzhen Guangdong, China
| | - Yali Luo
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen Guangdong, China
- *Correspondence: Yali Luo
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Tesfay N, Tariku R, Zenebe A, Firde H, Woldeyohannes F. Target areas to reduce the burden of maternal death due to obstetric hemorrhage in Ethiopia. PLoS One 2022; 17:e0274866. [PMID: 36173995 PMCID: PMC9522306 DOI: 10.1371/journal.pone.0274866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obstetric hemorrhage is defined as active bleeding of more than 500 ml in vaginal delivery or 1000ml following cesarean delivery. It is the leading cause of maternal death, which contributes to up to 50% of maternal deaths in Ethiopia. This study aims to assess the relationships between adverse maternal health exposure (personal and medical factors) and delay in health care (hesitancy in opting to seek care, lag in reaching a health facility, and wait in receiving health care at the facility) and adverse outcomes of obstetric hemorrhage among reviewed maternal deaths in Ethiopia. METHODS This study utilizes 4530 reported maternal death surveillance data obtained from Ethiopian maternal death surveillance and response (MDSR) system between 2013 to 2020. Latent class analysis was applied to identify underlying patterns of adverse maternal health exposures. Furthermore, the associations between latent classes and adverse outcomes of obstetric hemorrhage were analyzed using multilevel logistics regression model adjusted for clustering within reporting provinces. RESULTS Nearly 56% of the reviewed maternal deaths were due to the adverse outcome of obstetric hemorrhage, among which nearly 75% died during the postpartum period. The study identified six separate sub-groups of women based on their vulnerability to adverse maternal health conditions. The six subgroups identified by this study are 1) women who travelled for a long duration to reach a health care provider, 2) those who had no access to a health facility (HF) within a 5Km radius, 3) those who failed to decide to go to a health facility: 4) those with multiparity,5) those who were injured during delivery with history of coagulopathy, and 6) those who got injured during delivery and failed to decide to go to a health facility. Women in the class of grand multipara have demonstrated the highest risk of death due to the adverse outcomes of obstetric hemorrhage (β = 1.54, SE = 0.09, p<0.0001). CONCLUSIONS The study has attempted to identify women that are at a higher risk for the adverse outcomes of obstetric hemorrhage. Henceforth, targeted intervention should be taken on women of reproductive age group, and those identified as at a higher risk, to reduce the high rate of maternal death due to obstetric hemorrhage.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Haymanot Firde
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Chen L, Feng P, Shaver L, Wang Z. Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations. BMC Public Health 2021; 21:1536. [PMID: 34380436 PMCID: PMC8359022 DOI: 10.1186/s12889-021-11557-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. Methods Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991–2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. Results The yearly trends of the national, rural and urban maternal mortality ratio were − 2.290 (p < 0.01), − 3.167 (p < 0.01), and − 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = − 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). Conclusion China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.
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Affiliation(s)
- Lu Chen
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China
| | - Penghui Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lance Shaver
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Zengwu Wang
- Division of Prevention and Community Health, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, no. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China.
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