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Sample records for influence maternal mortality

  1. Maternal mortality in Sirur.

    PubMed

    Shrotri, A; Pratinidhi, A; Shah, U

    1990-01-01

    The research aim was 1) to determine the incidence of maternal mortality in a rural health center area in Sirur, Maharashtra state, India; 2) to determine the relative risk; and 3) to make suggestions about reducing maternal mortality. The data on deliveries was obtained between 1981 and 1984. Medical care at the Rural Training Center was supervised by the Department of Preventive and Social Medicine, the B.J. Medical College in Pune. Deliveries numbered 5994 singleton births over the four years; 5919 births were live births. 15 mothers died: 14 after delivery and 1 predelivery. The maternal mortality rate was 2.5/1000 live births. The maternal causes of death included 9 direct obstetric causes, 3 from postpartum hemorrhage of anemic women, and 3 from puerperal sepsis of anemic women with prolonged labor. 2 deaths were due to eclampsia, and 1 death was unexplained. There were 5 (33.3%) maternal deaths due to indirect causes (3 from hepatitis and 2 from thrombosis). One woman died of undetermined causes. Maternal jaundice during pregnancy was associated with the highest relative risk of maternal death: 106.4. Other relative risk factors were edema, anemia, and prolonged labor. Attributable risk was highest for anemia, followed by jaundice, edema, and maternal age of over 30 years. Maternal mortality at 30 years and older was 3.9/1000 live births. Teenage maternal mortality was 3.3/1000. Maternal mortality among women 20-29 years old was lowest at 2.1/1000. Maternal mortality for women with a parity of 5 or higher was 3.6/1000. Prima gravida women had a maternal mortality rate of 2.9/1000. Parities between 1 and 4 had a maternal mortality rate of 2.3/1000. The lowest maternal mortality was at parity of 3. Only 1 woman who died had received more than 3 prenatal visits. 11 out of 13 women medically examined prenatally were identified with the following risk factors: jaundice, edema, anemia, young or old maternal age, parity, or poor obstetric history. The local

  2. Maternal mortality from hemorrhage.

    PubMed

    Haeri, Sina; Dildy, Gary A

    2012-02-01

    Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage.

  3. Estimating the influence of maternal height on under-five mortality in Nigeria.

    PubMed

    Enwerem, Ngozi Y; Obirieze, Augustine C; Bishai, David M

    2014-03-01

    This study uses a nationally representative data sample to assess the effect of maternal height as an intergenerational influence on under-five mortality. Data from the 2003 and 2008 Nigerian Demographic Health Survey (NDHS) (n = 41,005) selecting women aged 15 to 49 yrs whose most recent births were within 5 years (n = 23,568), were analyzed. The outcome measure was under-five mortality. Independent variables included maternal height categorized as > or = 63 inch, 61-62.9 inch, 59.1-60.9 inch, < 59.1 inch. Confounding factors were controlled for. A multivariable logistic regression was used to obtain odds ratio estimates along with their respective confidence interval. After adjusting for confounding factors, we found that each 1 inch increase in maternal height, was associated with a decreased odds of mortality OR 0.98 (95% CI 0.97-0.99). The OR of under-five mortality when comparing women > or = 63 inch versus women < 59.1 inch was 1.13 (95% CI 0.98-1.31). The population attributable fraction of child death due to maternal short stature was 0.36. PMID:24796169

  4. Estimating the influence of maternal height on under-five mortality in Nigeria.

    PubMed

    Enwerem, Ngozi Y; Obirieze, Augustine C; Bishai, David M

    2014-03-01

    This study uses a nationally representative data sample to assess the effect of maternal height as an intergenerational influence on under-five mortality. Data from the 2003 and 2008 Nigerian Demographic Health Survey (NDHS) (n = 41,005) selecting women aged 15 to 49 yrs whose most recent births were within 5 years (n = 23,568), were analyzed. The outcome measure was under-five mortality. Independent variables included maternal height categorized as > or = 63 inch, 61-62.9 inch, 59.1-60.9 inch, < 59.1 inch. Confounding factors were controlled for. A multivariable logistic regression was used to obtain odds ratio estimates along with their respective confidence interval. After adjusting for confounding factors, we found that each 1 inch increase in maternal height, was associated with a decreased odds of mortality OR 0.98 (95% CI 0.97-0.99). The OR of under-five mortality when comparing women > or = 63 inch versus women < 59.1 inch was 1.13 (95% CI 0.98-1.31). The population attributable fraction of child death due to maternal short stature was 0.36.

  5. [Maternal mortality in Argentina].

    PubMed

    1994-01-01

    In Argentina, as in most countries, complications of pregnancy and delivery are important causes of mortality of fertile-age women. At the 1994 International Conference on Population and Development in Cairo, governments agreed on the objective of promoting maternity without risk in order to reduce maternal mortality. Maternal mortality rates in many developing countries are much higher than the 10/100,000 live births in the most developed countries. Deficiencies in reporting due either to failure to report deaths or errors in the cause of death are a major impediment to study of maternal mortality. Two studies were conducted recently to provide more accurate data on maternal mortality in Argentina. A study carried out during 1987-89 was designed to measure underregistration of maternal mortality in the federal capital in 1985. Data from death registers were paired with the corresponding clinical histories. The true maternal mortality rate was found to be 91/100,000 rather than the official 50. 38% of maternal deaths rather than the previously estimated 57% were found to be due to complications of illegal abortion. The degree of underreporting in the federal capital, which has the highest proportion of hospital deliveries and most developed infrastructure, suggests that the maternal mortality rate is also much higher than official estimates in other parts of Argentina. Official estimates for 1993 showed a maternal mortality rate of 46/100,000, with very significant regional differentials. A study using the indirect sister survival method was conducted in a low income neighborhood of Zarate in 1991. 8041 persons in 1679 households were interviewed. The resulting estimate of 140/100,000 corresponded to the early 1980s.

  6. HIV and maternal mortality.

    PubMed

    Lathrop, Eva; Jamieson, Denise J; Danel, Isabella

    2014-11-01

    The majority of the 17 million women globally that are estimated to be infected with HIV live in Sub-Saharan Africa. Worldwide, HIV-related causes contributed to 19 000-56 000 maternal deaths in 2011 (6%-20% of maternal deaths). HIV-infected pregnant women have two to 10 times the risk of dying during pregnancy and the postpartum period compared with uninfected pregnant women. Many of these deaths can be prevented with the implementation of high-quality obstetric care, prevention and treatment of common co-infections, and treatment of HIV with ART. The paper summarizes what is known about HIV disease progression in pregnancy, specific causes of HIV-related maternal deaths, and the potential impact of treatment with antiretroviral therapy on maternal mortality. Recommendations are proposed for improving maternal health and decreasing maternal mortality among HIV-infected women based on existing evidence.

  7. Embryonic exposure to maternal testosterone influences age-specific mortality patterns in a captive passerine bird.

    PubMed

    Schwabl, Hubert; Holmes, Donna; Strasser, Rosemary; Scheuerlein, Alex

    2012-02-01

    Hormones are potent mediators of developmental programming and maternal epigenetic effects. In vertebrates, developmental exposure to maternal androgen hormones has been shown to impact multiple behavioral and physiological traits of progeny, but the possible consequences of this early exposure in terms of aging-related changes in mortality and fitness remain largely unexplored. Avian eggs naturally contain variable doses of maternal hormones-in particular, androgens-which have documented effects on embryo growth and differentiation as well as adult behavior and physiology. Here, we report that injections of a physiological dose of testosterone (T) into yolks of freshly laid eggs of a small, seasonally breeding songbird, the house sparrow (Passer domesticus), increased survivorship in a semi-natural aviary environment. In addition, survival effects of developmental T exposure were sex-dependent, with males generally having a higher risk of death. Separate analyses for young birds in their first year of life (from hatching up to the first reproductive period the following calendar year) and in adulthood (after the first breeding season) showed similar effects. For first-year birds, mortality risk was higher during the winter than during the period after fledging; for adults, mortality risk was higher during the reproductive than the non-reproductive phase (post-breeding molt and winter). T treatment did not affect nestling body mass, but resulted in higher body mass at 3-4 months of age; T and body mass at this age interacted to influence mortality risk. Embryonic exposure to maternal testosterone may result in lower adult mortality by modifying intrinsic physiological processes involved in health or aging over the lifespan of adult birds.

  8. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  9. Maternal and perinatal mortality.

    PubMed

    Krishna Menon, M K

    1972-01-01

    A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved

  10. Maternal mortality due to trauma.

    PubMed

    Romero, Vivian Carolina; Pearlman, Mark

    2012-02-01

    Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

  11. Maternal mortality and severe maternal morbidity surveillance in Canada.

    PubMed

    Allen, Victoria M; Campbell, Melanie; Carson, George; Fraser, William; Liston, Robert M; Walker, Mark; Barrett, Jon

    2010-12-01

    The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada.

  12. An introduction to maternal mortality.

    PubMed

    Nour, Nawal M

    2008-01-01

    Approximately 529,000 women die from pregnancy-related causes annually and almost all (99%) of these maternal deaths occur in developing nations. One of the United Nations' Millennium Development Goals is to reduce the maternal mortality rate by 75% by 2015. Causes of maternal mortality include postpartum hemorrhage, eclampsia, obstructed labor, and sepsis. Many developing nations lack adequate health care and family planning, and pregnant women have minimal access to skilled labor and emergency care. Basic emergency obstetric interventions, such as antibiotics, oxytocics, anticonvulsants, manual removal of placenta, and instrumented vaginal delivery, are vital to improve the chance of survival. PMID:18769668

  13. Maternal mortality in southern India.

    PubMed

    Rao, P S; Amalraj, A

    1994-01-01

    In a 4 year prospective community survey of 20,000 women randomly selected in North Arcot District of Tamil Nadu State in South India, the maternal mortality rates per 1,000 liveborn were estimated to be 17.4 and 16.6 for rural and semi-urban areas, respectively. The rates based only on direct causes were 11.9 in rural and 14.4 in semi-urban areas. As expected, these figures are considerably higher than those based on official or hospital statistics. Factors associated with such high mortality and the implications for programme planning and implementation are discussed. PMID:7855917

  14. Maternal mortality: a global overview.

    PubMed

    Choolani, M; Ratnam, S S

    1995-02-01

    Reduction of maternal mortality in developing countries is possible through elimination of unsafe abortion, active management of labor, appropriate management of pregnancy complications, and availability of adequate facilities. Prevention and early recognition are key factors in preventing maternal deaths due to ruptured uteri. A well equipped hospital is the appropriate place for delivery of mothers with a history of previous cesarean sections, a grossly contracted pelvis, previous myomectomies, previous multiple births, and previous abnormal births or complications during delivery. Complicated procedures, use of oxytocins, and administration of anesthesia should be performed with experienced, trained medical personnel. Surveillance of and correction for anemia should occur during the course of the pregnancy. Infections can be controlled with tetanus toxoid immunization and use of chest X-rays. The health care system should be tiered with primary health care services located in suburbs and rural districts. Services should be situated to account for population distribution, extent of maternal mortality in the region, transportation facilities, and the nearest secondary hospital. Birthing homes with sanitary facilities are an option for rural districts. A two-way referral system should be established between the primary, secondary, and tertiary level hospitals. Audits should be conducted as a means of checking for needed improvements in the system. Planning that includes proper roads, transportation, and communication facilities is important. Funding can come in the form of money, materials, and manpower. Safe motherhood requires the commitment of local people and local governments. The first step in a safe motherhood program is creating awareness among the political and economic elite. Governments are encouraged to shift resources from the military to housing, transportation, communications, education, and health during peace-times. Local professional associations

  15. The influence of maternal age, birth order and socioeconomic status on infant mortality in Chile.

    PubMed Central

    Cabrera, R

    1980-01-01

    In Chile between 1969 and 1974 the birth rate declined by 10 per cent and the infant mortality rate by 18.6 per cent. In 1974 there were proportionately fewer births at high birth order than in 1969. Such births carry significantly higher risk to the infant in both the neonatal and postneonatal period of life. Comparison of data from urban areas of high and low socioeconomic status yield similar findings. PMID:7352614

  16. [Maternal mortality among black women in Brazil].

    PubMed

    Martins, Alaerte Leandro

    2006-11-01

    Every minute a woman dies in the world due to labor or complications of pregnancy. Maternal mortality is a public health problem in Brazil and affects the country's various regions unequally. Researchers agree that maternal death occurs mainly in women with lower income and less schooling. The racial issue emerges in the midst of socioeconomic issues. The analysis is hampered by the difficulty in understanding Brazil's official classification of race/color, which often impedes recording this information. Various Maternal Mortality Committees are applying the color item and reviewing their data. The current article analyzes various Maternal Mortality Committee reports, showing that the risk of maternal mortality is greater among black women (which encompasses two census categories, negra, or black, and parda, or brown), thus representing a major expression of social inequality. The article concludes with a review of political and technical recommendations to decrease maternal mortality.

  17. [Maternal mortality: levels, trends, and differentials].

    PubMed

    Langer, A; Lozano, R; Hernandez, B

    1993-01-01

    Maternal mortality in Mexico has declined significantly over the past half century. The maternal mortality rate was 53/10,000 live births in 1940 and 5.1 in 1990. The greatest and most rapid decline occurred in the 1940s. The maternal mortality rate is still too high, and in addition the differential between Mexican rates and those of the developed countries has increased. The average age at maternal death is 29 years, a full 40 years less than potential life expectancy. The risk of death from causes related to reproduction varies substantially by educational level. Of all maternal deaths between 1986 and 1991, 26% were in illiterate women, 33% in women with incomplete primary, and 24% in those with complete primary. In 1990, the average female school attainment was complete primary. The maternal mortality rate was eight times higher among illiterate women and five times higher in those not completing primary than in those finishing preparatory. Geographically, states with low maternal mortality rates of under 3.1 are mainly located in the north and those with high maternal mortality of over 6.0 are in the south. The central zone is an intermediate area. The 1991 maternal mortality rates of Oaxaca, Puebla, Tlaxcala, Veracruz, and the state of Mexico are similar to those of Nuevo Leon 30 years ago or Aguascalientes, Sonora, and Baja California 20 years ago. 72% of maternal deaths in the 1980s occurred in rural areas. The rates were 6.5/10,000 in rural areas and 4.1/10,000 in urban areas. The maternal mortality rate also increases with marginalization. An index of marginalization constructed with census data using multivariate techniques showed that fertile aged women in very marginalized municipios had maternal mortality rates of 11.5/10,000, or a risk of death three times greater than women in municipios scoring low for marginalization. Maternal mortality continues to be a priority public health problem in Mexico. Because so many maternal deaths are preventable

  18. Maternal mortality in Yazd Province, Iran

    PubMed Central

    Karimi-Zarchi, Mojgan; Ghane-Ezabadi, Marzie; Vafaienasab, Mohammadreza; Dehghan, Ali; Ghasemi, Fateme; Zaidabadi, Mahbube; Zanbagh, Leila; Yazdian-Anari, Pouria; Teimoori, Soraya

    2016-01-01

    Introduction Five hundred thousand maternal deaths occur each year worldwide, many of which are in developing countries. The maternal mortality rate is a measure that demonstrates the degree of adequacy of prenatal care and of economic and social conditions. The aim of this study was to determine the frequency and causes of pregnancy-related mortality rates in Yazd Province. Methods This cross-sectional study examined the maternal deaths related to pregnancy that were recorded in Yazd Province, Iran, from 2002 to 2011. All maternal deaths that occurred during pregnancy, during delivery, and 42 days after birth were analyzed in this study. The data were collected through a questionnaire, and both direct and indirect causes of maternal deaths were determined. Results Forty pregnancy-related deaths occurred in this period, and the maternal mortality rate was 20.8 deaths per 100,000 live births. The mean age of death in the mothers in this study was 29.17. Fifty-five percent of women of the women who died delivered their babies by cesarean section, and only 20% of them delivered their babies vaginally. Bleeding was the most common cause of maternal mortality (30%), and it was associated directly with maternal mortality. Furthermore 20% of the mothers died due to heart disease and cardiac complications, which were associated indirectly with maternal mortality. Conclusion Cesarean section and its complications were the main cause of death in many cases. Thus, providing a strategic plan to reduce the use of this procedure, educate mothers, and ensure adequate access to pre-maternal care and to care during pregnancy are the most important measures that can be taken to decrease the maternal mortality rate. PMID:27054003

  19. The Decline in Maternal Mortality in Sweden

    PubMed Central

    Högberg, Ulf

    2004-01-01

    The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy. PMID:15284032

  20. Lessons from history--maternal and infant mortality.

    PubMed

    1989-07-15

    Historical analysis of trends in infant and maternal mortality rates reveal different patterns and factors that influence them. Recent international and urban-rural differences in trends, associations with population density and the influence of parental social class and income has led to questioning the long accepted interpretation of the sharp decline of infant mortality in Britain (at the turn of the century) as due to such measures as pure water supplies, sewage disposal and pasteurization of milk. Several authors now believe that direct control of fertility influenced parity and birth spacing, with all other factors contributing to the decline in infant mortality. While the drop in infant mortality rates can be attributable to social and environmental influence, trends in maternal mortality differ considerably. Even though high maternal mortality has often been associated with areas of poverty, such a link has been indirect; the determining factor is the place of delivery, and the skill and care of the birth attendant. The decline in maternal mortality rates began by the mid-1930's and have been halved every 10 years since. National concerns due to high rates of maternal mortality led to different organizational solutions. The US adopted a specialist obstetrician/hospital-based delivery system; the Netherlands combined midwives with home delivery; New Zealand trained midwives but with delivery in hospitals, and Britain included specialized obstetricians with better training of midwives and general practitioners. All of these variations had no effect on mortality rates. The decline is attributed to the use of sulphonamids followed by penicillin and improvements in medical management. In a recent publication entitled "Working for Patients", mortality rates continue to remain the outcome measures to be used universally while infant mortality rates are considered crude and not amenable to health interventions. PMID:2567902

  1. A strategy for reducing maternal mortality.

    PubMed Central

    Suleiman, A. B.; Mathews, A.; Jegasothy, R.; Ali, R.; Kandiah, N.

    1999-01-01

    A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions. PMID:10083722

  2. Light on maternal mortality in India.

    PubMed

    Bhatia, J C

    1990-01-01

    In order to investigate the degree and causes of maternal mortality in Anantapur District, Andhra Pradesh, India, detailed enquiries were made at the grass roots and the records of health facilities were examined. The number of maternal deaths proved to be much higher than would have been revealed by a perusal of official data alone. Many women in a serious condition died on the way to hospital or soon after arrival because the means of transport were too slow or otherwise unsuitable. Maternal mortality rates varied substantially from place to place, reflecting differing levels of economic development and the presence or absence of primary health centres and subcentres. PMID:2271096

  3. Enhanced surveillance of maternal mortality in Texas.

    PubMed

    Estes, Larissa J; Lloyd, Linda E; Selwyn, Beatrice J

    2012-12-01

    Maternal mortality is often used to measure health and well-being for women. Improved surveillance efforts can improve maternal mortality estimates and inform the development of strategies to address the needs of maternal and child health populations. The purpose of this study was to provide better estimates of maternal mortality in Texas by using enhanced surveillance methods. Results from our analyses of fetal death and live birth records in Texas from 2000 through 2006 were then linked to pregnancy-related death records and death records of women of childbearing age (15-44 years) in Texas from 2001 through 2006. Enhanced surveillance identified almost 3.5 times as many deaths that might be associated with pregnancy than do current methods and confirmed a persistent race/ethnicity trend in maternal mortality. The leading cause of these 2001-2006 pregnancy-associated deaths was accidents. Enhanced surveillance allows the identification of additional deaths possibly associated with pregnancy and provides a stable foundation to investigate trends further and to review maternal mortality cases systematically.

  4. Maternal Mortality in the United States

    ERIC Educational Resources Information Center

    Lee, Anne S.

    1977-01-01

    Figures from 1800 through 1973 are used to demonstrate that black women have had substantially higher rates of death in childbirth than white women. As mortality has declined, the relative difference between whites and blacks has actually increased. Factors affecting mortality and future prospects for reducing maternal deaths are discussed. (GC)

  5. The pattern of maternal mortality at maternity hospital Kuala Lumpur.

    PubMed

    Nafisah Adeeb

    1983-01-01

    National data on maternal health status in Malaysia is minimal. These data, from Maternity Hospital, Kuala Lumpur, are presented toward the goal of accumulation of basic information. From 1978-81, there were 74,105 deliveries and 9,899 abortion admissions in this hospital, which serves as a referral center for areas within a 100-mile radius. 39 maternal mortalities were recorded in this time. Maternal mortality excluding that associated with abortions was 29.27/100,000 births; when abortions are included, the figure increases to 70.54. 50% of the women who died were under 30 years of age. 28.2% of deaths occurred among primigravida, and 25.64% were associated with parity 5 or above. Malays had a mortality rate double that of Chinese or Indians. Major causes of death were toxemia, hemorrhage, embolism, medical disease, and sepsis. These causes accounted for 89% of deaths, while the remaining 11% were due to uterine inversion, obstetric trauma, and pulmonary edema. Avoidable factors were isolated in all the deaths except 3, 1 due to infective hepatitis, and 2 due to cardiac disease. Inefficient hospital care occurred in 17 patients, defective care before admission in 2, and 4 death were associated with patients' failure to seek or accept medical attention. The need for documenting all maternal mortalities is a priority in Malaysia.

  6. Public health approach to address maternal mortality.

    PubMed

    Rai, Sanjay K; Anand, K; Misra, Puneet; Kant, Shashi; Upadhyay, Ravi Prakash

    2012-01-01

    Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health. PMID:23229211

  7. Estimates of maternal mortality for 1995.

    PubMed Central

    Hill, K.; AbouZhar, C.; Wardlaw, T.

    2001-01-01

    OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability. METHODS: For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age. FINDINGS: On the basis of this exercise, we have obtained a global estimate of 515,000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100,000 live births. The differences, by region, were very great, with over half (273,000 maternal deaths) occurring in Africa (MMRatio: > 1000 per 100,000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100,000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100,000 live births. These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time. CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes. PMID:11285661

  8. Maternal mortality in Riyadh, Saudi Arabia.

    PubMed

    Chattopadhyay, S K; Sengupta, B S; Chattopadhyay, C; Zaidi, Z; Showail, H

    1983-09-01

    The maternal mortality in the Maternity and Children Hospital, Riyadh, during the years 1978-1980 was 52 per 100 000 births, when the total births were 55 428. This is higher than the rate reported from the hospitals in developed countries but lower than rates reported by the university hospitals of developing countries such as India, Thailand and Nigeria. Haemorrhage, associated disease, pulmonary embolism and infection, in that order, were the main causes of maternal deaths. The main avoidable factor was failure by the patient to seek the medical care. Much could be done in reducing deaths due to haemorrhage by improving blood transfusion facilities in the peripheral hospitals. Adequate health education, especially of rural women and their midwives, is a crucial factor in improving the maternal death rate for the country as a whole. PMID:6615737

  9. [Maternal mortality in France, 2007-2009].

    PubMed

    Saucedo, M; Deneux-Tharaux, C; Bouvier-Colle, M-H

    2013-11-01

    To monitor the maternal mortality which is an indicator of the quality of obstetric and intensive care, France has a specific approach since 1996. Recently linkages have been introduced to improve the inclusion of cases. Here are the results for the 2007 to 2009 period. The identification of the pregnancy associated deaths is lying on different data bases that are medical causes of death, birth register and hospital discharges. To document the cases, confidential enquiries are conducted by two assessors on the field; a committee of medical experts analyses the documents, select the underlying cause and assess the quality of health care. Two hundred and fifty-four obstetric deaths were identified from 2007 to 2009 giving the maternal mortality ratio (MMR) of 10.3 per 100,000 births. The maternal age and nationality, the region of deaths are associated to the MMR. The haemorrhages are the leading cause but their ratio is 1.9 versus 2.5 previously; this decrease results from the postpartum haemorrhage by uterine atony going down. The suboptimal care are still frequent (60%) but slightly less than before. The linkage method should be pursued. Maternal mortality is rather stable in France. We may reach more reduction as deaths due to atony decreased as suboptimal care did.

  10. Trends in maternal mortality in the United States.

    PubMed

    Neggers, Yasmin H

    2016-09-01

    Maternal mortality is a major global concern. Although a notable decline in maternal mortality in the United States occurred during the mid-20th century, this progress stalled during the late 20th century. Furthermore, maternal mortality rates have increased during the early 21st century. Around the year 2000 the maternal mortality rate began to rise and has since nearly doubled. Given that at least half of maternal deaths in the U.S. are preventable, the rise in maternal deaths in the U.S. is historic and worrisome. This overview will try to provide a context for understanding the problem of this rise in maternal mortality in the U.S. by briefly discussing how maternal mortality rates are reported from National Vital Statistics data and from a National Surveillance system. Trends and causes of maternal deaths and the difficulty with interpreting these trends will be discussed.

  11. [New data on maternal mortality in India].

    PubMed

    Bhatia, J C

    1990-01-01

    A survey was carried out in urban and rural areas of the district of Anantapur, Andhra Pradesh state, India, between July 1, 1984-June 30, 1985 by a team of 6 interviewers and 1 supervisor to identify investigate, and study the causative factors/characteristics of the causes of maternal deaths. They visited each of the 15 hospitals in the district collecting information about maternal deaths that occurred in the reproductive age range of 15-49 years. 22 health centers and 50% of subcenters were also visited, registers were examined, and staff and families were also interviewed. The hospitals and centers served 569,500 people. During the 1st phase in the rural area all main village centers, 181 village subcenters, and 1192 other villages in the district with a total population of 1,090,640 were covered. During the 2nd phase all towns in the urban zones, 10 primary centers, 65 subcenters, and 135 others were visited. The maternal mortality rate was 7.9/1000 live births, well above the national average. 36% of female mortality occurred in women in reproductive age, but fewer than 1/2 of these deaths were registered and only 1/3 figured in center and subcenter records. In rural areas maternal mortality was 8.3/1000, ahead of the urban rate of 5.4/1000. 63% of 284 deaths detailed were related to live births, 14% to stillbirths, 10% to abortions, and 13% to obstructed labor. 19% of total maternal deaths occurred before birth, 12% during labor, and 69% after delivery. Among clinical causes of death sepsis accounted for 36%, hemorrhage for 12%, eclampsia for 9%, retention of placenta for 7%, and infectious hepatitis for 10%. 80% of these deaths could have been avoided by timely antenatal care, treatment of previous complaints, and medical attention and hospitalization at the right time. PMID:12179349

  12. Maternal effects on offspring mortality in rhesus macaques (Macaca mulatta)

    PubMed Central

    Blomquist, Gregory E.

    2012-01-01

    The genetics of primate life histories are poorly understood, but quantitative genetic patterns in other mammals suggest phenotypic differences among individuals early in life can be strongly affected by interactions with mothers or other caretakers. I used generalized linear mixed model extensions of complex pedigree quantitative genetic techniques to explore regression coefficients and variance components for infant and juvenile mortality rates across pre-reproductive age classes in the semi-free ranging Cayo Santiago rhesus macaques. Using a large set of records (max. n=977 mothers, 6240 offspring), strong maternal effects can be identified early in development but they rapidly “burn off” as offspring age and mothers become less consistent buffers from increasingly prominent environmental variation. The different ways behavioral ecologists and animal breeders have defined and studied maternal effects can be subsumed, and even blended, within the quantitative genetic framework. Regression coefficients identify loss of the mother, maternal age, and offspring age within their birth cohort as having significant maternal effects on offspring mortality, while variance components for maternal identity record significant maternal influence in the first month of life. PMID:23315583

  13. Maternal effects on offspring mortality in rhesus macaques (Macaca mulatta).

    PubMed

    Blomquist, Gregory E

    2013-03-01

    The genetics of primate life histories are poorly understood, but quantitative genetic patterns in other mammals suggest phenotypic differences among individuals early in life can be strongly affected by interactions with mothers or other caretakers. I used generalized linear mixed model extensions of complex pedigree quantitative genetic techniques to explore regression coefficients and variance components for infant and juvenile mortality rates across prereproductive age classes in the semifree ranging Cayo Santiago rhesus macaques. Using a large set of records (maximum n = 977 mothers, 6,240 offspring), strong maternal effects can be identified early in development but they rapidly "burn off" as offspring age and mothers become less consistent buffers from increasingly prominent environmental variation. The different ways behavioral ecologists and animal breeders have defined and studied maternal effects can be subsumed, and even blended, within the quantitative genetic framework. Regression coefficients identify loss of the mother, maternal age, and offspring age within their birth cohort as having significant maternal effects on offspring mortality, while variance components for maternal identity record significant maternal influence in the first month of life.

  14. Maternal mortality in St. Petersburg, Russian Federation.

    PubMed Central

    Gurina, Natalia A.; Vangen, Siri; Forsén, Lisa; Sundby, Johanne

    2006-01-01

    OBJECTIVE: To study the levels and causes of maternal mortality in St. Petersburg, Russian Federation. METHODS: We collected data about all pregnancy-related deaths in St. Petersburg over the period 1992-2003 using several sources of information. An independent research group reviewed and classified all cases according to ICD-10 and the Confidential Enquiries into Maternal Deaths in the United Kingdom. We tested trends of overall and cause specific ratios (deaths per 100,000 births) for four 3-year intervals using the chi2 test. FINDINGS: The maternal mortality ratio for the study period was 43 per 100,000 live births. A sharp decline of direct obstetric deaths was observed from the first to fourth 3-year interval (49.8 for 1992-94 versus 18.5 for 2001-03). Sepsis and haemorrhage were the main causes of direct obstetric deaths. Among the total deaths from sepsis, 63.8% were due to abortion. Death ratios from sepsis declined significantly from the first to second study interval. In the last study interval (2001-03), 50% of deaths due to haemorrhage were secondary to ectopic pregnancies. The death ratio from thromboembolism remained low (2.9%) and stable throughout the study period. Among indirect obstetric deaths a non-significant decrease was observed for deaths from cardiac disease. Death ratios from infectious causes and suicides increased over the study period. CONCLUSIONS: Maternal mortality levels in St. Petersburg still exceed European levels by a factor of five. Improved management of abortion, emergency care for sepsis and haemorrhage, and better identification and control of infectious diseases in pregnancy, are needed. PMID:16628301

  15. Maternal education and child mortality in Zimbabwe.

    PubMed

    Grépin, Karen A; Bharadwaj, Prashant

    2015-12-01

    In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policies were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today.

  16. Maternal education and child mortality in Zimbabwe.

    PubMed

    Grépin, Karen A; Bharadwaj, Prashant

    2015-12-01

    In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policies were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today. PMID:26569469

  17. [Maternal mortality in Spain, 1980-1992. Relationship with birth distributions according to the mother's age].

    PubMed

    Valero Juan, L F; Sáenz González, M C

    1997-11-01

    The maternal mortality evolution in Spain during the 1980-1992 period is reported. The influence of birth distribution according to maternal age is analyzed. The information was gathered from vital statistics published by Instituto Nacional de Estadística. The mortality rates have stabilized since 1985 (4.8 per 10(5) for 1992) associated with the increase in the proportion of births in women aged > or = 30 years (40.6% for 1992). Birth distributions according to maternal age account for 13.1% of the deaths observed. The predictions point to an increase in maternal mortality for the year 2000.

  18. [Situation of maternal mortality in Peru, 2000 - 2012].

    PubMed

    dl Carpio Ancaya, Lucy

    2013-07-01

    We perform an analysis concerning the situation of maternal mortality in Peru, based on the information of the System of Epidemiologic Surveillance of Maternal Mortality of the General Directorate of Epidemiology of the Ministry of Health and the Family and Health Demographic Survey. We can see a decrease in the rates of maternal mortality between 2000 and 2012. The direct causes are the same but in different proportions according to the natural regions, being the hemorrhage the first cause of maternal mortality. The coverage of birth attention in health establishments has increased in the last years but it is still necessary to improve the capacity of quick response and the quality of the health services. Maternal mortality in Peru is related to inequity and lack of women empowerment to excerpt their rights, specially the sexual and reproductive rights. It is necessary to strengthen the strategies that have been implemented in order to accomplish of the reduction in maternal mortality in Peru.

  19. Maternal mortality at government maternity hospital. Hyderabad, Andhra Pradesh (a review of 431 cases).

    PubMed

    Durgamba, K K; Qureshi, S

    1970-01-01

    This reviews 431 maternal deaths over 3 periods of 3-4 years each from January 1958 to December 1968. Trends in mortality are noted. A steady decline was noted. Associated diseases increased maternal mortality but age and parity had no significant influence. 47% of the deaths were intrapartum, 35% postpartum, and 18% antenatal. Major causes were hemorrhage, preeclampsia, eclampsia, sepsis, and anemia, in that order. Deaths due to infection diminished markedly during the period. 58.2% of the deaths were considered avoidable. Delay by patient or doctor and lack of facilities in rural areas were principle avoidable factors. Extension of obstetrical service to villages, emergency mobile squads, and periodic review of mortality statistics are recommended. PMID:12304876

  20. Community level risk factors for maternal mortality in Madagascar.

    PubMed

    Hernandez, Julio C; Moser, Christine M

    2013-12-01

    This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.

  1. Maternal Mortality in Six East Anglian Parishes, 1539-1619.

    PubMed

    Allison, Julia

    2015-01-01

    This study examines the maternal mortality rate in six early modern rural parishes of East Anglia where a midwife was known to be practicing. Register entries from the six parishes are translated and transcribed and maternal outcomes established and discussed. Midwives and their families are researched to establish marital status, parity and social standing. Maternal mortality is calculated and differing rates for women experiencing multiple births, stillbirths and base births examined.

  2. An update on maternal mortality and morbidity in the United States.

    PubMed

    Edwards, Joan E; Hanke, June C

    2013-10-01

    Significant strides have been made in recent years to reduce maternal morbidity and mortality rates around the world. But in the United States, maternal mortality rates have increased from 6.6/100,000 live births in the 1980s and 1990s to somewhere between 13.3/100,000 live births, as reported by the Centers for Disease Control and Prevention, and 21/100,000 live births, as reported by the World Health Organization. This article discusses factors influencing this trend, and explores organizations, systems and programs that have shown promise for reducing maternal morbidity and mortality.

  3. Modeling variation in early life mortality in the western lowland gorilla: Genetic, maternal and other effects.

    PubMed

    Ahsan, Monica H; Blomquist, Gregory E

    2015-06-01

    Uncovering sources of variation in gorilla infant mortality informs conservation and life history research efforts. The international studbook for the western lowland gorilla provides information on a sample of captive gorillas large enough for which to analyze genetic, maternal, and various other effects on early life mortality in this critically endangered species. We assess the importance of variables such as sex, maternal parity, paternal age, and hand rearing with regard to infant survival. We also quantify the proportions of variation in mortality influenced by heritable variation and maternal effects from these pedigree and survival data using variance component estimation. Markov chain Monte Carlo simulations of generalized linear mixed models produce variance component distributions in an animal model framework that employs all pedigree information. Two models, one with a maternal identity component and one with both additive genetic and maternal identity components, estimate variance components for different age classes during the first 2 years of life. This is informative of the extent to which mortality risk factors change over time during gorilla infancy. Our results indicate that gorilla mortality is moderately heritable with the strongest genetic influence just after birth. Maternal effects are most important during the first 6 months of life. Interestingly, hand-reared infants have lower mortality for the first 6 months of life. Aside from hand rearing, we found other predictors commonly used in studies of primate infant mortality to have little influence in these gorilla data.

  4. Modeling variation in early life mortality in the western lowland gorilla: Genetic, maternal and other effects.

    PubMed

    Ahsan, Monica H; Blomquist, Gregory E

    2015-06-01

    Uncovering sources of variation in gorilla infant mortality informs conservation and life history research efforts. The international studbook for the western lowland gorilla provides information on a sample of captive gorillas large enough for which to analyze genetic, maternal, and various other effects on early life mortality in this critically endangered species. We assess the importance of variables such as sex, maternal parity, paternal age, and hand rearing with regard to infant survival. We also quantify the proportions of variation in mortality influenced by heritable variation and maternal effects from these pedigree and survival data using variance component estimation. Markov chain Monte Carlo simulations of generalized linear mixed models produce variance component distributions in an animal model framework that employs all pedigree information. Two models, one with a maternal identity component and one with both additive genetic and maternal identity components, estimate variance components for different age classes during the first 2 years of life. This is informative of the extent to which mortality risk factors change over time during gorilla infancy. Our results indicate that gorilla mortality is moderately heritable with the strongest genetic influence just after birth. Maternal effects are most important during the first 6 months of life. Interestingly, hand-reared infants have lower mortality for the first 6 months of life. Aside from hand rearing, we found other predictors commonly used in studies of primate infant mortality to have little influence in these gorilla data. PMID:25809396

  5. Estimation of perinatal mortalities in the world's countries from maternal mortalities.

    PubMed

    Maeda, K

    1996-01-01

    Perinatal mortality was estimated by the regression equation log10 Y = 0.7826log10X + 0.08, obtained by perinatal mortality (Y) and maternal mortality (X) in Japan in 1960-1990. The error rate was approximately 9% in the estimation. Unpublished Japanese perinatal mortality in 1899-1947 was estimated from maternal mortality by using the equation, and appropriate results were obtained. Perinatal mortalities of the world's countries were estimated from their maternal mortalities listed in UNICEF reports with use of the above equation. Two peaks were noted in the country number distribution at 0-19 and 120-140 of estimated perinatal mortality. The mortality was 20-99 in 43% of 111 countries analyzed and 100 or more in 25%. The results suggest that further efforts should be made for the improvement of worldwide maternal and child health.

  6. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study

    PubMed Central

    2009-01-01

    Background Maternal health is one of the major worldwide health challenges. Currently, the unacceptably high levels of maternal mortality are a common subject in global health and development discussions. Although some countries have made remarkable progress, half of the maternal deaths in the world still take place in Sub-Saharan Africa where little or no progress has been made. There is no single simple, straightforward intervention that will significantly decrease maternal mortality alone; however, there is a consensus on the importance of a strong health system, skilled delivery attendants, and women's rights for maternal health. Our objective was to describe and determine different factors associated with the maternal mortality ratio in Sub-Saharan countries. Methods An ecological multi-group study compared variables between many countries in Sub-Saharan Africa using data collected between 1997 and 2006. The dependent variable was the maternal mortality ratio, and Health care system-related, educational and economic indicators were the independent variables. Information sources included the WHO, World Bank, UNICEF and UNDP. Results Maternal mortality ratio values in Sub-Saharan Africa were demonstrated to be high and vary enormously among countries. A relationship between the maternal mortality ratio and some educational, sanitary and economic factors was observed. There was an inverse and significant correlation of the maternal mortality ratio with prenatal care coverage, births assisted by skilled health personnel, access to an improved water source, adult literacy rate, primary female enrolment rate, education index, the Gross National Income per capita and the per-capita government expenditure on health. Conclusions Education and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others. PMID:20003411

  7. Contextual determinants of maternal mortality in rural Pakistan.

    PubMed

    Midhet, F; Becker, S; Berendes, H W

    1998-06-01

    Maternal mortality is high in Pakistan, particularly in the rural areas which have poor access to health services. We investigated the risk factors associated with maternal mortality in sixteen rural districts of Balochistan and the North-West Frontier (NWFP) provinces of Pakistan. We designed a nested case-control study comprising 261 cases (maternal deaths reported during last five years) and 9135 controls (women who survived a pregnancy during last five years). Using contextual analysis, we estimated the interactions between the biological risk factors of maternal mortality and the district-level indicators of health services. Women under 19 or over 39 yr of age, those having their first birth, and those having a previous history of fetal loss were at greater risk of maternal death. Staffing patterns of peripheral health facilities in the district and accessibility of essential obstetric care (EOC) were significantly associated with maternal mortality. These indicators also modified the effects of the biological risk factors of maternal mortality. For example, nulliparous women living in the under-served districts were at greater risk than those living in the better-served districts. Our results are consistent with several studies which have pointed out the role of health services in the causation of maternal mortality. Many such studies have implicated distance to hospital (an indicator of access to EOC) and lack of prenatal care as major determinants of maternal mortality. We conclude that better staffing of peripheral health facilities and improved access to EOC could reduce the risk of maternal mortality among women in rural Balochistan and the NWFP.

  8. Maternal mortality inquiry in a rural community of north India.

    PubMed

    Kumar, R; Sharma, A K; Barik, S; Kumar, V

    1989-08-01

    Community inquiry on maternal mortality was conducted in a rural area of North India. Maternal deaths were identified by multiple informants and investigated by doctors. Amongst 257 deaths registered in women in the 15-44 year age group, 55(21.4%) were maternal deaths. Maternal mortality ratio was 230 per 100,000 live births. Major causes were antepartum and postpartum hemorrhage (18.2%), puerperal sepsis (16.4%), severe anemia (16.4%), abortion (9.1%) and obstructed labor (7.3%). This rapid, simple and low cost method is recommended for application in areas where vital registration system is unsatisfactory. PMID:2571532

  9. Reduction in maternal mortality due to sepsis.

    PubMed

    Chhabra, S; Kaipa, A; Kakani, A

    2005-02-01

    The present study was undertaken at a rural medical institute in India to analyse the trends in maternal mortality due to sepsis and the factors associated with change, if any. During the study period of 20 years, a total of 37,155 women delivered, 192 deaths occurred and forty deaths (20.83%) were due to sepsis and it's sequlae. It was revealed that there is a definite decrease in the proportion of deaths due to sepsis, to 10% in the last five years from 35% in earlier years. The change seems to be due to the advocacy of clean deliveries and reduction in case fatality because of alterations in medication and earlier surgical intervention. However the percentage contribution of septic abortion has remained the same. Septic abortion continues to exist inspite of all the current laws and discussion about the availability of a liberal law, which permits abortion almost on request. Most of the women who had died due to septic abortion were married (65%). Deaths due to septic abortion, are persisting even in married women and it is a matter of concern for health providers, policy makers and governments. PMID:15814392

  10. Levels and causes of maternal mortality in southern India.

    PubMed

    Bhatia, J C

    1993-01-01

    Most studies of maternal mortality are hospital based. However, in developing countries, where many such deaths take place in the home, hospital statistics do not reflect the true extent of maternal mortality. Furthermore, the socioeconomic and demographic factors and health behavior affecting maternal mortality are rarely known. A study conducted in 1986 in South India demonstrates a new approach to investigating maternal mortality that combines the collection of information from hospital and health-facility records, field surveys, and case-control studies. The findings from this study indicate that there were 7.98 maternal deaths per 1,000 live births. Approximately one-half of the deaths occurred in the home or on the way to the hospital. Maternal deaths accounted for 36 percent of mortality for women of reproductive age. Analysis reveals that many of these deaths were preventable and that significant differentials existed with regard to demographic, social, and behavioral factors between the cases of maternal deaths and the controls. PMID:8296332

  11. Maternal mortality in India: estimates from a regression model.

    PubMed

    Bhat, P N; Navaneetham, K; Rajan, S I

    1995-01-01

    This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. Estimates derived for the major states suggest relatively high maternal mortality in the eastern and northern parts of the country. They also indicate a substantial decline in maternal mortality since the 1960s. The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5 percent of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India. PMID:7482679

  12. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe.

    PubMed

    Munyaradzi Kenneth, Dodzo; Marvellous, Mhloyi; Stanzia, Moyo; Memory, Dodzo-Masawi

    2016-01-01

    Religion affects people's daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner. PMID:27509018

  13. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe

    PubMed Central

    2016-01-01

    Religion affects people’s daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner. PMID:27509018

  14. Community Study of maternal mortality in South West Nigeria: how applicable is the sisterhood method.

    PubMed

    Adegoke, Adetoro A; Campbell, Malcolm; Ogundeji, Martins O; Lawoyin, Taiwo O; Thomson, Ann M

    2013-02-01

    A significant reduction in maternal mortality was witnessed globally in the year 2010, yet, no significant reduction in the maternal mortality ratio (MMR) in Nigeria was recorded. The absence of accurate data on the numbers, causes and local factors influencing adverse maternal outcomes has been identified as a major obstacle hindering appropriate distribution of resources targeted towards improving maternal healthcare. This paper reports the first community based study that measures the incidence of maternal mortality in Ibadan, Nigeria using the indirect sisterhood method and explores the applicability of this method in a community where maternal mortality is not a rare event. A community-based study was conducted in Ibadan using the principles of the sisterhood method developed by Graham et al. for developing countries. Using a multi-stage sampling design with stratification and clustering, 3,028 households were selected. All persons approached agreed to take part in the study (a participation rate of 100%), with 2,877 respondents eligible for analysis. There was a high incidence of maternal mortality in the study setting: 1,324/6,519 (20.3%) sisters of the respondents had died, with 1,139 deaths reportedly related to pregnancy, childbirth or the puerperium. The MMR was 7,778 per 100,000 live births (95% CI 7,326-8,229). Adjusted for a published Total Fertility Rate of 6.0, the MMR was 6,525 per 100,000 live births (95% CI 6,144-6,909). Women in Ibadan were dying more from pregnancy related complications than from other causes. Findings of this study have implications for midwifery education, training and practice and for the first time provide policy makers and planners with information on maternal mortality in the community of Ibadan city and shed light on the causes of maternal mortality in the area.

  15. Putting the "M" back in the Maternal and Child Health Bureau: reducing maternal mortality and morbidity.

    PubMed

    Lu, Michael C; Highsmith, Keisher; de la Cruz, David; Atrash, Hani K

    2015-07-01

    Maternal mortality and severe morbidity are on the rise in the United States. A significant proportion of these events are preventable. The Maternal Health Initiative (MHI), coordinated by the Maternal and Child Health Bureau at the Health Resources and Services Administration, is intensifying efforts to reduce maternal mortality and severe morbidity in the U.S. Through a public-private partnership, MHI is taking a comprehensive approach to improving maternal health focusing on five priority areas: improving women's health before, during and beyond pregnancy; improving the quality and safety of maternity care; improving systems of maternity care including both clinical and public health systems; improving public awareness and education; and improving surveillance and research.

  16. An update on maternal mortality in low-resource countries.

    PubMed

    Cabero-Roura, Luis; Rushwan, Hamid

    2014-05-01

    Maternal mortality constitutes a major problem in the context of women's health. All regions experienced a decline in maternal mortality ratio (MMR) between 1990 and 2010. Among those women who do not die, 300 million are currently living with health problems and disabilities caused by complications of pregnancy and childbirth. MMR in sub-Saharan Africa remains high, at more than 450 maternal deaths per 100,000 live births. It is currently accepted that in many areas the Millennium Development Goals will not have been achieved by 2015 and in some countries, if current trends continue, they will not be reached until after 2040. Maternal mortality is much more than just a health problem. It involves lack of respect for women's basic human rights and failure to show the disadvantages and risks to which they are exposed.

  17. Fetal, Infant, and Maternal Mortality During Periods of Economic Instability

    ERIC Educational Resources Information Center

    Brenner, M. H.

    1973-01-01

    One of the most sensitive indicators of the general socioeconomic level of a nation is the infant mortality rate. Evidence indicates that economic recessions and upswings have played a significant role in fetal, infant, and maternal mortality in the last 45 years. (RJ)

  18. Changing perspectives of infectious causes of maternal mortality

    PubMed Central

    Halder, Ajay; Vijayselvi, Reeta; Jose, Ruby

    2015-01-01

    Objective Infections significantly contribute to maternal mortality. There is a perceived change in the spectrum of such infections. This study aims to estimate the contribution of various types of infections to maternal mortality. Material and Methods We retrospectively reviewed records of maternal death cases that took place between 2003 and 2012 in the Christian Medical College, Vellore, India. The International Classification of Diseases-Maternal Mortality was used to classify the causes of deaths and World Health Organization near-miss criteria were used to identify organ dysfunction that occurred before death. Infections during pregnancy were divided into three groups, i.e., pregnancy-related infections, pregnancy-unrelated infections, and nosocomial infections. Results In this study, 32.53% of maternal deaths were because of some type of infection as the primary cause. The contribution of pregnancy-related infections was comparable with that of pregnancy-unrelated infections (16.03% vs. 16.50%). Metritis with pelvic cellulitis, septic abortions, tuberculosis, malaria, scrub typhus, and H1N1 influenza (influenza A virus subtype) were among the most commonly encountered causes of maternal death due to infections. Another 7.07% of cases developed severe systemic infection during the course of illness as nosocomial infection. A significant majority of mothers were below 30 years of age, were primiparae, had advanced gestational age, and had operative delivery. Cardiovascular and respiratory system dysfunctions were the most common organ dysfunctions encountered. Conclusion The contribution of pregnancy-unrelated infections to maternal deaths is significant. Control of these diverse community-acquired infections holds the key to a reduction in maternal mortality along with the promotion of clean birthing practices. Nosocomial infections should not be underestimated as a contributor to maternal mortality. PMID:26692770

  19. Maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    Tebeu, Pierre-Marie; Pierre-Marie, Tebeu; Halle-Ekane, Gregory; Gregory, Halle-Ekane; Da Itambi, Maxwell; Maxwell, Da Itambi; Enow Mbu, Robinson; Robinson, Enow Mbu; Mawamba, Yvette; Yvette, Mawamba; Fomulu, Joseph Nelson; Nelson, Fomulu Joseph

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.

  20. Age, period, and cohort effects on maternal mortality: a linear logit model.

    PubMed

    Tu, E J; Chuang, J L

    1983-01-01

    This analysis was aimed at disentangling the age, period, and cohort effects on the decline in maternal mortality in the 1917-77 period in New York State. New York maternal mortality rates were consistentley lower than US rates from 191-56, but fell considerably more slowly than national rates since 1957. Cohort analysis can potentially provide separate measures of age, period, and cohort effects by use of linear ligit models. Comparison of various age-period-cohort linear logit models on the logits of maternal mortality rates indicated that period and age effects are the dominant influences on maternal mortality. Cohortship did not make a significant contribution after age and period were already in the model. Age parameter results suggest that the 20-24 year age group faces the lowest maternal mortality risk, and risk increases rapidly with age after age 30 years. The infuctuation in the residuals for the 40-44 year age group is slightly higher due to the stochastic variation in diminishing small numbers of maternal deaths and pregnancies in this group. In addition, adding the period dimension after adjustment for age had a greater impact than adding the cohort dimension after adjustment for age. The implication of these findings is that, as a set, changes in temporal variables that cut across cohorts seem to be more important than those variables that distinguish cohorts.

  1. Every death counts: measurement of maternal mortality via a census.

    PubMed Central

    Stanton, C.; Hobcraft, J.; Hill, K.; Kodjogbé, N.; Mapeta, W. T.; Munene, F.; Naghavi, M.; Rabeza, V.; Sisouphanthong, B.; Campbell, O.

    2001-01-01

    Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates. We evaluated use of the national population census as a means of measuring maternal mortality by assessing data from five countries (Benin, Islamic Republic of Iran, Lao People's Democratic Republic, Madagascar, and Zimbabwe) which identified maternal deaths in their censuses. Standard demographic methods were used to evaluate the completeness of reporting of adult female deaths and births in the year prior to the census. The results from these exercises were used to adjust the data. In four countries, the numbers of adult female deaths needed to be increased and three countries required upward adjustment of the numbers of recent births. The number of maternal deaths was increased by the same factor as that used for adult female deaths on the assumption that the proportion of adult female deaths due to maternal causes was correct. Age patterns of the various maternal mortality indicators were plausible and consistent with external sources of data for other populations. Our data suggest that under favourable conditions a national census is a feasible and promising approach for the measurement of maternal mortality. Moreover, use of the census circumvents several of the weaknesses of methods currently in use. However, it should also be noted that careful evaluation of the data and adjustment, if necessary, are essential. The public health community is urged to encourage governments to learn from the experience of these five countries and to place maternal mortality estimation in the hands of statistical agencies. PMID:11477969

  2. Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi

    PubMed Central

    2015-01-01

    Background Maternal mortality, although largely preventable, remains unacceptably high in developing countries such as Malawi and creates a number of intergenerational impacts. Few studies have investigated the far-reaching impacts of maternal death beyond infant survival. This study demonstrates the short- and long-term impacts of maternal death on children, families, and the community in order to raise awareness of the true costs of maternal mortality and poor maternal health care in Neno, a rural and remote district in Malawi. Methods Qualitative in-depth interviews were conducted to assess the impact of maternal mortality on child, family, and community well-being. We conducted 20 key informant interviews, 20 stakeholder interviews, and six sex-stratified focus group discussions in the seven health centers that cover the district. Transcripts were translated, coded, and analyzed in NVivo 10. Results Participants noted a number of far-reaching impacts on orphaned children, their new caretakers, and extended families following a maternal death. Female relatives typically took on caregiving responsibilities for orphaned children, regardless of the accompanying financial hardship and frequent lack of familial or governmental support. Maternal death exacerbated children’s vulnerabilities to long-term health and social impacts related to nutrition, education, employment, early partnership, pregnancy, and caretaking. Impacts were particularly salient for female children who were often forced to take on the majority of the household responsibilities. Participants cited a number of barriers to accessing quality child health care or support services, and many were unaware of programming available to assist them in raising orphaned children or how to access these services. Conclusions In order to both reduce preventable maternal mortality and diminish the impacts on children, extended families, and communities, our findings highlight the importance of financing and

  3. Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale.

    PubMed

    Ronsmans, C; Vanneste, A M; Chakraborty, J; van Ginneken, J

    This study examines the impact of the Maternal-Child Health and Family Planning (MCH-FP) program in the Matlab, Bangladesh. Data were obtained from the Matlab surveillance system for treatment and comparison areas. This study reports the trends in maternal mortality since 1976. The MCH-FP area received extensive services in health and family planning since 1977. Services included trained traditional birth attendants and essential obstetric care from government district hospitals and a large number of private clinics. Geographic ease of access to essential obstetric care varied across the study area. Access was most difficult in the northern sector of the MCH-FP area. Contraception was made available through family welfare centers. Tetanus immunization was introduced in 1979. Door-to-door contraceptive services were provided by 80 female community health workers on a twice-monthly basis. In 1987, a community-based maternity care program was added to existing MCH-FP services in the northern treatment area. The demographic surveillance system began collecting data in 1966. During 1976-93 there were 624 maternal deaths among women aged 15-44 years in Matlab (510/100,000 live births). 72.8% of deaths were due to direct obstetric causes: postpartum hemorrhage, induced abortion, eclampsia, dystocia, and postpartum sepsis. Maternal mortality declined in a fluctuating fashion in both treatment and comparison areas. Direct obstetric mortality declined at about 3% per year. After 1987, direct obstetric mortality declined in the north by almost 50%. After the 1990 program expansion in the south, maternal mortality declined, though not significantly, in the south. Maternal mortality declined in the south comparison area during 1987-89 and stabilized. The comparison area of the north showed no decline. PMID:9428252

  4. Maternal health in fifty years of Tanzania independence: Challenges and opportunities of reducing maternal mortality.

    PubMed

    Shija, Angela E; Msovela, Judith; Mboera, Leonard E G

    2011-12-01

    High rate of maternal death is one of the major public health concerns in Tanzania. Most of maternal deaths are caused by factors attributed to pregnancy, childbirth and poor quality of health services. More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care and assured of skilled attendance at childbirth as well as emergency obstetric care. The objective of this review was to analyse maternal mortality situation in Tanzania during the past 50 years and to identify efforts, challenges and opportunities of reducing it. This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. From 1961 to 1990 maternal mortality ratio in Tanzania had been on a downward trend from 453 to 200 per 100,000 live births. However, from 1990's there been an increasing trend to 578 per 100,000 live births. Current statistics indicate that maternal mortality ratio has dropped slightly in 2010 to 454 per 100,000 live births. Despite a high coverage (96%) in pregnant women who attend at least one antenatal clinic, only half of the women (51%) have access to skilled delivery. Coverage of emergence obstetric services is 64.5% and utilization of modern family planning method is 27%. Only about 13% of home deliveries access post natal check-up. Despite a number of efforts maternal mortality is still unacceptably high. Some of the efforts done to reduce maternal mortality in Tanzania included the following initiatives: reproductive and child survival; increased skilled delivery; maternal death audit; coordination and integration of different programs including maternal and child health services, family planning, malaria interventions, expanded program on immunization and adolescent health and nutrition programmes. These initiatives are however challenged by inadequate access to maternal health care services. In order to considerably reduce maternal deaths some of recommended

  5. Causes of maternal mortality decline in Matlab, Bangladesh.

    PubMed

    Chowdhury, Mahbub Elahi; Ahmed, Anisuddin; Kalim, Nahid; Koblinsky, Marge

    2009-04-01

    Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor

  6. Causes of maternal mortality decline in Matlab, Bangladesh.

    PubMed

    Chowdhury, Mahbub Elahi; Ahmed, Anisuddin; Kalim, Nahid; Koblinsky, Marge

    2009-04-01

    Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor

  7. Maternal mortality in rural Gambia: levels, causes and contributing factors.

    PubMed Central

    Walraven, G.; Telfer, M.; Rowley, J.; Ronsmans, C.

    2000-01-01

    A demographic study carried out in a rural area of the Gambia between January 1993 and December 1998 recorded 74 deaths among women aged 15-49 years. Reported here is an estimation of maternal mortality among these 74 deaths based on a survey of reproductive age mortality, which identified 18 maternal deaths by verbal autopsy. Over the same period there were 4245 live births in the study area, giving a maternal mortality ratio of 424 per 100,000 live births. This maternal mortality estimate is substantially lower than estimates made in the 1980s, which ranged from 1005 to 2362 per 100,000 live births, in the same area. A total of 9 of the 18 deaths had a direct obstetric cause--haemorrhage (6 deaths), early pregnancy (2), and obstructed labour (1). Indirect causes of obstetric deaths were anaemia (4 deaths), hepatitis (1), and undetermined (4). Low standards of health care for obstetric referrals, failure to recognize the severity of the problem at the community level, delays in starting the decision-making process to seek health care, lack of transport, and substandard primary health care were identified more than once as probable or possible contributing factors to these maternal deaths. PMID:10859854

  8. Zero in on postpartum hemorrhage to reduce Cuba's maternal mortality.

    PubMed

    Águila, Sonia

    2015-01-01

    Postpartum hemorrhage (PPH) is the most frequent cause of severe maternal morbidity (SMM) and the first direct cause of maternal death in most countries. In Africa and Asia, it accounts for about one third of all maternal deaths. Put more graphically: worldwide, one woman dies every minute from PPH. Defined as blood loss of ≥500 mL after vaginal birth or ≥1000 mL after cesarean delivery, PPH can be fatal in just two hours. In Cuba, between 2000 and 2012, maternal deaths directly related to obstetric causes totaled 410, 24.1% of which occurred postpartum, with PPH the leading cause.[1] While Cuba is among the Latin American countries with lowest maternal mortality, the decline has been slow over the last 20 years: in 1998, direct maternal mortality was 26.5 per 100,000 live births and in 2012, the rate was 21.5. This is troubling and deserves careful study, especially given that Cuba has a single, unified health system supported by significant political will-determining factors in important advances made in maternal-child health on par with wealthier countries.

  9. A Needs Assessment of Health Issues Related to Maternal Mortality Rates in Afghanistan: A Pilot Study.

    PubMed

    Naim, Ali; Feldman, Robert; Sawyer, Robin

    2015-01-01

    Maternal death rates in Afghanistan were among the highest in the world during the reign of the Taliban. Although these figures have improved, current rates are still alarming. The aim of this pilot study was to develop a needs assessment of the major health issues related to the high maternal mortality rates in Afghanistan. In-depth interviews were conducted with managerial midwives, clinical midwives, and mothers. Results of the interviews indicate that the improvement in the maternal mortality rate may be attributed to the increase in the involvement of midwives in the birthing process. However, barriers to decreasing maternal mortality still exist. These include transportation, access to care, and sociocultural factors such as the influence of the husband and mother-in-law in preventing access to midwives. Therefore, any programs to decrease maternal mortality need to address infrastructure issues (making health care more accessible) and sociocultural factors (including husbands and mother-in-laws in maternal health education). However, it should be noted that these findings are based on a small pilot study to help develop a larger scale need assessment.

  10. Impact of reproductive laws on maternal mortality: the chilean natural experiment.

    PubMed

    Koch, Elard

    2013-05-01

    Improving maternal health and decreasing morbidity and mortality due to induced abortion are key endeavors in developing countries. One of the most controversial subjects surrounding interventions to improve maternal health is the effect of abortion laws. Chile offers a natural laboratory to perform an investigation on the determinants influencing maternal health in a large parallel time-series of maternal deaths, analyzing health and socioeconomic indicators, and legislative policies including abortion banning in 1989. Interestingly, abortion restriction in Chile was not associated with an increase in overall maternal mortality or with abortion deaths and total number of abortions. Contrary to the notion proposing a negative impact of restrictive abortion laws on maternal health, the abortion mortality ratio did not increase after the abortion ban in Chile. Rather, it decreased over 96 percent, from 10.8 to 0.39 per 100,000 live births. Thus, the Chilean natural experiment provides for the first time, strong evidence supporting the hypothesis that legalization of abortion is unnecessary to improve maternal health in Latin America. PMID:24844146

  11. Impact of reproductive laws on maternal mortality: the chilean natural experiment.

    PubMed

    Koch, Elard

    2013-05-01

    Improving maternal health and decreasing morbidity and mortality due to induced abortion are key endeavors in developing countries. One of the most controversial subjects surrounding interventions to improve maternal health is the effect of abortion laws. Chile offers a natural laboratory to perform an investigation on the determinants influencing maternal health in a large parallel time-series of maternal deaths, analyzing health and socioeconomic indicators, and legislative policies including abortion banning in 1989. Interestingly, abortion restriction in Chile was not associated with an increase in overall maternal mortality or with abortion deaths and total number of abortions. Contrary to the notion proposing a negative impact of restrictive abortion laws on maternal health, the abortion mortality ratio did not increase after the abortion ban in Chile. Rather, it decreased over 96 percent, from 10.8 to 0.39 per 100,000 live births. Thus, the Chilean natural experiment provides for the first time, strong evidence supporting the hypothesis that legalization of abortion is unnecessary to improve maternal health in Latin America.

  12. Exploration and innovation in addressing maternal, infant and neonatal mortality.

    PubMed

    Khanal, L; Dawson, P; Silwal, R C; Sharma, J; Kc, N P; Upreti, S R

    2012-05-01

    The Government of Nepal has been remarkably progressive in introducing innovative community-based maternal newborn and child health interventions in an effort to address the major causes of maternal and child mortality in the country. This article describes the introduction of innovative interventions, including a review of the landmark research that precipitated the discussion and provided evidence of practical feasibility, the acceptance of the intervention concept and validity, the approval process and the introduction and results from the pilot interventions. These interventions, which include the use of misoprostol to prevent post partum haemorrhage during homebirths, Morang Innovative Neonatal Intervention, gentamicin in Uniject and for the management of neonatal sepsis and newborn vitamin A supplementation, are in various stages and demonstrate the responsiveness of the Government to new approaches that address the major causes of maternal and child mortality. PMID:23034368

  13. A New Method for Deriving Global Estimates of Maternal Mortality.

    PubMed

    Wilmoth, John R; Mizoguchi, Nobuko; Oestergaard, Mikkel Z; Say, Lale; Mathers, Colin D; Zureick-Brown, Sarah; Inoue, Mie; Chou, Doris

    2012-07-13

    Maternal mortality is widely regarded as a key indicator of population health and of social and economic development. Its levels and trends are monitored closely by the United Nations and others, inspired in part by the UN's Millennium Development Goals (MDGs), which call for a three-fourths reduction in the maternal mortality ratio between 1990 and 2015. Unfortunately, the empirical basis for such monitoring remains quite weak, requiring the use of statistical models to obtain estimates for most countries. In this paper we describe a new method for estimating global levels and trends in maternal mortality. For countries lacking adequate data for direct calculation of estimates, we employed a parametric model that separates maternal deaths related to HIV/AIDS from all others. For maternal deaths unrelated to HIV/AIDS, the model consists of a hierarchical linear regression with three predictors and variable intercepts for both countries and regions. The uncertainty of estimates was assessed by simulating the estimation process, accounting for variability both in the data and in other model inputs. The method was used to obtain the most recent set of UN estimates, published in September 2010. Here, we provide a concise description and explanation of the approach, including a new analysis of the components of variability reflected in the uncertainty intervals. Final estimates provide evidence of a more rapid decline in the global maternal mortality ratio than suggested by previous work, including another study published in April 2010. We compare findings from the two recent studies and discuss topics for further research to help resolve differences. PMID:24416714

  14. Addressing the sluggish progress in reducing maternal mortality in India.

    PubMed

    Rai, Rajesh Kumar; Tulchinsky, Theodore Herzl

    2015-03-01

    Although some progress has been made in India, achievement of the Fifth Millennium Development Goal (MDG5; ie, 75% reduction in maternal mortality ratio [MMR] from 1990 by 2015) target seems to be unattainable by 2015. Failure of the National Population Policy, 2000, and the National Health Policy, 2002, to reduce the MMR demanded a new direction, leading to the establishment of a National Rural Health Mission in 2005. This commentary addresses both the real achievements and the hurdles faced in India's stagnating progress in maternal health. Promotion of maternal nutrition and health education, with greater attention to emergency obstetrical care at the district subcenter and primary health care center levels, must be prioritized. These changes of focus are vital to make prenatal, delivery, and postnatal care safer with increased resources allotted to adolescents, the poor, and women living in rural areas in order to enhance maternal health and achieve the MDG target.

  15. Maternal mortality in a district hospital in West Bengal.

    PubMed

    Gun, K M

    1970-06-01

    To ascertain the causes of high maternal mortality in West Bengal, the author examined maternal mortality between 1964-68. It was intended that measures to improve the situation in rural areas could be suggested. Women in labor often arrive at the hospital very late and few antenatal care facilities are available in rural areas. High risk cases often are delivered at home, a situation which often results in fetal complications. Maternal deaths have declined, but not dramatically. Of the 24,265 deliveries at the Burdwan district hospital, there were 333 maternal deaths for an incidence of 13.7/1000, along with another 42 cases where death was due to pregnancy-associated causes. In contrast, the maternal mortality rate in a district hospital in Calcutta was 4/1000 in 1968. Eclampsia accounted for 42.34% (141) of maternal deaths making it the major cause of death. In Calcutta this cause of death is receding gradually but in the districts it still accounts for a heavy loss of life (an incidence of 1 in 38). Adequate antenatal care would reduce this high mortality. 2 factors which have contributed to the high mortality are the hours lost in transporting a patient from a rural area and inadequate hospital staff. Postpartum hemorrhage and/or retained placenta was responsible for 39 deaths and none of the cases admitted from outside had received antenatal care. A shortage of blood was also a contributory factor. Severe anemia was responsible for 34 deaths and abortions resulted in another 29 deaths (16 because of severe sepsis; 13 due to hemorrhage or shock). An emergency service would help reduce the number of deaths but at present such a service does not even exist in the urban areas. Ruptured uterus resulted in 29 deaths and obstructed labor in 27 deaths. Placenta previa brought about 14 deaths and the remaining 20 deaths were due to such causes as accidental hemorrhage (10), hydatidiform mole (4), puerperal sepsis (3), ectopic pregnancy (2), and uterine inversion (1

  16. [Epidemiology of maternal mortality by infectious cause in France, 2007-2009, using data from confidential maternal mortality report].

    PubMed

    Ghesquière, L; Deruelle, P; Charbonneau, P; Puech, F

    2015-01-01

    Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. Over the period 2007-2009, 18 deaths occurred, eight by direct infectious causes and 10 by indirect infectious causes. Among the 18 deaths, 17 were examined by the National Expert Committee on Maternal Mortality (CNEMM) with the objectives to determine the direct or indirect link with pregnancy, the adequacy of care and the preventability of death. Among 8 deaths from direct infectious causes, four deaths were deemed "preventable" or "possibly preventable" because of inadequate care. Among nine deaths from indirect infectious causes, preventability could not be established in two deaths, five were non-preventable and two were preventable due to non-optimal care. These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs.

  17. Maternal mortality in India: current status and strategies for reduction.

    PubMed

    Prakash, A; Swain, S; Seth, A

    1991-12-01

    The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the

  18. Success in reducing maternal and child mortality in Afghanistan.

    PubMed

    Rasooly, Mohammad Hafiz; Govindasamy, Pav; Aqil, Anwer; Rutstein, Shea; Arnold, Fred; Noormal, Bashiruddin; Way, Ann; Brock, Susan; Shadoul, Ahmed

    2014-01-01

    After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

  19. Causes of maternal mortality in rural Bangladesh, 1976-85.

    PubMed

    Fauveau, V; Koenig, M A; Chakraborty, J; Chowdhury, A I

    1988-01-01

    Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral. PMID:3264766

  20. Facility-based maternal death reviews: effects on maternal mortality in a district hospital in Senegal.

    PubMed Central

    Dumont, Alexandre; Gaye, Alioune; de Bernis, Luc; Chaillet, Nils; Landry, Anne; Delage, Joanne; Bouvier-Colle, Marie-Hélène

    2006-01-01

    OBJECTIVE: The improvement of obstetric services is one of the key components of the Safe Motherhood Programme. Reviewing maternal deaths and complications is one method that may make pregnancy safer, but there is no evidence about the effectiveness of this strategy. The objective of our before and after study is to assess the effect of facility-based maternal deaths reviews (MDR) on maternal mortality rates in a district hospital in Senegal that provides primary and referral maternity services. METHODS: We included all women who were admitted to the maternity unit for childbirth, or within 24 hours of delivery. We recorded maternal mortality during a 1-year baseline period from January to December 1997, and during a 3-year period from January 1998 to December 2000 after MDR had been implemented. Effects of MDR on organization of care were qualitatively evaluated. FINDINGS: The MDR strategy led to changes in organizational structure that improved life-saving interventions with a relatively large financial contribution from the community. Overall mortality significantly decreased from 0.83 (95% CI (confidence interval) = 0.60 -1.06) in baseline period to 0.41 (95% CI = 0.25 -0.56) per 100 women 3 years later. CONCLUSION: MDR had a marked effect on resources, management and maternal outcomes in this facility. However, given the design of our study and the local specific context, further research is needed to confirm the feasibility of MDR in other settings and to confirm the benefits of this approach for maternal health in developing countries. PMID:16583081

  1. [Maternal mortality: socio-demographic and causal profile].

    PubMed

    Riquinho, Deise Lisboa; Correia, Sandra Gomes

    2006-01-01

    This study had as an objective to evaluate the maternal death in the city of Porto Alegre (RS) at the years of 1999, 2000 and 2001. Made part of the population all the women between 10 and 49 years old who died during the pregnancy, on birth or one year from these events. The data was collected from the Information Team about Mortality (Equipe de Informação sobre Mortalidade) and from the Municipal Council of Studies and Prevention of the Maternal Deaths of Porto Alegre (Conselho Municipal de Estudos e Prevençăo das Mortes Maternas de Porto Alegre). The most frequent causes of the maternal death were: infection post-birth (15%) and hypertensive trouble of the pregnancy (15%), followed by illness of the circulatory system/Heart Attack (13%), septicemy (10%) and the causes related to the Acquired Immune Deficiency Syndrome (AIDS) (8%).

  2. Reducing maternal mortality in the eastern Mediterranean region.

    PubMed

    Mahaini, R; Mahmoud, H

    2005-07-01

    Current efforts in some countries of the Eastern Mediterranean Region are still insufficient to achieve the fifth Millennium Development Goal on improving maternal health. Strong commitment, intensive efforts and effective national policies and strategies are now urgently required in order to translate vision into action. Such efforts and plans should target the strengthening of health systems, the expansion in the coverage of effective integrated interventions, and the recognition of the essential role of individuals, families and communities in making pregnancy safer. This article provides a background on the current situation of maternal health in the Eastern Mediterranean Region, including underlying causes and contributing factors, and describes strategic directions aimed at accelerating the reduction of maternal mortality in the Region and moving closer to the achievement of the Millennium Development Goals.

  3. [Model for a comprehensive approach to maternal mortality and severe maternal morbidity].

    PubMed

    Karolinski, Ariel; Mercer, Raúl; Micone, Paula; Ocampo, Celina; Salgado, Pablo; Szulik, Dalia; Swarcz, Lucila; Corte, Vicente R; del Moral, Belén Fernández; Pianesi, Jorge; Balladelli, Pier Paolo

    2015-05-01

    Maternal mortality is an important public health and human rights problem and reflects the effects of social determinants on women's health. Understanding the extent and causes of maternal death has been insufficient to achieve the Millennium Development Goals. This article proposes a model for a comprehensive approach to maternal mortality, covering seven areas: prioritization and definition of the problem, contextual description, methodological scope, knowledge management, innovation, implementation, and a monitoring and evaluation system. This model helps address problems associated with maternal mortality and severe maternal morbidity through early monitoring of potentially fatal complications in the reproductive process. Knowledge management is important for the reorientation of policies, programs, and health care. Interaction and synergies among people, communities, and actors in the health system should be strengthened in order to improve the results of health programs. More validated scientific information is needed on how actions should be implemented in different environments. It is essential to strengthen communication among research centers, cooperation agencies, and government organizations and to include them in programs and in the definition of a new women's health agenda in the Region of the Americas. PMID:26208207

  4. Predicting In-Hospital Maternal Mortality in Senegal and Mali

    PubMed Central

    Ndour, Cheikh; Dossou Gbété, Simplice; Bru, Noelle; Abrahamowicz, Michal; Fauconnier, Arnaud; Traoré, Mamadou; Diop, Aliou; Fournier, Pierre; Dumont, Alexandre

    2013-01-01

    Objective We sought to identify predictors of in-hospital maternal mortality among women attending referral hospitals in Mali and Senegal. Methods We conducted a cross-sectional epidemiological survey using data from a cluster randomized controlled trial (QUARITE trial) in 46 referral hospitals in Mali and Senegal, during the pre-intervention period of the trial (from October 1st 2007 to October 1st 2008). We included 89,518 women who delivered in the 46 hospitals during this period. Data were collected on women's characteristics, obstetric complications, and vital status until the hospital discharge. We developed a tree-like classification rule (classification rule) to identify patient subgroups at high risk of maternal in-hospital mortality. Results Our analyses confirm that patients with uterine rupture, hemorrhage or prolonged/obstructed labor, and those who have an emergency ante-partum cesarean delivery have an increased risk of in-hospital mortality, especially if they are referred from another health facility. Twenty relevant patterns, based on fourteen predictors variables, are used to predict in-hospital maternal mortality with 81.41% sensitivity (95% CI = [77.12%–87.70%]) and 81.6% specificity (95% CI = [81.16%–82.02%]). Conclusion The proposed class association rule method will help health care professionals in referral hospitals in Mali and Senegal to identify mothers at high risk of in-hospital death, and can provide scientific evidence on which to base their decisions to manage patients delivering in their health facilities. PMID:23737972

  5. Success factors for reducing maternal and child mortality.

    PubMed

    Kuruvilla, Shyama; Schweitzer, Julian; Bishai, David; Chowdhury, Sadia; Caramani, Daniele; Frost, Laura; Cortez, Rafael; Daelmans, Bernadette; de Francisco, Andres; Adam, Taghreed; Cohen, Robert; Alfonso, Y Natalia; Franz-Vasdeki, Jennifer; Saadat, Seemeen; Pratt, Beth Anne; Eugster, Beatrice; Bandali, Sarah; Venkatachalam, Pritha; Hinton, Rachael; Murray, John; Arscott-Mills, Sharon; Axelson, Henrik; Maliqi, Blerta; Sarker, Intissar; Lakshminarayanan, Rama; Jacobs, Troy; Jack, Susan; Jacks, Susan; Mason, Elizabeth; Ghaffar, Abdul; Mays, Nicholas; Presern, Carole; Bustreo, Flavia

    2014-07-01

    Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond.

  6. One in Five Maternal Deaths in Bangladesh Associated with Acute Jaundice: Results from a National Maternal Mortality Survey.

    PubMed

    Shah, Rupal; Nahar, Quamrun; Gurley, Emily S

    2016-03-01

    We estimated the proportion of maternal deaths in Bangladesh associated with acute onset of jaundice. We used verbal autopsy data from a nationally representative maternal mortality survey to calculate the proportion of maternal deaths associated with jaundice and compared it to previously published estimates. Of all maternal deaths between 2008 and 2010, 23% were associated with jaundice, compared with 19% from 1998 to 2001. Approximately one of five maternal deaths was preceded by jaundice, unchanged in 10 years. Our findings highlight the need to better understand the etiology of these maternal deaths in Bangladesh.

  7. Evaluation of maternal mortality cases in the province of Elazig, Turkey, 2007-2013: a retrospective study.

    PubMed

    Burcin Kavak, Salih; Celik Kavak, Ebru; Demirel, Ismail; Turkoglu, Abdurrahim; Halil Akkus, Ibrahim; Ilhan, Rasit; Kaplan, Selcuk

    2014-08-31

    The aim of this study was to determine the causes and factors influencing maternal mortality. All maternal deaths occurring between January 2007 and November 2013 in the Elazig Province of Turkey were retrospectively investigated. The maternal age, obstetric history, cause of death, encountered delay model of each case, as well as the overall number of annual live births in the Province were determined. The information of cases was obtained from Directorate of Public Health and hospital records.  Families or family doctors were also interviewed to obtain details about the circumstances surrounding each death. There were a total of 64,423 live births in the Province of Elazig between 2007- 2013. The number and ratio of maternal deaths due to direct and indirect causes were 12 and 18.6, respectively. The direct causes of maternal death were hypertensive diseases of pregnancy (n=5, 41.7%), obstetric hemorrhages (n=3, 25%) and pulmonary embolism (n=1, 8.3%). The indirect causes of death were cardiac diseases (n=2, 16.7%) and malignancy (n=1, 8.3%). When classified according to the "Three Delays Model", 2 cases were in the first delay model and 3 cases in the third delay model; the second delay model led to no maternal deaths. Hypertensive diseases of pregnancy are the leading cause of maternal mortality in our province. The preventable causes of maternal mortality and factors contributing to death must be identified to reduce the incidence.

  8. [Maternal mortality: relation between directive management and opportune clinical care].

    PubMed

    Montesano-Delfín, Jesús Rafael; Hernández, Arturo; Zapién-Moreno, José; Olivares-Durán, Enrique; Guizar-Mendoza, Juan Manuel; Luna-Ruiz, Miguel Angel

    2009-01-01

    The authorities of the High Medical Specialized Units (HMSUs) Obstetric/Gynecology Service (OB/GYN) and Intensive Care Unit (ICU) elaborated a strategy, which included the organization and interrelation of both hospital services and the implementation of an Epidemiologic Monitoring Program for all critical complicated pregnancies. This plan consisted in an assignment of personnel for special care, immediate communication with heads of services to coordinate the attention and to facilitate the resources for medical attention in these patients, as well as daily follow up by the authorities until complete resolution. Through epidemiological monitoring, 274 cases of pregnant women with high risk of mortality were identified during 2005, and 437 during 2006 (increased 59 %). The admittance to ICU for this reason in 2003 was 17; in 2005 was 24 and in 2006 was 42 (147 % from 2003 to 2006). Maternal deaths diminished from: 3/17 (17.6 %) to 1/24 (4.1 %) to 2/42 (4.7 %) during the same years, respectively. The maternal death rate from 2004 to 2006 was: 33.2, 17.4, and 22 per 100,000 newborns, respectively, below the national and institutional average. The coordination between the Headquarters and the HMSUs that take care of obstetrical patients helped diminution maternal death over this period.

  9. Reducing maternal mortality from ruptured uterus--the Sokoto initiative.

    PubMed

    Ahmed, Y; Shehu, C E; Nwobodo, E I; Ekele, B A

    2004-06-01

    Uterine rupture is the most common cause of maternal mortality in our institution. Case fatality for the year 2001 was 47%. Health care including emergency obstetric care (EmOC) is not free, hence, delays in receiving care could occur in patients with limited resources. The objectives of the study were to promote access to emergency obstetric care through a loan scheme for indigent patients with ruptured uterus and determine the success or otherwise of the scheme. The scheme was initiated in January 2002, with the sum of thirty eight Thousand Naira (about 300 US dollars) by consultant obstetricians in the department. Funds were released to the patient only after assessment of her financial capability to enable her get emergency surgical packs. All that was required was a promise to pay back the loan before discharge. Following resuscitation, surgery was performed by one of the consultants. Eighteen cases of ruptured uterus have been managed. Treatment was initiated within 30 minutes of admission. Admission-laparotomy interval averaged 3.5 hours (+/-1.2). There were two maternal deaths, giving a case fatality of 11% (2/ 18). The case fatality from a previous study from the same centre was 38% (16/42). There was a significant difference in case fatality between the two studies (P<0.05; confidence limits are-0.328 and -0.211). Of the seventeen patients that benefited from the scheme, 16 repaid the loan before discharge (94% loan recovery). Only one patient defaulted with five thousand Naira (40 US dollars). A loan scheme for indigent patients with ruptured uterus that enabled them receive emergency obstetric care reduced case fatality. Loan recovery was good. In our quest to reduce maternal mortality in low-income countries without health insurance policies, there might be a need to extend similar initiative to other obstetric emergencies.

  10. Success factors for reducing maternal and child mortality

    PubMed Central

    Schweitzer, Julian; Bishai, David; Chowdhury, Sadia; Caramani, Daniele; Frost, Laura; Cortez, Rafael; Daelmans, Bernadette; de Francisco, Andres; Adam, Taghreed; Cohen, Robert; Alfonso, Y Natalia; Franz-Vasdeki, Jennifer; Saadat, Seemeen; Pratt, Beth Anne; Eugster, Beatrice; Bandali, Sarah; Venkatachalam, Pritha; Hinton, Rachael; Murray, John; Arscott-Mills, Sharon; Axelson, Henrik; Maliqi, Blerta; Sarker, Intissar; Lakshminarayanan, Rama; Jacobs, Troy; Jacks, Susan; Mason, Elizabeth; Ghaffar, Abdul; Mays, Nicholas; Presern, Carole; Bustreo, Flavia

    2014-01-01

    Abstract Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond. PMID:25110379

  11. A Systematic Review of Interventions to Reduce Maternal Mortality among HIV-Infected Pregnant and Postpartum Women

    PubMed Central

    Holtz, Sara A.; Thetard, Rudi; Konopka, Sarah N.; Albertini, Jennifer; Amzel, Anouk; Fogg, Karen P.

    2015-01-01

    Background: In high-prevalence populations, HIV-related maternal mortality is high with increased mortality found among HIV-infected pregnant and postpartum women compared to their uninfected peers. The scale-up of HIV-related treatment options and broader reach of programming for HIV-infected pregnant and postpartum women is likely to have decreased maternal mortality. This systematic review synthesized evidence on interventions that have directly reduced mortality among this population. Methods: Studies published between January 1, 2003 and November 30, 2014 were searched using PubMed. Of the 1,373 records screened, 19 were included in the analysis. Results: Interventions identified through the review include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A, and selenium), and antibiotics. ART during pregnancy was shown to reduce mortality. Timing of ART initiation, duration of treatment, HIV disease status, and ART discontinuation after pregnancy influence mortality reduction. Incident pregnancy in women already on ART for their health appears not to have adverse consequences for the mother. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality. Conclusions: ART was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment. Global Health Implications: Maternal mortality is a rare event that highlights challenges in measuring the impact of interventions on mortality. Developing effective patient-centered interventions to reduce maternal morbidity and mortality, as well as corresponding evaluation measures of their impact, requires further attention by policy makers

  12. A Systematic Review of Interventions to Reduce Maternal Mortality among HIV-Infected Pregnant and Postpartum Women

    PubMed Central

    Holtz, Sara A.; Thetard, Rudi; Konopka, Sarah N.; Albertini, Jennifer; Amzel, Anouk; Fogg, Karen P.

    2015-01-01

    Background: In high-prevalence populations, HIV-related maternal mortality is high with increased mortality found among HIV-infected pregnant and postpartum women compared to their uninfected peers. The scale-up of HIV-related treatment options and broader reach of programming for HIV-infected pregnant and postpartum women is likely to have decreased maternal mortality. This systematic review synthesized evidence on interventions that have directly reduced mortality among this population. Methods: Studies published between January 1, 2003 and November 30, 2014 were searched using PubMed. Of the 1,373 records screened, 19 were included in the analysis. Results: Interventions identified through the review include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A, and selenium), and antibiotics. ART during pregnancy was shown to reduce mortality. Timing of ART initiation, duration of treatment, HIV disease status, and ART discontinuation after pregnancy influence mortality reduction. Incident pregnancy in women already on ART for their health appears not to have adverse consequences for the mother. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality. Conclusions: ART was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment. Global Health Implications: Maternal mortality is a rare event that highlights challenges in measuring the impact of interventions on mortality. Developing effective patient-centered interventions to reduce maternal morbidity and mortality, as well as corresponding evaluation measures of their impact, requires further attention by policy makers

  13. Tracking maternal mortality declines in Mongolia between 1992 and 2007: the importance of collaboration

    PubMed Central

    Merialdi, Mario; Davaadorj, Ishnyam; Requejo, Jennifer Harris; Betrán, Ana Pilar; Ahmad, Asima; Nymadawa, Pagvajav; Erkhembaatar, Tudevdorj; Barcelona, Delia; Ba-thike, Katherine; Hagan, Robert J; Prado, Richard; Wagner, Wolf; Khishgee, Seded; Sodnompil, Tserendorj; Tsedmaa, Baatar; Jav, Baldan; Govind, Salik R; Purevsuren, Genden; Tsevelmaa, Baldan; Soyoltuya, Bayaraa; Johnson, Brooke R; Fajans, Peter; Van Look, Paul FA; Otgonbold, Altankhuyag

    2010-01-01

    Abstract Objective To describe the declining trend in maternal mortality observed in Mongolia from 1992 to 2007 and its acceleration after 2001 following implementation of the Maternal Mortality Reduction Strategy by the Ministry of Health and other partners. Methods We performed a descriptive analysis of maternal mortality data collected through Mongolia’s vital registration system and provided by the Mongolian Ministry of Health. The observed declining mortality trend was analysed for statistical significance using simple linear regression. We present the maternal mortality ratios from 1992 to 2007 by year and review the basic components of Mongolia’s Maternal Mortality Reduction Strategy for 2001–2004 and 2005–2010. Findings Mongolia achieved a statistically significant annual decrease in its maternal mortality ratio of almost 10 deaths per 100 000 live births over the period 1992–2007. From 2001 to 2007, the maternal mortality ratio in Mongolia decreased approximately 47%, from 169 to 89.6 deaths per 100 000 live births. Conclusion Disparities in maternal mortality represent one of the major persisting health inequities between low- and high-resource countries. Nonetheless, important reductions in low-resource settings are possible through collaborative strategies based on a horizontal approach and the coordinated involvement of key partners, including health ministries, national and international agencies and donors, health-care professionals, the media, nongovernmental organizations and the general public. PMID:20428386

  14. Costs of Inaction on Maternal Mortality: Qualitative Evidence of the Impacts of Maternal Deaths on Living Children in Tanzania

    PubMed Central

    Yamin, Alicia Ely; Boulanger, Vanessa M.; Falb, Kathryn L.; Shuma, Jane; Leaning, Jennifer

    2013-01-01

    Background Little is known about the interconnectedness of maternal deaths and impacts on children, beyond infants, or the mechanisms through which this interconnectedness is established. A study was conducted in rural Tanzania to provide qualitative insight regarding how maternal mortality affects index as well as other living children and to identify shared structural and social factors that foster high levels of maternal mortality and child vulnerabilities. Methods and Findings Adult family members of women who died due to maternal causes (N = 45) and key stakeholders (N = 35) participated in in-depth interviews. Twelve focus group discussions were also conducted (N = 83) among community leaders in three rural regions of Tanzania. Findings highlight the widespread impact of a woman’s death on her children’s health, education, and economic status, and, by inference, the roles that women play within their families in rural Tanzanian communities. Conclusions The full costs of failing to address preventable maternal mortality include intergenerational impacts on the nutritional status, health, and education of children, as well as the economic capacity of families. When setting priorities in a resource-poor, high maternal mortality country, such as Tanzania, the far-reaching effects that reducing maternal deaths can have on families and communities, as well as women’s own lives, should be considered. PMID:23990971

  15. Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti

    PubMed Central

    Smith-Greenaway, Emily; Thomas, Kevin

    2014-01-01

    Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the prevalence of migration in Haiti, it remains unknown whether Haitian women’s diverse patterns of migration influence their children’s health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers’ internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that, compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti’s rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration’s association with child health. PMID:25506111

  16. Knowledge gaps in scientific literature on maternal mortality: a systematic review.

    PubMed Central

    Gil-González, Diana; Carrasco-Portiño, Mercedes; Ruiz, Maria Teresa

    2006-01-01

    Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown. PMID:17143465

  17. Knowledge gaps in scientific literature on maternal mortality: a systematic review.

    PubMed

    Gil-González, Diana; Carrasco-Portiño, Mercedes; Ruiz, Maria Teresa

    2006-11-01

    Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown.

  18. [Maternal mortality in Brazil: what has the scientific literature shown in the last 30 years?].

    PubMed

    Morse, Marcia Lait; Fonseca, Sandra Costa; Barbosa, Mariane Doelinger; Calil, Manuele Bonatto; Eyer, Fernanda Pinella Carvalhal

    2011-04-01

    The aim of this study was to analyze maternal mortality in Brazil in the last 30 years, by means of a literature review. The authors performed an electronic search of scientific articles from 1980 to 2010 in LILACS and MEDLINE and found 486 abstracts, of which 50 articles were selected. Studies showed a decrease in the maternal mortality ratio (MMR), although varying across regions of the country. A few articles evaluated maternal mortality factors, identifying social inequalities associated with skin color and schooling. There was persistent underreporting of maternal deaths and inadequate completion of death certificates. Direct obstetric causes were the most frequent, mainly hypertensive diseases of pregnancy. Analysis of avoidability revealed deficiencies in prenatal and childbirth care. Despite the relevance of maternal mortality in Brazil, there are few studies on the subject. Although MMR has decreased, it is still above the desired levels. Improvements are thus needed in the quality of prenatal and perinatal care.

  19. The 2016 Hughes Lecture: What's new in maternal morbidity and mortality?

    PubMed

    Arendt, K W

    2016-05-01

    Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. This 2016 Hughes Lecture review article focuses specifically on the 2014 publications that relate to maternal morbidity and mortality. It begins by discussing the 2014 research that was published on severe maternal morbidity and maternal mortality in developed countries. This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world. PMID:26847944

  20. The 2016 Hughes Lecture: What's new in maternal morbidity and mortality?

    PubMed

    Arendt, K W

    2016-05-01

    Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. This 2016 Hughes Lecture review article focuses specifically on the 2014 publications that relate to maternal morbidity and mortality. It begins by discussing the 2014 research that was published on severe maternal morbidity and maternal mortality in developed countries. This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world.

  1. Applying the lessons of maternal mortality reduction to global emergency health.

    PubMed

    Calvello, Emilie J; Skog, Alexander P; Tenner, Andrea G; Wallis, Lee A

    2015-06-01

    Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions.

  2. Next steps to reduce maternal morbidity and mortality in the USA.

    PubMed

    Kilpatrick, Sarah J

    2015-03-01

    Maternal mortality is rising in the USA. The pregnancy-related maternal mortality ratio increased from 10/100,000 to 17/100,000 live births from the 1990s to 2012. A large proportion of maternal deaths are preventable. This review highlights a national approach to reduce maternal death and morbidity and discusses multiple efforts to reduce maternal morbidity, death and improve obstetric safety. These efforts include communication and collaboration between all stake holders involved in perinatal health, creation of national bundles addressing key maternal care areas such as hemorrhage management, call for all obstetric hospitals to review and analyze all cases of severe maternal morbidity, and access to contraception. Implementation of interventions based on these efforts is a national imperative to improve obstetric safety. PMID:25776293

  3. Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues Short title: U.S. Maternal Mortality Trends

    PubMed Central

    Declercq, Eugene; Cabral, Howard; Morton, Christine

    2016-01-01

    Background A pregnancy question was added to the U.S. standard death certificate in 2003 to improve ascertainment of maternal deaths. The delayed adoption of this question among states led to data incompatibilities, and impeded accurate trend analysis. Our objectives were to develop methods for trend analysis, and to provide an overview of U.S. maternal mortality trends from 2000–2014. Methods This observational study analyzed vital statistics maternal mortality data from all U.S. states in relation to the format and year-of-adoption of the pregnancy question. Correction factors were developed to adjust data from before the standard pregnancy question was adopted, to promote accurate trend analysis. Joinpoint regression was used to analyze trends for groups of states with similar pregnancy questions. Results The estimated maternal mortality rate (per 100,000 live births) for 48 states and Washington D.C. (excluding California and Texas, analyzed separately) increased by 26.6%, from 18.8 in 2000 to 23.8 in 2014. California showed a declining trend, while Texas had a sudden increase in 2011–2012. Analysis of the measurement change suggests that U.S. rates in the early 2000s were higher than previously reported. Discussion Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington D.C. increased from 2000–2014, while the international trend was in the opposite direction. There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year. PMID:27500333

  4. Maternal Mortality at Federal Medical Centre Yola, Adamawa State: A Five-Year Review

    PubMed Central

    Bukar, M; Kunmanda, V; Moruppa, JY; Ehalaiye, B; Takai, UI; Ndonya, DN

    2013-01-01

    Background: The North Eastern region of Nigeria has one of the highest maternal mortality ratios (MMRs) in the world, and most of these deaths are preventable. Culture, religion and customs that prevent access to care contribute immensely to these deaths. Aim: To review and document the MMR. Materials and Methods: This was a retrospective study of all maternal deaths recorded at the Federal Medical Centre Yola (FMCY). The case notes of all cases of maternal deaths from January 2007 to December 2011 were retrieved and relevant data obtained and analyzed. The age, parity, literacy level, booking status, causes of maternal deaths, were analysed. Data were presented in tables and percentages, using SPSS version 16(Chicago, USA 2006). Results: There were 54 maternal deaths among the 8497 deliveries, giving an overall MMR of 636 per 100,000 deliveries. Thirty three folders (33) folders were retrieved and 28 had complete information for analysis. The mean (SD) age and parity were 28.2 (6.2) and 3.4 (2.0), respectively. Most deaths (9/28; 32.1%) were in the age group of 20-24 years. Multiparae (14/28; 50%) constituted the largest parity group. Majority (16/28; 57.1) were non-literates, 16/28 (57.1%) were of Hausa/Fulani extraction and 12/28 (42.9%) were unbooked. The leading causes of maternal mortality were preeclampsia/eclampsia (9/28; 32.1%), obstetric hemorrhage (8/28; 28.6%) and severe anemia (3/28; 10.7%). All those who died of preeclampsia/eclampsia were Hausa/Fulani. Most (14/28; 50%) deaths occurred within 24 h of admission. Majority of the deaths were Muslims (χ2 = 15.108, P = <0.001). Ethnicity had no significant influence on maternal death (χ2 = 15.550, P = 0.21). Conclusion: In conclusion, the MMR in FMCY is higher than the national average. The fact that most deaths occurred within 24 h of admission suggests that many of the patients delayed reaching the referring center for a variety of reasons. Preventive measures should focus on this delay, which is

  5. Maternal mortality in a subdivisional hospital of eastern Himalayan region.

    PubMed

    Ray, A

    1992-05-01

    This study was conducted in a subdivisional hospital of eastern Himalayan region among 5,273 pregnant women over a period of 8 years. There were 29 deaths, the maternal mortality rate was 55 per 10,000. Septic abortion was encountered in 4 among them. Direct obstetric cause was responsible in 72.41% of cases and indirect cause in 27.59% cases. Sepsis, both puerperal and postabortal resulted in 24.14% followed by postpartum haemorrhage in 20.69%. Two of these cases were associated with inversion of the uterus. Preeclampsia caused 10.34% and eclampsia 6.9% of the deaths. Among the indirect causes severe anaemia and pulmonary tuberculosis accounted for 10.34% and 6.9% respectively. Infective hepatitis was the cause in 6.9% cases. Only 17% of the cases were booked and the rest were unbooked. Majority of the cases (62.07%) belonged to the age group of 20-30 years. Primigravida constituted 41.38% of the cases. PMID:1517613

  6. Maternal and child mortality indicators across 187 countries of the world: converging or diverging.

    PubMed

    Goli, Srinivas; Arokiasamy, Perianayagam

    2014-01-01

    This study reassessed the progress achieved since 1990 in maternal and child mortality indicators to test whether the progress is converging or diverging across countries worldwide. The convergence process is examined using standard parametric and non-parametric econometric models of convergence. The results of absolute convergence estimates reveal that progress in maternal and child mortality indicators is diverging for the entire period of 1990-2010 [maternal mortality ratio (MMR) - β = .00033, p < .574; neonatal mortality rate (NNMR) - β = .04367, p < .000; post-neonatal mortality rate (PNMR) - β = .02677, p < .000; under-five mortality rate (U5MR) - β = .00828, p < .000)]. In the recent period, such divergence is replaced with convergence for MMR but diverged for all the child mortality indicators. The results of Kernel density estimate reveal considerable reduction in divergence of MMR for the recent period; however, the Kernel density distribution plots show more than one 'peak' which indicates the emergence of convergence clubs based on their mortality levels. For child mortality indicators, the Kernel estimates suggest that divergence is in progress across the countries worldwide but tended to converge for countries with low mortality levels. A mere progress in global averages of maternal and child mortality indicators among a global cross-section of countries does not warranty convergence unless there is a considerable reduction in variance, skewness and range of change. PMID:24593038

  7. Reduction of maternal mortality due to preeclampsia in Colombia-an interrupted time-series analysis

    PubMed Central

    Herrera-Medina, Rodolfo; Herrera-Escobar, Juan Pablo; Nieto-Díaz, Aníbal

    2014-01-01

    Introduction: Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002 - 2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR=0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR=0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations. PMID:24970956

  8. Maternal mortality in a teaching hospital in southern India. A 13-year study.

    PubMed

    Rao, K B

    1975-10-01

    During the 13 years 1960-1972, in a teaching hospital that serves a predominantly rural and semiurban population in southern India, there were 74,384 deliveries and 1245 maternal deaths, a maternal mortality rate of 16.7 per 1000 births. Direct obstetric factors caused 854 (65.5%) of these deaths. The leading indirect or associated causes of maternal deaths were anemia, cerebrovascular accidents, and infectious hepatitis. During the past 13 years, monthly maternal mortality meetings have helped to reduce the incidence of avoidable factors in maternal deaths among patients from the city but not among those brought from the surrounding countryside. The important causes of maternal deaths in this developing country, and their prevention, are individually discussed. PMID:1080844

  9. Risk factors for maternal mortality in five Kampala hospitals, 1980-1986.

    PubMed

    Kampikaho, A; Irwig, L M

    1990-12-01

    A case-control study assessing risk factors for maternal mortality was carried out in five Kampala hospitals covering a period of seven years (1 January 1980 to 31 December 1986). The major predictors of maternal mortality were the general condition on admission, the mode of delivery and the Apgar score of the newborn. These predictors indicate that women at high risk were those admitted to hospital for delivery in a poor state of health. We believe that the risk of maternal mortality can be reduced through appropriate action by health workers and that there is a need for a more complete view of risk factors for both maternal and perinatal mortality to be obtained through population-based studies rather than only those women who deliver in hospital.

  10. Maternal mortality in the developed world: lessons from the UK confidential enquiry.

    PubMed

    de Swiet, Michael

    2008-09-01

    The UK confidential maternal mortality enquiry shows that not only has maternal mortality decreased since 1952, the year of the first enquiry, but also the pattern of maternal mortality has changed markedly. Major surgical causes of death, such as post-partum haemorrhage and ruptured uterus, are no longer as important as medical causes such as heart disease. The 'Top Ten' recommendations in the current report for the years 2003-2005 emphasise the need for health care practitioners to be aware of the risks that medical conditions, both pre-existing and those arising de novo in pregnancy, impose on the expectant and newly delivered mother. Training and further education programmes should emphasise the importance of medical problems in pregnancy without omitting the knowledge and skills in basic obstetrics that have made such an impact on maternal mortality in the past. PMID:27630739

  11. Maternal mortality in the developed world: lessons from the UK confidential enquiry

    PubMed Central

    de Swiet, Michael

    2008-01-01

    The UK confidential maternal mortality enquiry shows that not only has maternal mortality decreased since 1952, the year of the first enquiry, but also the pattern of maternal mortality has changed markedly. Major surgical causes of death, such as post-partum haemorrhage and ruptured uterus, are no longer as important as medical causes such as heart disease. The ‘Top Ten’ recommendations in the current report for the years 2003–2005 emphasise the need for health care practitioners to be aware of the risks that medical conditions, both pre-existing and those arising de novo in pregnancy, impose on the expectant and newly delivered mother. Training and further education programmes should emphasise the importance of medical problems in pregnancy without omitting the knowledge and skills in basic obstetrics that have made such an impact on maternal mortality in the past. PMID:27630739

  12. [The analysis of maternal mortality in the Republic of Sakha (Yakutiya)].

    PubMed

    Savvina, N V; Yavorskiy, A A; Platonova, M V

    2014-01-01

    In the Republic of Sakha (Yakutiya) a stable increase of indicator of birth rate was marked during 1990-2012. Against the background of increase of indicator of birth rate the indicator of maternal mortality has a positive tendency to decrease. During 1990-2012, indicator of maternal mortality decreased from 560.8 to 29.4 per 100 000 of born alive. In the structure of causes of maternal mortality the percentage of direct obstetric causes of death decreased i.e. toxicosis on 18%, bleeding on 82%, sepsis on 9.1%. During 2007-2012 no death case was detected. The increase of specific weight of unavoidable causes made up to 25% of obstetrical embolism, 5% in the structure of causes of maternal mortality was attached to extra-genital diseases in 2007-2012. The percentage of deceased because of complications of anesthesia increased (1.5-5%).

  13. Aetiology of maternal mortality using verbal autopsy at Sokoto, North-Western Nigeria

    PubMed Central

    Umar, Sadiq

    2013-01-01

    Abstract Background Maternal mortality in developing countries is higher than that in developed countries. There are few published articles on the factors associated with maternal deaths in northern Nigeria. Objectives The objective of this study was to identify the medical causes and factors associated with maternal mortality in Sokoto, northern Nigeria. Method A verbal autopsy questionnaire was used to interview close relatives of women within the reproductive age group who had died of pregnancy-related complications in the Sokoto metropolis during the preceding two years. A multistage sampling method using simple random sampling at each step was used to select areas of study within the Sokoto metropolis. Data analysis was carried out using a statistical package for social sciences (SPSS), version 19, and the Spearman correlation was used to test association. Significance level was set at 0.05. Results The major causes of death were haemorrhage (48.3%), eclampsia (19%) and prolonged labour (13.8%). The association between maternal mortality and the absence of antenatal booking was significant (p < 0.001); the association between maternal mortality and the ‘three delays’ was also significant (p = 0.013). The association between maternal mortality and educational status and occupation was, however, not significant (p = 0.687 and p = 0.427 respectively). Conclusion The medical causes of maternal mortality identified in this study were similar to those of the hospital-based studies in the area. In addition, an association between maternal deaths and the ‘three delays’ and the absence of antenatal booking was found. There is a need for public education efforts to address these factors in order to reduce maternal mortality in the study area.

  14. Maternal mortality in seven districts of Uttar Pradesh--an ICMR task force study.

    PubMed

    Gupta, N; Kumar, S; Saxena, N C; Nandan, Deoki; Saxena, B N

    2006-01-01

    Maternal mortality is a major health and development concern. The available information on maternal mortality in rural India is inadequate and scanty. This study presented maternal mortality data from the demographically and developmentally (including for health) poor performing state of Uttar Pradesh. A descriptive, cross-sectional survey was conducted utilizing a stratified cluster sampling design between 1989-90 in eight districts of Uttar Pradesh. Four good performing districts namely, Agra, Farrukhabad, Ghaziabad and Badaun from the western region and four poor performing districts from the eastern region namely, Gorakhpur, Basti, Varanasi and Pratapgarh were chosen. A door-to-door household interview survey was carried out in the selected villages covering a population of 11.67 lakhs in 889 villages. Maternal mortality rates during 1989 ranged between 533745 per 100,000 live births except in Ghaziabad district where the rate was as low as 101 per 100,000 live births. The rate in Eastern U.P. was higher (573 per 100,000 live births) as compared to that in Western U.P. (472 per 100,000 live births). A total of 286 maternal deaths were reported during the study period. The direct obstetric causes accounted for 55.7% of maternal deaths with haemorrhage (26.4%) being the most prevalent. Anaemia and jaundice (17.4%) were the most prevalent indirect causes of maternal deaths. Most of the maternal deaths could have been prevented if timely medical care was available. PMID:17191404

  15. Maternal mortality in the government hospitals, West Malaysia 1967-1969.

    PubMed

    Ariffin Bin Marzuki; Thambu, J A

    1973-03-01

    The attempt was made to determine the factors responsible for the maternal deaths in the government hospitals of West Malaysia over the 1967-1969 period. The study covered all maternal deaths in the government hospitals during this 2-year period. Despite an increase in the number of deliveries in government hospitals from 83,654 in 1964 to 92,583 in 1969, the maternal mortality had declined from 27/10,000 to 22/10,000. The maternal mortality rate in government hospitals was higher than the national maternal mortality rate because of the practice of referring all abnormal obstetric cases to hospitals for management. Hemorrhage continued as the primary cause of maternal deaths with toxemia as the 2nd important cause and infection as the 3rd. In the rural areas midwives found postpartum hemorrhage a major problem because of the coexistence of anemia in pregnancy. Other complications of pregnancy, childbirth and puerperium included obstructed and neglected labors due to cephalo-pelvic disproportion, abnormal lie, and presentation and ruptured uterus referred from the rural areas to the hospitals. Hypertension was the most important cause in the associated maternal diseases. The following are included among the steps taken by the government to reduce maternal mortality: 1) development of an excellent infrastructure of health units; 2) a training program for midwives; and 3) a plan to integrate the family planning services with the health services.

  16. Audit of maternal mortality ratio and causes of maternal deaths in the largest maternity hospital in Cairo, Egypt (Kasr Al Aini) in 2008 and 2009: lessons learned.

    PubMed

    Saleh, Wael F; Ragab, Wael S; Aboulgheit, Samah S

    2013-09-01

    This study examined maternal deaths at Cairo University Maternity Hospital between January 2008 and December 2009. The aim was to calculate Maternal Mortality Ratio (MMR) as well as identify the causes and predisposing factors to maternal deaths. Data were collected from the files of the hospitalized pregnant women in the hospital. There were 38 maternal deaths and MMR was 79 per 100,000 live births for the two years examined. The main causes of death were obstetric hemorrhage, hypertensive disorders of pregnancy and cardiac arrest. Substandard medical care and the delay in seeking of medical advice were two contributing factors to maternal deaths recorded. The need for audit and publication of all obstetric hospitals MMR to compare and identify areas of improvements is recommended.

  17. Investigating Maternal Mortality in a Public Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

    PubMed Central

    Ezegwui, HU; Onoh, RC; Ikeako, LC; Onyebuchi, A; Umeora, OUJ; Ezeonu, P; Ibekwe, P

    2013-01-01

    Background: Maternal mortality in sub-Saharan Africa has remained high and this is a reflection of the poor quality of maternal services. Aim: To determine the causes, trends, and level of maternal mortality rate in Abakaliki, Ebonyi. Materials and Methods: This was a review of the records of all maternal deaths related to pregnancy over a ten-year period, that is, January 1999 to December 2008. Relevant information on number of deaths, booking status, age, parity, educational level of women, mode of delivery, and causes of death were extracted and analyzed. Results: During the study period, there were 12,587 deliveries and 171 maternal deaths. The maternal mortality ratio (MMR) was 1,359 per 100,000 live births. The trend over the period was lowest in 2008 and highest in 1999 with an MMR of 757 per 100,000 live births and 4,000 per 100,000 live births, respectively. There was a progressive decline in the MMR over the period of study except in the years 2003 and 2006, when the ratio spiked a little, giving an MMR of 1,510 per 100,000 live births and 1,290 per 100,000 live births, respectively. The progressive decline in maternal mortality corresponded with the time that free maternal services were introduced. Hemorrhage was the most important cause of maternal death, accounting for 23.0% (38/165), whereas diabetic ketoacidosis, congestive cardiac failure, and asthma in pregnancy were the least important causes of maternal deaths, each accounting for 0.6% (1/165). Majority of the maternal deaths occurred in unbooked patients (82.4% (136/165)), whereas 17.6% (29/165) of the deaths occurred in booked cases. Forty-seven (28.5% (47/165)) patients died following a cesarean section, 8.5% (14/165) died as a result of abortion complications, and 10.9% (18/165) died undelivered. Seventy-seven (46.7% (77/165)) of the maternal death patients had no formal education. Low socioeconomic status, poor educational level, and grand multiparity were some of the risk factors for

  18. Global progress and potentially effective policy responses to reduce maternal mortality.

    PubMed

    Mbizvo, Michael T; Say, Lale

    2012-10-01

    Reducing maternal mortality within significant margins is a global imperative that reflects attainment of development goals. Progress in reducing maternal mortality, in particular among countries with notably high maternal mortality ratios (MMRs), has been substantially slower than the Millennium Development Goal target of an annual rate of 5.5% decline. The latest UN maternal mortality estimates show a reduction in MMR in a number of countries between 1990 and 2008. Understanding the factors associated with progress in countries that have reduced maternal mortality provides other countries and development partners with opportunities to consider and implement policies and interventions that could help accelerate progress. This paper reviews 6 countries that have demonstrated marked progress. The policies that have been effective include innovative financing measures; investment in human resources both in terms of strengthening pre-service education and emphasizing in-service training for healthcare providers; strengthening obstetric care by enhancing infrastructure and upgrading equipment, as well as improving quality of services; and investing in the broader determinants of maternal mortality, particularly family planning and women's education and socioeconomic empowerment. This range of actions, which includes a combination of facility and community-based approaches, provides a list of potentially effective strategies that could be considered when developing programs in other countries with slower progress. Strong political will and multistakeholder involvement and interventions are key in the development and implementation of these policies and actions.

  19. Influences of Maternal Care on Chicken Welfare

    PubMed Central

    Edgar, Joanne; Held, Suzanne; Jones, Charlotte; Troisi, Camille

    2016-01-01

    Simple Summary For a domestic chick, the mother hen is an important role model; chicks learn a great deal from their mother about what to peck, when to rest and how to behave when there is a threat. However, in large farms, natural brooding is not commercially viable and so chicks are hatched in large incubators and reared artificially. Chicks reared without a mother in this way are more fearful and more likely to develop behavioural problems, such as feather pecking. We discuss the important features of maternal care in chickens, the behavioural consequences of deprivation, and the welfare implications on commercial farms. We finish by suggesting ways to simulate natural maternal care to improve commercial chick rearing practice. Abstract In domestic chickens, the provision of maternal care strongly influences the behavioural development of chicks. Mother hens play an important role in directing their chicks’ behaviour and are able to buffer their chicks’ response to stressors. Chicks imprint upon their mother, who is key in directing the chicks’ behaviour and in allowing them to develop food preferences. Chicks reared by a mother hen are less fearful and show higher levels of behavioural synchronisation than chicks reared artificially. In a commercial setting, more fearful chicks with unsynchronised behaviour are more likely to develop behavioural problems, such as feather pecking. As well as being an inherent welfare problem, fear can also lead to panic responses, smothering, and fractured bones. Despite the beneficial effects of brooding, it is not commercially viable to allow natural brooding on farms and so chicks are hatched in large incubators and reared artificially, without a mother hen. In this review we cover the literature demonstrating the important features of maternal care in domestic chickens, the behavioural consequences of deprivation and the welfare implications on commercial farms. We finish by suggesting ways to use research in natural

  20. Measuring maternal mortality: An overview of opportunities and options for developing countries

    PubMed Central

    Graham, WJ; Ahmed, S; Stanton, C; Abou-Zahr, CL; Campbell, OMR

    2008-01-01

    Background There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015. Methods Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts. Results There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates. Conclusion Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act. PMID:18503716

  1. Maternal mortality in Bahrain 1987-2004: an audit of causes of avoidable death.

    PubMed

    Sandhu, A K; Mustafa, F E

    2008-01-01

    The aim of this report was to establish the national maternal mortality rate in Bahrain over the period 1987-2004, to identify preventable factors in maternal deaths and to make recommendations for safe motherhood. There were 60 maternal deaths out of 243 232 deliveries giving an average maternal mortality rate of 24.7 per 100 000 total births. The main causes of death were sickle-cell disease (25.0%), hypertension (18.3%), embolism (13.3%), haemorrhage (13.3%), heart disease (11.7%), infection (8.3%) and other (10.0%). In an audit of care, 17 (28.3%) out of 60 deaths were judged to be avoidable, nearly half of which were due to a shortage of intensive care beds. We recommend that a confidential enquiry of maternal deaths be conducted at the national level every 3 to 5 years.

  2. Threats to safe motherhood in Honduran Miskito communities: local perceptions of factors that contribute to maternal mortality.

    PubMed

    Arps, Shahna

    2009-08-01

    Despite global initiatives to lower rates of maternal death, barriers to safe motherhood persist, particularly in socially and economically marginalized communities. This article describes the risks that women in Honduran Miskito villages encounter during pregnancy and childbirth. Ethnographic data are used to examine emic understandings of the underlying causes of maternal death. Participant observation, four community discussions, individual interviews with 218 women and five midwives, and a maternal mortality survey were conducted during November 2004 through November 2005. Case studies are drawn from the 55 death histories collected during the survey to illustrate the factors that contribute to maternal mortality. Community members identified poverty, gender inequality, witchcraft, and sorcery as major threats to safe motherhood. All of these factors influence women's health-related behaviors; and therefore, each issue deserves attention from public health officials. Designing appropriate interventions to improve maternal health depends on understanding the forces that increase women's vulnerability during pregnancy and childbirth. Local perspectives of risk, even when they diverge from biomedical understandings, point to specific needs, issues to address, and avenues for effective intervention.

  3. Maternal mortality in resource-poor settings: policy barriers to care.

    PubMed

    Mavalankar, Dileep V; Rosenfield, Allan

    2005-02-01

    Maternal mortality remains one of the most daunting public health problems in resource-poor settings, and reductions in maternal mortality have been identified as a prominent component of the United Nations Millennium Development Goals. The World Health Organization estimates that 515000 women die each year from pregnancy-related causes, and almost all of these deaths occur in developing countries. Evidence has shown that access to and utilization of high-quality emergency obstetric care (EmOC) is central to efforts aimed at reducing maternal mortality. We analyzed health care policies that restrict access to life-saving EmOC in most resource-poor settings, focusing on examples from rural India, a country of more than 1 billion people that contributes approximately 20% to 24% of the world's maternal deaths. PMID:15671450

  4. Maternal Mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey

    PubMed Central

    Montgomery, Ann L.; Ram, Usha; Kumar, Rajesh; Jha, Prabhat

    2014-01-01

    Background Data on cause-specific mortality, skilled birth attendance, and emergency obstetric care access are essential to plan maternity services. We present the distribution of India's 2001–2003 maternal mortality by cause and uptake of emergency obstetric care, in poorer and richer states. Methods and Findings The Registrar General of India surveyed all deaths occurring in 2001–2003 in 1.1 million nationally representative homes. Field staff interviewed household members about events that preceded the death. Two physicians independently assigned a cause of death. Narratives for all maternal deaths were coded for variables on healthcare uptake. Distribution of number of maternal deaths, cause-specific mortality and uptake of healthcare indicators were compared for poorer and richer states. There were 10 041 all-cause deaths in women age 15–49 years, of which 1096 (11.1%) were maternal deaths. Based on 2004–2006 SRS national MMR estimates of 254 deaths per 100 000 live births, we estimated rural areas of poorer states had the highest MMR (397, 95%CI 385–410) compared to the lowest MMR in urban areas of richer states (115, 95%CI 85–146). We estimated 69 400 maternal deaths in India in 2005. Three-quarters of maternal deaths were clustered in rural areas of poorer states, although these regions have only half the estimated live births in India. Most maternal deaths were attributed to direct obstetric causes (82%). There was no difference in the major causes of maternal deaths between poorer and richer states. Two-thirds of women died seeking some form of healthcare, most seeking care in a critical medical condition. Rural areas of poorer states had proportionately lower access and utilization to healthcare services than the urban areas; however this rural-urban difference was not seen in richer states. Conclusions Maternal mortality and poor access to healthcare is disproportionately higher in rural populations of the poorer states of India. PMID

  5. Maternal Mortality among Tribal Women at a Tertiary Level of Care in Bastar, Chhattisgarh

    PubMed Central

    Chauhan, Prabha; Chauhan, V. K. S.; Shrivastava, Praveen

    2012-01-01

    Objectives: The primary objective of this study is to study Maternal Mortality as per Gravidity among Tribal women at a tertiary level of care in Bastar, Chhattisgarh, India. Materials and Methods: This is a hospital based, retrospective, reproductive-age mortality study (RAMOS) of tribal women of Bastar region, Chhattisgarh, that were admitted and managed in Obstetrics and Gynecology Department Govt. Medical College, Jagdalpur, Bastar, Chhattisgarh, between July 2007 and October 2011. There were total 120 cases. Result: Results of the present study showed that among 120 deceased tribal women highest maternal mortality 65 cases (54.166%) was noted in Primigravida (Nullipara G1P0), second highest maternal mortality 44 cases (38.333%) was noted in 2nd to 4th Gravida (Multipara), 10 cases (8.333%) were in 6th and 7th Grand Multigravida (Grand Multipara), and 01 case (0.833%) was in 8th Great Grand Multigravida. Direct causes of maternal mortality were highest 46 cases (38.333%) due to hypertensive disorders of pregnancy. Among direct causes second highest 18 cases (14.999%) maternal mortality were due to Rupture Uterus, third highest 12 cases (09.999%) of Septicemia, 06 cases (04.999%) of obstructed labor, 06 (04.999%) of Hemorrhage, 02 cases (01.666%) of unsafe Abortion, 02 cases (01.666%) of Pulmonary Embolism and 01 case (0.833%) due to Aspiration. Indirect causes of maternal mortality maximum 15 cases (12.5%) of Malaria and 10 cases (08.333%) were due to Anemia and 02 cases (01.666%) were of Sickle cell Anemia. The result of the present study showed that in tertiary level of care of Bastar in the year 2007 – 2008, 2008 - 2009, 2009 – 2010 and 2010 - 2011 the total maternal deaths were 34 (n=34); 35 (n=35); 27 (n=27) and 26 (n=26) respectively. The Maternal Mortality Ratio was 1611.876; 1615.881; 1168.325 and 1000.769 Per 1, 00,000 live births in the year 2007- 2008; 2008 - 2009; 2009 – 2010 and 2010 - 2011 respectively. In the year 2007 - 2008, maternal

  6. Influences of Maternal Care on Chicken Welfare.

    PubMed

    Edgar, Joanne; Held, Suzanne; Jones, Charlotte; Troisi, Camille

    2016-01-05

    In domestic chickens, the provision of maternal care strongly influences the behavioural development of chicks. Mother hens play an important role in directing their chicks' behaviour and are able to buffer their chicks' response to stressors. Chicks imprint upon their mother, who is key in directing the chicks' behaviour and in allowing them to develop food preferences. Chicks reared by a mother hen are less fearful and show higher levels of behavioural synchronisation than chicks reared artificially. In a commercial setting, more fearful chicks with unsynchronised behaviour are more likely to develop behavioural problems, such as feather pecking. As well as being an inherent welfare problem, fear can also lead to panic responses, smothering, and fractured bones. Despite the beneficial effects of brooding, it is not commercially viable to allow natural brooding on farms and so chicks are hatched in large incubators and reared artificially, without a mother hen. In this review we cover the literature demonstrating the important features of maternal care in domestic chickens, the behavioural consequences of deprivation and the welfare implications on commercial farms. We finish by suggesting ways to use research in natural maternal care to improve commercial chick rearing practice.

  7. Medical disease as a cause of maternal mortality: the pre-imminence of cardiovascular pathology.

    PubMed

    Mocumbi, A O; Sliwa, K; Soma-Pillay, P

    2016-01-01

    Maternal mortality ratio in low- to middle-income countries (LMIC) is 14 times higher than in high-income countries. This is partially due to lack of antenatal care, unmet needs for family planning and education, as well as low rates of birth managed by skilled attendants. While direct causes of maternal death such as complications of hypertension, obstetric haemorrhage and sepsis remain the largest cause of maternal death in LMICs, cardiovascular disease emerges as an important contributor to maternal mortality in both developing countries and the developed world, hampering the achievement of the millennium development goal 5, which aimed at reducing by three-quarters the maternal mortality ratio until the end of 2015. Systematic search for cardiac disease is usually not performed during pregnancy in LMICs despite hypertensive disease, rheumatic heart disease and cardiomyopathies being recognised as major health problems in these settings. New concern has been rising due to both the HIV/AIDS epidemic and the introduction of highly active antiretroviral therapy. Undetected or untreated congenital heart defects, undiagnosed pulmonary hypertension, uncontrolled heart failure and complications of sickle cell disease may also be important challenges. This article discusses issues related to the role of cardiovascular disease in determining a substantial portion of maternal morbidity and mortality. It also presents an algorhitm to be used for suspected and previously known cardiac disease in pregnancy in the context of LIMCs. PMID:27213855

  8. Medical disease as a cause of maternal mortality: the pre-imminence of cardiovascular pathology.

    PubMed

    Mocumbi, A O; Sliwa, K; Soma-Pillay, P

    2016-01-01

    Maternal mortality ratio in low- to middle-income countries (LMIC) is 14 times higher than in high-income countries. This is partially due to lack of antenatal care, unmet needs for family planning and education, as well as low rates of birth managed by skilled attendants. While direct causes of maternal death such as complications of hypertension, obstetric haemorrhage and sepsis remain the largest cause of maternal death in LMICs, cardiovascular disease emerges as an important contributor to maternal mortality in both developing countries and the developed world, hampering the achievement of the millennium development goal 5, which aimed at reducing by three-quarters the maternal mortality ratio until the end of 2015. Systematic search for cardiac disease is usually not performed during pregnancy in LMICs despite hypertensive disease, rheumatic heart disease and cardiomyopathies being recognised as major health problems in these settings. New concern has been rising due to both the HIV/AIDS epidemic and the introduction of highly active antiretroviral therapy. Undetected or untreated congenital heart defects, undiagnosed pulmonary hypertension, uncontrolled heart failure and complications of sickle cell disease may also be important challenges. This article discusses issues related to the role of cardiovascular disease in determining a substantial portion of maternal morbidity and mortality. It also presents an algorhitm to be used for suspected and previously known cardiac disease in pregnancy in the context of LIMCs.

  9. Maternal mortality in different Pakistani sites: ratios, clinical causes and determinants.

    PubMed

    Fikree, F F; Midhet, F; Sadruddin, S; Berendes, H W

    1997-08-01

    To determine the magnitude of and factors associated with maternal mortality in Pakistan, population-based surveys were conducted in selected clusters in Karachi, Balochistan, and North West Frontier Provinces during 1989-92. Questionnaires were administered to 38,563 households and verbal autopsy questionnaires were conducted when a maternal death was reported. The overall maternal mortality ratio was 433 per 100,000 live births, with a range from 281 in Karachi to 673 in Balochistan. The leading causes of death were hemorrhage (52.9%), puerperal sepsis (16.3%), and eclampsia (14.4%). Overall, the majority of maternal deaths occurred among women 20-35 years of age with 2-7 children. According to logistic regression analysis, the primary risk factors for maternal mortality were poor housing construction material (odds ratio (OR), 2.1; 95% confidence interval (CI), 1.3-3.2), distance of 40 miles or more from the nearest hospital (OR, 1.3; 95% CI, 0.9-1.8), grandmultigravidae (OR, 1.6; 95% CI, 1.1-2.4), and prior fetal losses (OR, 5.3; 95% CI, 3.8-7.4). These findings indicate a need to focus on special groups of pregnant women, especially those with a poor obstetric history and disadvantaged socioeconomic status, to decrease the high rate of maternal mortality in Pakistan.

  10. Estimating the impact of interventions on cause-specific maternal mortality: a Delphi approach

    PubMed Central

    2013-01-01

    Background Approximately 287,000 women die of causes related to pregnancy and childbirth every year. While effective interventions exist to prevent maternal death, high quality impact evaluations for these interventions are often lacking. Methods We conducted a Delphi process consisting of three rounds in which we asked maternal health experts to provide effectiveness estimates for 31 intervention-cause of death pairs relating to maternal mortality. Anonymous feedback in the form of medians and histograms for each question was given to experts following the first and second rounds. A diverse panel of 37 experts completed all three rounds, for a final response rate 80.4%. Results This Delphi process produced a total of 31 effectiveness estimates for key maternal interventions on cause-specific maternal mortality. Overall, many interventions had high estimated effectiveness, with the majority of interventions having effectiveness estimates above 70%. Where possible, the estimates of effectiveness of interventions were compared to previous efforts and in general there was strong agreement between the estimates in this exercise as compared to those of earlier efforts. Conclusions There are many maternal health interventions with high estimated effectiveness that, with expansion of effective delivery channels, have the potential to have a large impact on reducing maternal mortality worldwide.

  11. Impacts of maternal mortality on living children and families: A qualitative study from Butajira, Ethiopia

    PubMed Central

    2015-01-01

    Background The consequences of maternal mortality on orphaned children and the family members who support them are dramatic, especially in countries that have high maternal mortality like Ethiopia. As part of a four country, mixed-methods study (Ethiopia, Malawi, South Africa, and Tanzania) qualitative data were collected in Butajira, Ethiopia with the aim of exploring the far reaching consequences of maternal deaths on families and children. Methods We conducted interviews with 28 adult family members of women who died from maternal causes, as well as 13 stakeholders (government officials, civil society, and a UN agency); and held 10 focus group discussions with 87 community members. Data were analyzed using NVivo10 software for qualitative analysis. Results We found that newborns and children whose mothers died from maternal causes face nutrition deficits, and are less likely to access needed health care than children with living mothers. Older children drop out of school to care for younger siblings and contribute to household and farm labor which may be beyond their capacity and age, and often choose migration in search of better opportunities. Family fragmentation is common following maternal death, leading to tenuous relationships within a household with the births and prioritization of additional children further stretching limited financial resources. Currently, there is no formal standardized support system for families caring for vulnerable children in Ethiopia. Conclusions Impacts of maternal mortality on children are far-reaching and have the potential to last into adulthood. Coordinated, multi-sectorial efforts towards mitigating the impacts on children and families following a maternal death are lacking. In order to prevent impacts on children and families, efforts targeting maternal mortality must address inequalities in access to care at the community, facility, and policy levels. PMID:26001276

  12. Maternal mortality in the Islamic Republic of Iran: on track and in transition.

    PubMed

    Moazzeni, Miranda Sonntag

    2013-05-01

    The Maternal Mortality Ratio is an important public health indicator that reflects both the quality of a health care system and the role of women within that society. In September 2000 the United Nations Millennium Declaration outlined the eight Millennium Development Goals (MDGs) that set targets to be achieved by 2015. MDG 5 focused on improving maternal health. It had two clear subgoals: to reduce maternal mortality globally by three quarters between 1990 and 2015 and to obtain universal access to reproductive health for women. Despite a global trend of declining maternal mortality only a handful of nations are currently 'on track' to achieve their MDG targets by 2015. The Islamic Republic of Iran is one of these nations. In just over three decades, Iran has undergone demographic transition with significant reductions in total fertility and population growth rates. In concert with this transition, Iran has achieved a dramatic decline in the maternal mortality ratio that has fallen to a rate comparable with developed nations. Significantly Iran has also experienced a paradigm shift in its major causes of maternal mortality from those characteristic of developing nations (postpartum haemorrhage, infection) to causes more commonly seen in developed nations (pulmonary embolus, stroke). There is no single explanation that may account for this transition, rather it is the product of a number of different initiatives that have incorporated family planning, grass roots focus and wider improvements within the health care system of Iran over the past three decades. However the experience of this nation may provide a useful example to other developing countries looking to reduce maternal mortality.

  13. Global Reduction in HIV-related Maternal Mortality: ART as a Key Strategy

    PubMed Central

    Salihu, Hamisu M.

    2015-01-01

    Dr. Holtz and colleagues present a synthesis of evidence from published studies over the previous decade on the collective impact of HIV-targeted interventions on maternal mortality. Amongst an assortment of interventions [that include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A and selenium), and antibiotics], only ART reduced maternal mortality among HIV-infected pregnant and post-partum mothers. These findings have fundamental and global strategic implications. They are also timely since they provide the evidence that ART reduces HIV-related maternal mortality, and by further enhancing access to ART in HIV-challenged and poor regions of the world, significant improvement in maternal morbidity and mortality indices could be attained. The paper bears good tidings and sound scientific proof that the financial investment made globally by government and non-governmental organizations and agencies to reduce the global burden of HIV/AIDS primarily by making ART more accessible to regions of the world most affected by the epidemic is beginning to show beneficial effects not only in terms of numerical reductions in the rates of new cases of HIV/AIDS among women, but also in maternal mortality levels.

  14. Global Reduction in HIV-related Maternal Mortality: ART as a Key Strategy.

    PubMed

    Salihu, Hamisu M

    2015-01-01

    Dr. Holtz and colleagues present a synthesis of evidence from published studies over the previous decade on the collective impact of HIV-targeted interventions on maternal mortality. Amongst an assortment of interventions [that include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A and selenium), and antibiotics], only ART reduced maternal mortality among HIV-infected pregnant and post-partum mothers. These findings have fundamental and global strategic implications. They are also timely since they provide the evidence that ART reduces HIV-related maternal mortality, and by further enhancing access to ART in HIV-challenged and poor regions of the world, significant improvement in maternal morbidity and mortality indices could be attained. The paper bears good tidings and sound scientific proof that the financial investment made globally by government and non-governmental organizations and agencies to reduce the global burden of HIV/AIDS primarily by making ART more accessible to regions of the world most affected by the epidemic is beginning to show beneficial effects not only in terms of numerical reductions in the rates of new cases of HIV/AIDS among women, but also in maternal mortality levels.

  15. Maternal mortality at the end of a decade: signs of progress?

    PubMed Central

    AbouZahr, C.; Wardlaw, T.

    2001-01-01

    Maternal mortality is an important measure of women's health and indicative of the performance of health care systems. Several international conferences, most recently the Millennium Summit in 2000, have included the goal of reducing maternal mortality. However, monitoring progress towards the goal has proved to be problematic because maternal mortality is difficult to measure, especially in developing countries with weak health information and vital registration systems. This has led to interest in using alternative indicators for monitoring progress. This article examines recent trends in two indicators associated with maternal mortality: the percentage of births assisted by a skilled health care worker and rates of caesarean delivery. Globally, modest improvements in coverage of skilled care at delivery have occurred, with an average annual increase of 1.7% over the period 1989-99. Progress has been greatest in Asia, the Middle East and North Africa, with annual increases of over 2%. In sub-Saharan Africa, on the other hand, coverage has stagnated. In general, caesarean delivery rates were stable over the 1990s. Countries where rates of caesarean deliveries were the lowest--and where the needs were greatest--showed the least change. This analysis leads us to conclude that whereas there may be grounds for optimism regarding trends in maternal mortality in parts of North Africa, Latin America, Asia, and the Middle East, the situation in sub-Saharan Africa remains disquieting. PMID:11436479

  16. New Findings for Maternal Mortality Age Patterns: Aggregated Results for 38 Countries

    PubMed Central

    Blanc, Ann K.; Winfrey, William; Ross, John

    2013-01-01

    Background With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality. Methods We aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level. Findings The age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A “J” shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence. Conclusions The largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns. PMID:23613716

  17. Infant mortality differences between whites and African Americans: the effect of maternal education.

    PubMed Central

    Din-Dzietham, R; Hertz-Picciotto, I

    1998-01-01

    OBJECTIVES: Despite decreasing infant mortality in North Carolina, the gap between African Americans and Whites persists. This study examined how racial differences in infant mortality vary by maternal education. METHODS: Data came from Linked Birth and Infant Death files for 1988 through 1993. Multiple logistic regression models adjusted for confounders. RESULTS: Infant mortality risk ratios comparing African Americans and Whites increased with higher levels of maternal education. Education beyond high school reduced risk of infant mortality by 20% among Whites but had little effect among African Americans. CONCLUSIONS: Higher education magnifies racial differences in infant mortality on a multiplicative scale. Possible reasons include greater stress, fewer economic resources, and poorer quality of prenatal care among African Americans. PMID:9551012

  18. Tackling Health Inequities in Chile: Maternal, Newborn, Infant, and Child Mortality Between 1990 and 2004

    PubMed Central

    Requejo, Jennifer Harris; Nien, Jyh Kae; Merialdi, Mario; Bustreo, Flavia; Betran, Ana Pilar

    2009-01-01

    Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. PMID:19443831

  19. Obstetric near miss morbidity and maternal mortality in a Tertiary Care Centre in Western Rajasthan.

    PubMed

    Kalra, Priyanka; Kachhwaha, Chetan Prakash

    2014-01-01

    Obstetric near-miss (ONM) describes a situation of lethal complication during pregnancy, labor or puerperium in which the woman survives either because of medical care or just by chance. In a cross-sectional observational study, five factor scoring system was used to identify the near-miss cases from all the cases of severe obstetric morbidity. Assessment of the causes of maternal mortality and near-miss obstetric cases was done. The ONM rate in this study was 4.18/1000 live births. Totally 54 maternal deaths occurred during this period, resulting in a ratio of 202 maternal deaths per 100,000 live births. Hemorrhage, hypertension and sepsis were major causes of near-miss maternal morbidity and mortality, respectively in descending order.

  20. Trend and causes of maternal mortality among women delivering in S. N. Medical College Hospital, Agra.

    PubMed

    Jain, A; Gupta, S C; Misra, S K; Singh, Richa; Bhagoliwal, A K; Kaushal, S K

    2009-01-01

    A retrospective data analysis from records of patients from medical record section of department of gynecology and obstetric, S. N. Medical College and Hospital, Agra was done to find out the trend and causes of maternal mortality occurred during 1999-2007. The maternal deaths in the context of different causes were analyzed. A total of 192 maternal deaths occurred on 6386 live-births during last 9 years which gives anoverall hospitalized Maternal Mortality Ratio (MMR) as 30.07 per 1000 live births during the period. Out of these total deaths more than half (51.04%) were due to indirect causes. Anaemia (47, 24.48%), hemorrhage (35,18.23%), toxemia (35,18.23%), septicemia (18, 19.23%) were the main causes.

  1. Effect on mortality of community-based maternity-care programme in rural Bangladesh.

    PubMed

    Fauveau, V; Stewart, K; Khan, S A; Chakraborty, J

    1991-11-01

    Various community-based interventions have been proposed to improve maternity care, but hardly any studies have reported the effect of these measures on maternal mortality. In this study, the efficacy of a maternity-care programme to reduce maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh. Trained midwives were posted in villages, and asked to attend as many home-deliveries as possible, detect and manage obstetric complications at onset, and accompany patients requiring referral for higher-level care to the project central maternity clinic. The effect of the programme was evaluated by comparison of direct obstetric maternal mortality ratios between the programme area and a neighbouring control area without midwives. Random assignment of the intervention was not possible but potentially confounding characteristics, including coverage and use of other health and family planning services, were similar in both areas. Maternal mortality ratios due to obstetric complications were similar in both areas during the 3 years preceding the start of the programme. By contrast, during the following 3 years, the ratio was significantly lower in the programme than in the control area (1.4 vs 3.8 per 1000 live births, p = 0.02). The findings suggest that maternal survival can be improved by the posting of midwives at village level, if they are given proper training, means, supervision, and back-up. The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated. PMID:1682600

  2. Maternal mortality estimated using the Sisterhood method in Gulu district, Uganda.

    PubMed

    Orach, C G

    2000-04-01

    A community-based retrospective maternal mortality study using the Sisterhood method was conducted in Gulu district between February and March 1996. The objectives were to estimate the magnitude of and identify factors associated with maternal mortality in the district. A total of 5522 adult respondents, randomly selected from 27 parishes, of the five counties in the district were interviewed. Between 1960-1996 324 maternal deaths occurred in the sisterhood sample. The maternal mortality rate (MMR) was estimated to be 662 per 100,000 deliveries [95% confidence interval (CI) 421-839 per 100 deliveries]. The leading causes of maternal death were: haemorrhage 45.1%; obstructed labour 26.2%; puerperal sepsis 9.6%; anaemia 2.2%; AIDS 2.2%; and gunshot wounds (GSW) 1.0%. Factors associated with maternal mortality included: age--31.8% of the mothers who died were below 20 years; education--57.1% had no formal education; 65% of the mothers had delivered at home, 50.6% had been attended to by untrained traditional birth attendants (TBAs), while 37.8% were attended to by relatives. The MMR was found to be 1.3 times higher than the estimated national MMR of 500 per 100,000 deliveries. Most maternal deaths (80.9%) were due to preventable causes, being related to low socioeconomic status and low-level education of women in the district. The intractable civil war in the district was a major underlying and contributory factor to the high maternal mortality in the area. A multifaceted approach to reduce maternal mortality in the district should target improving the socioeconomic conditions in the district with special emphasis on encouraging and supporting female education. Intensive education on maternal healthcare in antenatal clinics be conducted targeting husbands/spouses and relatives who care for the prenatal/pregnant and postnatal mothers. There is need for more trained TBAs per village who should be given effective support supervision. Ambulance transport services, motor

  3. What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries.

    PubMed

    Cross, Suzanne; Bell, Jacqueline S; Graham, Wendy J

    2010-02-01

    The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.

  4. Association of Maternal Smoking during Pregnancy with Infant Hospitalization and Mortality Due to Infectious Diseases

    PubMed Central

    Metzger, Michael J.; Halperin, Abigail C.; Manhart, Lisa E.; Hawes, Stephen E.

    2012-01-01

    Background Maternal smoking is associated with infant respiratory infections and with increased risk of low birthweight (LBW) infants and preterm birth. This study assesses the association of maternal smoking during pregnancy with both respiratory and non-respiratory infectious disease (ID) morbidity and mortality in infants. Methods We conducted two retrospective case-control analyses of infants born in Washington State from 1987–2004 using linked birth certificate, death certificate, and hospital discharge records. One assessed morbidity—infants hospitalized due to ID within one year of birth (47,404 cases/48,233 controls). The second assessed mortality—infants who died within one year due to ID (627 cases/2,730 controls). Results Maternal smoking was associated with both hospitalization (Adjusted Odds Ratio (AOR)=1.52; 95%CI: 1.46, 1.58) and mortality (AOR=1.51; 95%CI: 1.17, 1.96) due to any ID. In subgroup analyses, maternal smoking was associated with hospitalization due to a broad range of ID including both respiratory (AOR=1.69; 95%CI: 1.63, 1.76) and non-respiratory ID (AOR=1.27; 95%CI: 1.20, 1.34). Further stratification by birthweight and gestational age did not appreciably change these estimates. In contrast, there was no association of maternal smoking with ID infant mortality when only LBW infants were considered. Conclusions Maternal smoking was associated with a broad range of both respiratory and non-respiratory ID outcomes. Despite attenuation of the mortality association among LBW infants, ID hospitalization was found to be independent of both birthweight and gestational age. These findings suggest that full-term infants of normal weight whose mothers smoked may suffer an increased risk of serious ID morbidity and mortality. PMID:22929173

  5. The trends in maternal mortality between 1996 and 2009 in Guizhou, China: ethnic differences and associated factors.

    PubMed

    Du, Qing; Lian, Wu; Naess, Øyvind; Bjertness, Espen; Kumar, Bernadette Nirmal; Shi, Shu-hua

    2015-02-01

    China bears a large burden of global maternal mortality, and the largest burden of maternal deaths in China is in poor western provinces. This study aimed to investigate the trends in maternal mortality and its associated factors in Guizhou province of western China between 1996 and 2009, and examine differences between minority and non-minority counties. A population-based, longitudinal, retrospective study was performed in a poor western province of China with a considerably large ethnic minority population. All 86 counties/districts of Guizhou were included with population at county, township and village level. Maternal mortality data were collected from routine reporting database of Guizhou Provincial Health Bureau. Trend and comparative analyses and multivariate linear regression analyses were performed using SPSS 17.0. Maternal mortality ratio (MMR) and its change over time, differences between ethnic groups were analyzed. A declining trend in maternal mortality and rising trend in hospital delivery in Guizhou was observed; ethnic differences between two ethnic groups persisted. The reduction in maternal mortality between 1996 and 2009 was related with increased gross domestic product, decreased male illiteracy rate, and increased hospital delivery rate. We found the declining trends in maternal mortality in Guizhou with persisting ethnic differences. The declining trends are related with economic development, hospital delivery and male illiteracy. Effective health education on maternal health is urgently needed for the minority groups, and basic education for the new generation should be enhanced to eradicate the illiteracy.

  6. Effects of nutritional stress and socio-economic status on maternal mortality in six German villages, 1766-1863.

    PubMed

    Scalone, Francesco

    2014-01-01

    We examined the effects of nutritional stress on maternal mortality arising from short-term economic crises in eighteenth-century and nineteenth-century Germany, and how these effects might have been mitigated by socio-economic status. Historical data from six German villages were used to assess how socio-economic conditions and short-term economic crises following poor harvests may have affected maternal mortality. The results show that 1 year after an increase in grain prices the risk of maternal death increased significantly amongst the wives of those working outside the agricultural sector, and more so than for the wives of those working on farms. Nutritional crises seem to have had a significantly stronger impact on maternal mortality in the period 2-6 weeks after childbirth, when mothers were most prone to infections and indirect, obstetrical causes of maternal death. The findings indicate that both nutritional stress and socio-economic factors contributed to maternal mortality.

  7. Maternal mortality and morbidity: epidemiology of intensive care admissions in pregnancy.

    PubMed

    Senanayake, H; Dias, T; Jayawardena, A

    2013-12-01

    Maternal mortality reviews are used globally to assess the quality of health-care services. With the decline in the number of maternal deaths, it has become difficult to derive meaningful conclusions that could have an impact on quality of care using maternal mortality data. The emphasis has recently shifted to severe acute maternal morbidity (SAMM), as an adjunct to maternal mortality reviews. Due to its heterogeneity, there are difficulties in recognising SAMM. The problem of identifying SAMM accurately is the main issue in investigating them. However, admission to an intensive care unit (ICU) provides an unambiguous, management-based inclusion criterion for a SAMM. ICU data are available across health-care settings prospectively and retrospectively, making them a tool that could be studied readily. However, admission to the ICU depends on many factors, such as accessibility and the availability of high-dependency units, which will reduce the need for ICU admission. Thresholds for admission vary widely and are generally higher in facilities that handle a heavier workload. In addition, not all women with SAMM receive intensive care. However, women at the severe end of the spectrum of severe morbidity will almost invariably receive intensive care. Notwithstanding these limitations, the epidemiology of intensive care admissions in pregnancy will provide valuable data about women with severe morbidity. The overall rate of obstetric ICU admission varies from 0.04% to 4.54%.

  8. The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework.

    PubMed

    Pacagnella, Rodolfo Carvalho; Cecatti, Jose Guilherme; Osis, Maria Jose; Souza, João Paulo

    2012-06-01

    Maternal mortality has gained importance in research and policy since the mid-1980s. Thaddeus and Maine recognized early on that timely and adequate treatment for obstetric complications were a major factor in reducing maternal deaths. Their work offered a new approach to examining maternal mortality, using a three-phase framework to understand the gaps in access to adequate management of obstetric emergencies: phase I--delay in deciding to seek care by the woman and/or her family; phase II--delay in reaching an adequate health care facility; and phase III--delay in receiving adequate care at that facility. Recently, efforts have been made to strengthen health systems' ability to identify complications that lead to maternal deaths more rapidly. This article shows that the combination of the "three delays" framework with the maternal "near-miss" approach, and using a range of information-gathering methods, may offer an additional means of recognizing a critical event around childbirth. This approach can be a powerful tool for policymakers and health managers to guarantee the principles of human rights within the context of maternal health care, by highlighting the weaknesses of systems and obstetric services.

  9. Maternal mortality in obstetrics and gynaecology in a tertiary care hospital.

    PubMed

    Khatun, K; Ara, R; Aleem, N T; Khan, S; Husein, S; Alam, S; Roy, A S

    2015-01-01

    Maternal mortality is the leading causes of death and disability of reproductive age in the developing countries. Bangladesh is one of the developing countries where maternal mortality is very high. The purpose of the present study was to see the causes of maternal deaths at Obstetrics and Gynaecology ward. This retrospective study was carried out in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital (DMCH). All maternal deaths were included in this study from July 2003 to June 2004 for a period of one year. The incidence of maternal death was 18.5/1000 live birth. Hypertensive disorder of pregnancy (41.84%) was the most common cause of maternal death followed by unsafe abortions (21.4%), PPH (10.2%), obstructed labour (8.2%). Among 98 patients 36(36.7%) cases are died due to eclampsia. Death due to pre-eclampsia (5.1%), unsafe Abortion (21.4%), Obstetric haemorrhage (18.4%) and obstructed labour (8.3%) were commonly found in this study. The study permits to conclude that Hypertensive disorder of pregnancy is the leading cause of pregnancy related deaths followed by unsafe abortions and obstetric haemorrhage. Other causes include obstructed labour, anaesthetic complications and others.

  10. Reducing maternal mortality: can we derive policy guidance from developing country experiences?

    PubMed

    Liljestrand, Jerker; Pathmanathan, Indra

    2004-01-01

    Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations. PMID:15683067

  11. Reducing maternal mortality: can we derive policy guidance from developing country experiences?

    PubMed

    Liljestrand, Jerker; Pathmanathan, Indra

    2004-01-01

    Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.

  12. Perimortem cesarean delivery: its role in maternal mortality.

    PubMed

    Katz, Vern L

    2012-02-01

    Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timely cesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child. PMID:22280869

  13. Reducing high maternal mortality rates in western China: a novel approach.

    PubMed

    Gyaltsen Gongque Jianzan, Kunchok; Gyal Li Xianjia, Lhusham; Gipson, Jessica D; Kyi Cai Rangji, Tsering; Pebley, Anne R

    2014-11-01

    Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity. PMID:25555773

  14. A Strategy for the Evaluation of Activities to Reduce Maternal Mortality in Developing Countries.

    ERIC Educational Resources Information Center

    Ward, Victoria M.; And Others

    1994-01-01

    An evaluation strategy in which a set of process indicators is applied to programs to reduce maternal mortality in developing countries is presented. The four-stage strategy is illustrated for three interventions: (1) providing safe abortion services; (2) increasing knowledge of obstetric complications; and (3) improving medical care quality. (SLD)

  15. Discrepancies between national maternal mortality data and international estimates: the experience of Papua New Guinea.

    PubMed

    Mola, Glen; Kirby, Barry

    2013-11-01

    Over the past 30 years maternal mortality estimates for Papua New Guinea have varied widely. There is no mandatory vital registration in PNG, and 85% of the population live in rural areas with limited or no access to health services. Demographic Health Survey data for PNG estimates the maternal mortality ratio to be 370 deaths per 100,000 live births in 1996 and 733 in 2006, whereas estimates based upon mathematical models (as calculated by international bodies) gave figures of 930 for 1980 and 230 for 2010. This disparity has been a source of considerable confusion for health workers, policy makers and development partners. In this study, we compared 2009 facility-based survey data with figures from the national Health Information System records. The comparison revealed similar maternal mortality ratios: for provincial hospitals (245 and 295), government health centres (574 and 386), church agency health centres (624 and 624), and nationally (394 and 438). Synthesizing these estimates for supervised births in facilities and data on unsupervised births from a community-based survey in one province indicates a national MMR of about 500. Knowing the maternal mortality ratio is a necessary starting point for working out how to reduce it.

  16. Reducing high maternal mortality rates in western China: a novel approach.

    PubMed

    Gyaltsen Gongque Jianzan, Kunchok; Gyal Li Xianjia, Lhusham; Gipson, Jessica D; Kyi Cai Rangji, Tsering; Pebley, Anne R

    2014-11-01

    Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity.

  17. Reducing high maternal mortality rates in western China: a novel approach

    PubMed Central

    Gyaltsen, Kunchok; Jianzan, Gongque; Gyal, Lhusham; Xianjia, Li; Gipson, Jessica D; Kyi, Tsering; Rangji, Cai; Pebley, Anne R

    2015-01-01

    Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity. PMID:25555773

  18. Does maternal birth outcome differentially influence the occurrence of infant death among African Americans and European Americans?

    PubMed

    Masho, Saba W; Archer, Phillip W

    2011-11-01

    The United States continues to have one of the highest infant mortality rates (IMR). Although studies have examined the association between maternal and infant birth outcomes, few studies have examined the impact of maternal birth outcome on infant mortality. This study was designed to examine the influence of maternal low birth weight and preterm birth on infant mortality. The 1997-2007 Virginia birth and infant death registry was analyzed. The infant birth and death data was linked to maternal birth registry data using the mother's maiden name and date of birth. From the mother's birth registry data, the grandmother's demographic and pregnancy history was obtained. Logistic regression modeling was used to estimate adjusted odds ratios and their 95% confidence intervals. There was a statistically significant association between maternal birth outcome and subsequent infant mortality. Infants born from a mother who was low birth weight were 2.3 times more likely to have an infant die within the first year of life. Similarly, infants born from a mother born preterm were 2.2 times more likely to have an infant die. Stratification by race showed that there was no statistical association between maternal birth weight and infant death among Whites. However, a strong association was observed among Blacks. Maternal birth outcomes may be an important indicator for infant mortality. Future longitudinal studies are needed to understand the underlying cause of these associations.

  19. Does maternal birth outcome differentially influence the occurrence of infant death among African Americans and European Americans?

    PubMed

    Masho, Saba W; Archer, Phillip W

    2011-11-01

    The United States continues to have one of the highest infant mortality rates (IMR). Although studies have examined the association between maternal and infant birth outcomes, few studies have examined the impact of maternal birth outcome on infant mortality. This study was designed to examine the influence of maternal low birth weight and preterm birth on infant mortality. The 1997-2007 Virginia birth and infant death registry was analyzed. The infant birth and death data was linked to maternal birth registry data using the mother's maiden name and date of birth. From the mother's birth registry data, the grandmother's demographic and pregnancy history was obtained. Logistic regression modeling was used to estimate adjusted odds ratios and their 95% confidence intervals. There was a statistically significant association between maternal birth outcome and subsequent infant mortality. Infants born from a mother who was low birth weight were 2.3 times more likely to have an infant die within the first year of life. Similarly, infants born from a mother born preterm were 2.2 times more likely to have an infant die. Stratification by race showed that there was no statistical association between maternal birth weight and infant death among Whites. However, a strong association was observed among Blacks. Maternal birth outcomes may be an important indicator for infant mortality. Future longitudinal studies are needed to understand the underlying cause of these associations. PMID:21057863

  20. Task shifting: A key strategy in the multipronged approach to reduce maternal mortality in India.

    PubMed

    Bhushan, Himanshu; Bhardwaj, Ajey

    2015-10-01

    Task shifting from specialist to nonspecialist doctors (NSDs) is an important strategy that has been implemented in India to overcome the critical shortage of healthcare workers by using the human resources available to serve the vast population, particularly in rural areas. A competency-based training program in comprehensive emergency obstetric care was implemented to train and certify NSDs. Trained NSDs were able to provide key services in maternal health, which contribute toward reductions in maternal morbidity and mortality. The present article provides an overview of the maternal health challenges, shares important steps in program implementation, and shows how challenges can be overcome. The lessons learned from this experience contribute to understanding how task shifting can be used to address large-scale public health issues in low-resource countries and in particular solutions to address maternal health issues.

  1. Innovations and Challenges in Reducing Maternal Mortality in Tamil Nadu, India

    PubMed Central

    Padmanaban, P.; Mavalankar, Dileep V.

    2009-01-01

    Although India has made slow progress in reducing maternal mortality, progress in Tamil Nadu has been rapid. This case study documents how Tamil Nadu has taken initiatives to improve maternal health services leading to reduction in maternal morality from 380 in 1993 to 90 in 2007. Various initiatives include establishment of maternal death registration and audit, establishment and certification of comprehensive emergency obstetric and newborn-care centres, 24-hour x 7-day delivery services through posting of three staff nurses at the primary health centre level, and attracting medical officers to rural areas through incentives in terms of reserved seats in postgraduate studies and others. This is supported by the better management capacity at the state and district levels through dedicated public-health officers. Despite substantial progress, there is some scope for further improvement of quality of infrastructure and services. The paper draws out lessons for other states and countries in the region. PMID:19489416

  2. Task shifting: A key strategy in the multipronged approach to reduce maternal mortality in India.

    PubMed

    Bhushan, Himanshu; Bhardwaj, Ajey

    2015-10-01

    Task shifting from specialist to nonspecialist doctors (NSDs) is an important strategy that has been implemented in India to overcome the critical shortage of healthcare workers by using the human resources available to serve the vast population, particularly in rural areas. A competency-based training program in comprehensive emergency obstetric care was implemented to train and certify NSDs. Trained NSDs were able to provide key services in maternal health, which contribute toward reductions in maternal morbidity and mortality. The present article provides an overview of the maternal health challenges, shares important steps in program implementation, and shows how challenges can be overcome. The lessons learned from this experience contribute to understanding how task shifting can be used to address large-scale public health issues in low-resource countries and in particular solutions to address maternal health issues. PMID:26433512

  3. Maternal mortality -- aetiological factors: analytic study from a teaching hospital of Punjab.

    PubMed

    Sarin, A R; Singla, P; Kaur, H

    1992-01-01

    A review of maternal deaths at Rajendra Hospital, Punjab, from January 1978 to December 1991 yielded important data for the planning of maternal health services in this area of India, During the 14 year study period, there were 33,160 births and 339 deaths, for a maternal mortality rate of 1002/100,000 live births. Women who had received no prenatal care accounted for 47.4% of deliveries but 92.8% of maternal deaths. In addition, a disproportionate number of deaths involved rural women (74.6%) and poor women (76.4%). 57.8% of maternal deaths involved women 21-30 years of age; 37.1% occurred among primigravidas. Direct obstetrical causes were considered the etiologic factor in 83.1% of these deaths. Primary among these causes were sepsis (37.1%), obstetric hemorrhage (26.2%), hypertensive disorders of pregnancy (21.4%), and obstructed labor (15.3%). 30.6% of deaths occurred during pregnancy, 50.3% during labor, and 19.1% in the postpartum period. Indirect obstetrical causes, notably severe anemia and anesthesia complications, were implicated in 15.3% of the maternal deaths. Critical analysis of the maternal deaths in this series suggested that 89.6% were totally preventable, 9.6% were probably preventable, and only 0.8% were not avoidable. Factors that would reduce the high rate of maternal mortality in this region include more widespread use of prenatal care, training of traditional birth attendants in asepsis, referral of high-risk pregnancies, and improved transportation in rural areas. PMID:12288813

  4. Maternal education, birth weight, and infant mortality in the United States.

    PubMed

    Gage, Timothy B; Fang, Fu; O'Neill, Erin; Dirienzo, Greg

    2013-04-01

    This research determines whether the observed decline in infant mortality with socioeconomic level, operationalized as maternal education (dichotomized as college or more, versus high school or less), is due to its "indirect" effect (operating through birth weight) and/or to its "direct" effect (independent of birth weight). The data used are the 2001 U.S. national African American, Mexican American, and European American birth cohorts by sex. The analysis explores the birth outcomes of infants undergoing normal and compromised fetal development separately by using covariate density defined mixture of logistic regressions (CDDmlr). Among normal births, mean birth weight increases significantly (by 27-108 g) with higher maternal education. Mortality declines significantly (by a factor of 0.40-0.96) through the direct effect of education. The indirect effect of education among normal births is small but significant in three cohorts. Furthermore, the indirect effect of maternal education tends to increase mortality despite improved birth weight. Among compromised births, education has small and inconsistent effects on birth weight and infant mortality. Overall, our results are consistent with the view that the decrease in infant death by socioeconomic level is not mediated by improved birth weight. Interventions targeting birth weight may not result in lower infant mortality.

  5. Improving the accuracy of maternal mortality and pregnancy related death.

    PubMed

    Schaible, Burk

    2014-01-01

    Comparing abortion-related death and pregnancy-related death remains difficult due to the limitations within the Abortion Mortality Surveillance System and the International Statistical Classification of Diseases and Related Health Problems (ICD). These methods lack a systematic and comprehensive method of collecting complete records regarding abortion outcomes in each state and fail to properly identify longitudinal cause of death related to induced abortion. This article seeks to analyze the current method of comparing abortion-related death with pregnancy-related death and provide solutions to improve data collection regarding these subjects.

  6. Challenges of maternal mortality reduction and opportunities under National Rural Health Mission--a critical appraisal.

    PubMed

    Kumar, Satish

    2005-01-01

    Maternal Mortality Ratio (MMR) continues to remain high in our country without showing any declining trend over a period of two decades. The proportions of maternal deaths contributed by direct obstetric causes have also remained more or less the same in rural areas. There is a strong need to improve coverage of antenatal care, promote institutional deliveries and provide emergency obstetric care. Delays occur in seeking care for obstetric complications and levels of 'met obstetric need' continue to be low in many parts of the country. Most of the First Referral Units (FRUs) and CHCs function at sub-optimal level in the country. National Rural Health Mission (NRHM) offers institutional mechanism and strategic options to reduce high MMR. 'Janani Suraksha Yojna', strengthening of CHCs (as per Indian Public Health standards) to offer 24 hours quality services including that of anesthetists and Accredited Social Health Activist (ASHA) are important proposals in this regard. District Health Mission can play an important role in monitoring maternal deaths occurring in hospitals or in community and thus create a social momentum to prevent and reduce maternal deaths. NRHM, however, depends largely on Panchayati Raj Institutions for effective implementation of proposed interventions and utilization of resources. In most parts of our country, State Governments have not empowered PRIs with real devolution of power. Therefore, much needs to be done locally to build the capacity of PRIs and develop state-specific guidelines in operational terms to implement interventions under NRHM for reducing maternal mortality ratio. PMID:16468281

  7. Maternal Mortality in Andaman and Nicobar Group of Islands: 10 Years Retrospective Study

    PubMed Central

    Chawla, Indu; Saha, Mrinmoy Kumar; Akhtarkharvi, Anis

    2014-01-01

    Context: Maternal mortality ratio (MMR) is an indicator of effectiveness of health care facilities for women of child bearing age group. Andaman and Nicobar (A&N) group of islands are unique as they are situated 1200 km from the mainland India. Healthcare delivery for the these islands is exclusively provided and controlled by only one authority, Directorate of Health Services, A&N Islands. GB Pant Hospital, Port Blair is the only referral hospital with round the clock specialists and surgical services. Aims: To estimate the MMR in A&N islands from 2001 to 2010, and study the causes of maternal mortality. Settings and Design: Retrospective. Materials and Methods: Data for the estimation of MMR were collected from office of Registrar of Births and Deaths, Hospital and Peripheral Health Centres. Case records of maternal deaths in GB Pant Hospital were reviewed to study the causes of death. Statistical analysis used: Proportions and Ratios. Results: Ten years average MMR for the entire island was 85.42. Analysis of 30 maternal deaths in GB Pant Hospital showed that 63.3% were due to direct obstetric causes (eclampsia 30%, hemorrhage 23.33%, sepsis 6.66%, and 3.33% amniotic fluid embolism). Of the indirect causes, anemia was the commonest (16.66%). Conclusions: The MMR of A&N islands is much lower than the national average of 250. Direct obstetric causes accounted for more than half of maternal deaths 63.33%. PMID:24696538

  8. Reducing maternal, newborn, and infant mortality globally: an integrated action agenda.

    PubMed

    Bhutta, Zulfiqar A; Cabral, Sergio; Chan, Chok-Wan; Keenan, William J

    2012-10-01

    There has been increasing awareness over recent years of the persisting burden of worldwide maternal, newborn, and child mortality. The majority of maternal deaths occur during labor, delivery, and the immediate postpartum period, with obstetric hemorrhage as the primary medical cause of death. Other causes of maternal mortality include hypertensive diseases, sepsis/infections, obstructed labor, and abortion-related complications. Recent estimates indicate that in 2009 an estimated 3.3 million babies died in the first month of life and that overall, 7.3 million children under 5 die each year. Recent data also suggest that sufficient evidence- and consensus-based interventions exist to address reproductive, maternal, newborn, and child health globally, and if implemented at scale, these have the potential to reduce morbidity and mortality. There is an urgent need to put elements in place to promote integrated interventions among healthcare professionals and their associations. What is needed is the political will and partnerships to implement evidence-based interventions at scale. PMID:22883919

  9. Maternal mortality among migrants in Western Europe: a meta-analysis.

    PubMed

    Pedersen, Grete Skøtt; Grøntved, Anders; Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo; Rich-Edwards, Janet

    2014-09-01

    To examine whether an excess risk of maternal mortality exists among migrant women in Western Europe. We searched electronic databases for studies published 1970 through 2013 for all observational studies comparing maternal mortality between the host country and a defined migrant population. Results were derived from a random-effects meta-analysis, and statistical heterogeneity assessed by the I (2) statistic. In sub-analyses we also calculated summary estimates stratified by direct and indirect death causes. We included 13 studies with more than 42 million women and 4,995 maternal deaths. Compared with indigenous born women, the pooled risk estimate (RR) was 2.00 with 95 % confidence interval (CI) of 1.72, 2.33. Migrant women had a non-significantly higher risk of dying from direct than indirect death causes; pooled RRs of 2.65 CI 1.88, 3.74 and 1.83 CI 1.37, 2.45. This meta-analysis provides evidence that migrant women in Western European countries have an excess risk of maternal mortality.

  10. Determinants of maternal mortality in Eastern Mediterranean region: A panel data analysis

    PubMed Central

    Bayati, Mohsen; Vahedi, Sajad; Esmaeilzadeh, Firooz; Kavosi, Zahra; Jamali, Zahra; Rajabi, Abdolhalim; Alimohamadi, Yousef

    2016-01-01

    Background: As one of the main criteria of health outcomes, maternal mortality indicates the socioeconomic development level of countries. The present study aimed at identifying and analyzing the effective factors on maternal mortality in Eastern Mediterranean Region (EMR) of the World Health Organization (WHO). Methods: Analytical model was developed based on the literature review. Panel data of 2004-2011 periods for 22 EMR countries was used. Required data were collected from WHO online database. Based on results of diagnostic tests for panel data model, parameters of model were estimated by fixed effects method. Results: Descriptive statistics demonstrated the large disparities in social, economic, and health indicators among EMRO countries. Findings obtained from evaluating the model showed a negative, significant relationship between GDP per capita (β=-0.869, p<0.01), health expenditure) β=-0.525, p<0.01 (female literacy rate) β=-1.045, <0.01 (skilled birth attendance) β=-0.899, p<0.05) and maternal mortality rate. Conclusion: Improved income and economic development, increased resources allocated to the health sector, improved delivery services particularly the increased use of trained staff in the delivery, improve quality of primary care centers, mitigating the risks of marginalization and its dangers, and especially improving the level of women's education and knowledge are the key factors in policy making related to maternal health promotion. PMID:27453890

  11. Prenatal Exposure to Maternal Depression and Cortisol Influences Infant Temperament

    ERIC Educational Resources Information Center

    Davis, Elysia Poggi; Glynn, Laura M.; Schetter, Christine Dunkel; Hobel, Calvin; Chicz-Demet, Aleksandra; Sandman, Curt A.

    2007-01-01

    Background: Accumulating evidence indicates that prenatal maternal and fetal processes can have a lasting influence on infant and child development. Results from animal models indicate that prenatal exposure to maternal stress and stress hormones has lasting consequences for development of the offspring. Few prospective studies of human pregnancy…

  12. Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

    PubMed

    Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

    2015-11-01

    Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance.

  13. Effective strategies for reducing maternal mortality in Isfahan University of Medical Sciences, 2014

    PubMed Central

    Nosraty, Somaye; Rahimi, Mojtaba; Kohan, Shahnaz; Beigei, Margan

    2016-01-01

    Background: Maternal mortality rate is among the most important health indicators. This indicator is a function of factors that are related to pregnant women; these factors include economic status, social and family life of the pregnant woman, human resources, structure of the hospitals and health centers, and management factors. Strategic planning, with a comprehensive analysis and coverage of all causes of maternal mortality, can be helpful in improving this indicator. Materials and Methods: This research is a descriptive exploratory study. After needs assessment and review of the current situation through eight expert panel meetings and evaluating the organization's internal and external environment, the strengths, weaknesses, threats, and opportunities of maternal mortality reduction were determined. Then, through mutual comparison of strengths/opportunities, strengths/threats, weaknesses/opportunities, and weaknesses/threats, WT, WO, ST, and SO strategies and suggested activities of the researchers for reducing maternal mortality were developed and dedicated to the areas of education, research, treatment, and health, as well as food and drug administration to be implemented. Results: In the expert panel meetings, seven opportunity and strength strategies, eight strength and threat strategies, five weakness and threat strategies, and seven weakness and opportunity strategies were determined and a strategic plan was developed. Conclusions: Dedication of the developed strategies to the areas of education, research, treatment, and health, as well as food and drug administration has coordinated these areas to develop Ministry of Health indicators. In particular, it emphasizes the key role of university management in improving the processes related to maternal health. PMID:27186210

  14. Argentina: risk factors and maternal mortality in La Matanza, Province of Buenos Aires, 1990.

    PubMed

    Szmoisz, S; Vuegen, S E; Plaza, A S; Barracchini, R; Checa, S; Derlindati, A; Espinola, D A; Rúgolo, E C

    1995-01-01

    An evaluation of the health services infrastructure of the La Matanza part of Buenos Aires in 1990 was carried out in addition to an evaluation of maternal mortality case studies. This procedure allowed for an assessment of factors related to the performance of health services and the health behaviour of women which, concomitantly, led to maternal deaths. Approximately 50% of maternal deaths went unreported in La Matanza on the basis of record checks performed in the institutions, hence the maternal mortality was twice as high as officially indicated for 1990. Flaws in the proper clinical diagnosis of the causes of deaths were detected and a higher degree of precision was called for. In the case of women who came from the poorest section of La Matanza, most deaths were due to complications related to abortion (either self-induced or non-professionally induced). Most of the maternal deaths could have been avoided. The sociological enquiry revealed conflicting social pressures which led the women onto the path of maternal death. The men were found not to be involved in the health issues arising from pregnancy and delivery, and the reproductive process was seen to lie exclusively in the women's domain. The services were not prepared to cater for the needs of poor women, and the inadequacy of the existing system to reach the women in need was well documented. Detection of women at risk was lacking in most establishments and, with the exception of one hospital, referral procedures did not exist. At the municipal level the absence of a policy for maternal and child health was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Maternal stress and infant mortality: the importance of the preconception period.

    PubMed

    Class, Quetzal A; Khashan, Ali S; Lichtenstein, Paul; Långström, Niklas; D'Onofrio, Brian M

    2013-07-01

    Although preconception and prenatal maternal stress are associated with adverse outcomes in birth and childhood, their relation to infant mortality remains uncertain. We used logistic regression to study infant mortality risk following maternal stress within a population-based sample of infants born in Sweden between 1973 and 2008 (N = 3,055,361). Preconception (6-0 months before conception) and prenatal (between conception and birth) stress were defined as death of a first-degree relative of the mother. A total of 20,651 offspring were exposed to preconception stress, 26,731 offspring were exposed to prenatal stress, and 8,398 cases of infant mortality were identified. Preconception stress increased the risk of infant mortality independently of measured covariates, and this association was timing specific and robust across low-risk groups. Prenatal stress did not increase risk of infant mortality. These results suggest that the period immediately before conception may be a sensitive developmental period with ramifications for infant mortality risk.

  16. The influence of maternal psychosocial characteristics on infant feeding styles.

    PubMed

    Barrett, Katherine J; Thompson, Amanda L; Bentley, Margaret E

    2016-08-01

    Maternal feeding styles in infancy and early childhood are associated with children's later risk for overweight and obesity. Maternal psychosocial factors that influence feeding styles during the complementary feeding period, the time during which infants transition from a milk-based diet to one that includes solid foods and other non-milk products, have received less attention. The present study explores how maternal psychosocial factors-specifically self-esteem, parenting self-efficacy, parenting satisfaction, and depression symptoms-influence mothers' infant feeding styles at nine months of age, a time during which solid foods eating habits are being established. Participants included 160 low-income, African-American mother-infant pairs in central North Carolina who were enrolled in the Infant Care and Risk of Obesity Study. Regression models tested for associations between maternal psychosocial characteristics and pressuring and restrictive feeding styles. Models were first adjusted for maternal age, education, marital status and obesity status. To account for infant characteristics, models were then adjusted for infant weight-for-length, distress to limitations and activity level scores. Maternal self-esteem was negatively associated with pressuring to soothe. Maternal parenting self-efficacy was positively associated with restriction-diet quality. Maternal parenting satisfaction and depression symptoms were not associated with feeding styles in the final models. Focusing on strengthening maternal self-esteem and parenting self-efficacy may help to prevent the development of less desirable infant feeding styles. PMID:27174251

  17. The influence of maternal psychosocial characteristics on infant feeding styles.

    PubMed

    Barrett, Katherine J; Thompson, Amanda L; Bentley, Margaret E

    2016-08-01

    Maternal feeding styles in infancy and early childhood are associated with children's later risk for overweight and obesity. Maternal psychosocial factors that influence feeding styles during the complementary feeding period, the time during which infants transition from a milk-based diet to one that includes solid foods and other non-milk products, have received less attention. The present study explores how maternal psychosocial factors-specifically self-esteem, parenting self-efficacy, parenting satisfaction, and depression symptoms-influence mothers' infant feeding styles at nine months of age, a time during which solid foods eating habits are being established. Participants included 160 low-income, African-American mother-infant pairs in central North Carolina who were enrolled in the Infant Care and Risk of Obesity Study. Regression models tested for associations between maternal psychosocial characteristics and pressuring and restrictive feeding styles. Models were first adjusted for maternal age, education, marital status and obesity status. To account for infant characteristics, models were then adjusted for infant weight-for-length, distress to limitations and activity level scores. Maternal self-esteem was negatively associated with pressuring to soothe. Maternal parenting self-efficacy was positively associated with restriction-diet quality. Maternal parenting satisfaction and depression symptoms were not associated with feeding styles in the final models. Focusing on strengthening maternal self-esteem and parenting self-efficacy may help to prevent the development of less desirable infant feeding styles.

  18. TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala.

    PubMed

    Martínez-Fernández, Andrés; Lobos-Medina, Isabel; Díaz-Molina, Cesar Augusto; Chen-Cruz, Moisés Faraón; Prieto-Egido, Ignacio

    2015-07-01

    The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q'eqchí and/or Poqomchi' languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas).

  19. TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala.

    PubMed

    Martínez-Fernández, Andrés; Lobos-Medina, Isabel; Díaz-Molina, Cesar Augusto; Chen-Cruz, Moisés Faraón; Prieto-Egido, Ignacio

    2015-07-01

    The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q'eqchí and/or Poqomchi' languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas). PMID:25766857

  20. TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala

    PubMed Central

    Lobos-Medina, Isabel; Díaz-Molina, Cesar Augusto; Chen-Cruz, Moisés Faraón; Prieto-Egido, Ignacio

    2015-01-01

    Summary The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q’eqchí and/or Poqomchi’ languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas). PMID:25766857

  1. Maternal mortality revisited: the application of the new ICD-MM classification system in reference to maternal deaths in Sri Lanka

    PubMed Central

    2014-01-01

    Background The recently published WHO guidelines on applications of ICD-10 to deaths during pregnancy, childbirth, and the puerperium (ICD-MM) aimed at enabling a comprehensive framework for international comparison of maternal deaths, which includes maternal suicides as a direct cause of maternal deaths. At present, most developing countries do not include suicide as a maternal death. Methods We extracted and analysed data from the maternal death surveillance system in North Central Province of Sri Lanka for the period of 2005 to 2011, in order to identify the implications of this new classification on maternal mortality estimates. All reported deaths of pregnant women and women within 12 months of termination of pregnancy were included in this study. Causes of deaths were extracted and coded using ICD-10 reclassified according to new ICD-MM for maternal deaths. Results Of the 118 deaths analysed, the maternal death investigation system had classified 53 (44.9%) deaths as maternal deaths. These 53 maternal deaths included one deaths due to suicied, out of 21 (17.8%) suicide deaths among 118 reported deaths. Application of the new ICD-MM showed 83 maternal deaths which resulted in a 56.6% increase of number of maternal deaths in the province. Detailed analysis of all individual causes by ICD 10 codes showed that intentional self-poisoning by an exposure to pesticide (ICD code X63) as the leading cause of maternal deaths in NCP (n = 11, 13.3% of all maternal deaths) during this period. The estimated MMR in the study area based on the new classification in years 2009, 2010 and 2011 was 115, 103 and 88 per 100,000 live births respectively. Conclusions The new classification system may have an immediate effect in raising maternal mortality thresholds, making the MDG Goal 5A more elusive for many countries. However, this new approach may ultimately lead to a more accurate understanding of maternal mortality, as well as the real number of maternal deaths attributed

  2. Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil

    PubMed Central

    Esteves-Pereira, Ana Paula; Deneux-Tharaux, Catherine; Nakamura-Pereira, Marcos; Saucedo, Monica; Bouvier-Colle, Marie-Hélène; Leal, Maria do Carmo

    2016-01-01

    Background Cesarean delivery rates continue to increase worldwide and reached 57% in Brazil in 2014. Although the safety of this surgery has improved in the last decades, this trend is a concern because it carries potential risks to women’s health and may be a modifiable risk factor of maternal mortality. This paper aims to investigate the risk of postpartum maternal death directly associated with cesarean delivery in comparison to vaginal delivery in Brazil. Methods This was a population-based case—control study performed in eight Brazilian states. To control for indication bias, deaths due to antenatal morbidity were excluded. We included 73 cases of postpartum maternal deaths from 2009–2012. Controls were selected from the Birth in Brazil Study, a 2011 nationwide survey including 9,221 postpartum women. We examined the association of cesarean section and postpartum maternal death by multivariate logistic regression, adjusting for confounders. Results After controlling for indication bias and confounders, the risk of postpartum maternal death was almost three-fold higher with cesarean than vaginal delivery (OR 2.87, 95% CI 1.63–5.06), mainly due to deaths from postpartum hemorrhage and complications of anesthesia. Conclusion Cesarean delivery is an independent risk factor of postpartum maternal death. Clinicians and patients should consider this fact in balancing the benefits and risks of the procedure. PMID:27073870

  3. Maternal morbidity and mortality from severe sepsis: a national cohort study

    PubMed Central

    Acosta, Colleen D; Harrison, David A; Rowan, Kathy; Lucas, D Nuala; Kurinczuk, Jennifer J; Knight, Marian

    2016-01-01

    Objectives To describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK. Design National cohort study. Setting 198 critical care units in the UK. Participants 646 pregnant and recently pregnant women who had severe sepsis within the first 24 hours of admission in 2008–2010. Primary and secondary outcome measures Septic shock, mortality. Results Of all maternal critical care admissions, 14.4% (n=646) had severe sepsis; 10.6% (n=474) had septic shock. The absolute risk of maternal critical care admission with severe sepsis was 4.1/10 000 maternities. Pneumonia/respiratory infection (irrespective of the H1N1 pandemic influenza strain) and genital tract infection were the most common sources of sepsis (40% and 24%, respectively). We identified a significant gradient in the risk of severe maternal sepsis associated with increasing deprivation (RR=6.5; 95% CI 4.9 to 8.5 most deprived compared with most affluent women). The absolute risk of mortality was 1.8/100 000 maternities. The most common source of infection among women who died was pneumonia/respiratory infection (41%). Known risk factors for morbidity supported by this study were: younger age, multiple gestation birth and caesarean section. Significant risk factors for mortality in unadjusted analysis were: age ≥35 years (unadjusted OR (uOR)=3.5; 95% CI 1.1 to 10.6), ≥3 organ system dysfunctions (uOR=12.7; 95% CI 2.9 to 55.1), respiratory dysfunction (uOR=6.5; 95% CI1.9 to 21.6), renal dysfunction (uOR=5.6; 95% CI 2.3 to 13.4) and haematological dysfunction (uOR=6.5; 95% CI 2.9 to 14.6). Conclusions This study suggests a need to improve timely recognition of severe respiratory tract and genital tract infection in the obstetric population. The social gradient associated with the risk of severe sepsis morbidity and mortality raises important questions regarding maternal health service provision and usage. PMID:27554107

  4. Measuring maternal mortality in developing Pacific island countries: experience with the sisterhood method in the Solomon Islands.

    PubMed

    O'Brien, J; Wierzba, T; Knott, S; Pikacha, J

    1994-07-13

    The aim was to estimate the maternal mortality rate in the Solomon Islands and to assist health planning in the implementation of effective interventions. In many Pacific Island countries, registration of deaths is inaccurate and incomplete. The survey in the Solomon Islands was conducted in June 1992, and 2580 randomly chosen women were interviewed using the standard World Health Organization cluster sampling technique. The sisterhood method, an indirect technique for deriving population-based estimates of maternal mortality, was used in interviews reporting on the fertility and mortality experience of subjects' sisters. The sisterhood method was developed at the London School of Hygiene and Tropical Medicine in 1987 as an indirect technique for deriving population-based estimates of maternal mortality. In order to calculate the proportions of sisters dying of maternal causes, 4 questions were asked about deaths of their sisters 15 years of age or over during pregnancy, delivery or the puerperium. These, together with the 5-year age group of the respondents, formed the basic data for deriving an estimate of maternal mortality. An overall estimate of lifetime risk of maternal death across all respondent age groups was derived by dividing the total reported maternal deaths by the sum of the units of risk exposure across all age groups (73/2227 = 0.033) or a lifetime risk of 1 in 30. Through a series of well-defined mathematical calculations, it was possible to convert the information into retrospective estimates of maternal mortality. The maternal mortality ratio in this study was 549/100,000 (95% CI 431, 684), equivalent to 1 maternal death in every 180 pregnancies. The sisterhood method was found to be easy to administer, inexpensive, and quick, and is recommended as a measurement tool to other developing countries. The publication of the results has prompted the government of the Solomon Islands to act. PMID:8022583

  5. Maternal affection moderates friend influence on schoolwork engagement.

    PubMed

    Marion, Donna; Laursen, Brett; Kiuru, Noona; Nurmi, Jari-Erik; Salmela-Aro, Katariina

    2014-03-01

    This study investigated friend influence over adolescent schoolwork engagement in 160 same-sex friend dyads (94 female dyads and 66 male dyads). Participants were approximately 16 years of age at the outset. Each friend described his or her own schoolwork engagement, school burnout, and perceptions of maternal affection. The results revealed that maternal affection moderated the influence that the higher burnout friend exerted over the subsequent schoolwork engagement of the lower burnout friend. The schoolwork engagement of the friend reporting higher levels of school burnout predicted a decline in the schoolwork engagement of the friend reporting lower school burnout, but only if the latter perceived below-average maternal affection. PMID:24015690

  6. Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life.

    PubMed

    Lee, Kuan Ken; Raja, Edwin A; Lee, Amanda J; Bhattacharya, Sohinee; Bhattacharya, Siladitya; Norman, Jane E; Reynolds, Rebecca M

    2015-11-01

    One in 5 pregnant women is obese but the impact on later health is unknown. We aimed to determine whether maternal obesity during pregnancy associates with increased premature mortality and later life major cardiovascular events. Maternity records of women who gave birth to their first child between 1950 and 1976 (n=18 873) from the Aberdeen Maternity and Neonatal databank were linked to the National Register of Deaths, Scotland and Scottish Morbidity Record. The effect of maternal obesity at first antenatal visit on death and hospital admissions for cardiovascular events was tested using time-to-event analysis with Cox proportional hazard regression to compare outcomes of mothers in underweight, overweight, or obese body mass index (BMI) categories compared with normal BMI. Median follow-up was at 73 years. All-cause mortality was increased in women who were obese during pregnancy (BMI>30 kg/m(2)) versus normal BMI after adjustment for socioeconomic status, smoking, gestation at BMI measurement, preeclampsia, and low birth weight (hazard ratio, 1.35; 95% confidence interval, 1.02-1.77). In adjusted models, overweight and obese mothers had increased risk of hospital admission for a cardiovascular event (1.16; 1.06-1.27 and 1.26; 1.01-1.57) compared with normal BMI mothers. Adjustment for parity largely unchanged the hazard ratios (mortality: 1.43, 1.09-1.88; cardiovascular events overweight: 1.17, 1.07-1.29; and obese: 1.30, 1.04-1.62). In conclusion, maternal obesity is associated with increased risk of premature death and cardiovascular disease. Pregnancy and early postpartum could represent an opportunity for interventions to identify obesity and reduce its adverse consequences.

  7. Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life.

    PubMed

    Lee, Kuan Ken; Raja, Edwin A; Lee, Amanda J; Bhattacharya, Sohinee; Bhattacharya, Siladitya; Norman, Jane E; Reynolds, Rebecca M

    2015-11-01

    One in 5 pregnant women is obese but the impact on later health is unknown. We aimed to determine whether maternal obesity during pregnancy associates with increased premature mortality and later life major cardiovascular events. Maternity records of women who gave birth to their first child between 1950 and 1976 (n=18 873) from the Aberdeen Maternity and Neonatal databank were linked to the National Register of Deaths, Scotland and Scottish Morbidity Record. The effect of maternal obesity at first antenatal visit on death and hospital admissions for cardiovascular events was tested using time-to-event analysis with Cox proportional hazard regression to compare outcomes of mothers in underweight, overweight, or obese body mass index (BMI) categories compared with normal BMI. Median follow-up was at 73 years. All-cause mortality was increased in women who were obese during pregnancy (BMI>30 kg/m(2)) versus normal BMI after adjustment for socioeconomic status, smoking, gestation at BMI measurement, preeclampsia, and low birth weight (hazard ratio, 1.35; 95% confidence interval, 1.02-1.77). In adjusted models, overweight and obese mothers had increased risk of hospital admission for a cardiovascular event (1.16; 1.06-1.27 and 1.26; 1.01-1.57) compared with normal BMI mothers. Adjustment for parity largely unchanged the hazard ratios (mortality: 1.43, 1.09-1.88; cardiovascular events overweight: 1.17, 1.07-1.29; and obese: 1.30, 1.04-1.62). In conclusion, maternal obesity is associated with increased risk of premature death and cardiovascular disease. Pregnancy and early postpartum could represent an opportunity for interventions to identify obesity and reduce its adverse consequences. PMID:26370890

  8. A study of maternal mortality and midwifery on the Isle of Man, 1882 to 1961.

    PubMed Central

    Pantin, C G

    1996-01-01

    The living conditions and the health of Manx mothers continued to improve from 1881 to 1961. Against this background they were at first delivered conservatively and mostly by midwives. During this conservative phase the proportion of mothers surviving childbirth increased as their health improved: by the quinquennium 1907-1911 the maternal mortality rate on the Island was half what it had been twenty years earlier. Between 1912 and 1927 maternal mortality rose and during the quinquennium 1922-1926 the MD/BR was again at the level it had been thirty years before. Some of the maternal deaths during the quinquennium were among women who were subjected to intervention during childbirth by doctors in the unfavourable surroundings of their homes; conditions more suited to delivery by the conservative methods of kindly and patient handywomen. Following the opening of a small maternity home on 6 May 1927 the family doctors began to send their difficult deliveries into the Home where they were looked after by skilled staff and delivered in a well-equipped labour room. Throughout the subsequent decade the MD/BR remained at a level below that in 1907-1911. PMID:8936059

  9. Normal maternal behavior, but increased pup mortality, in conditional oxytocin receptor knockout females.

    PubMed

    Macbeth, Abbe H; Stepp, Jennifer E; Lee, Heon-Jin; Young, W Scott; Caldwell, Heather K

    2010-10-01

    Oxytocin (Oxt) and the Oxt receptor (Oxtr) are implicated in the onset of maternal behavior in a variety of species. Recently, we developed two Oxtr knockout lines: a total body knockout (Oxtr-/-) and a conditional Oxtr knockout (OxtrFB/FB) in which the Oxtr is lacking only in regions of the forebrain, allowing knockout females to potentially nurse and care for their biological offspring. In the current study, we assessed maternal behavior of postpartum OxtrFB/FB females toward their own pups and maternal behavior of virgin Oxtr-/- females toward foster pups and compared knockouts of both lines to wildtype (Oxtr+/+) littermates. We found that both Oxtr-/- and OxtrFB/FB females appear to have largely normal maternal behaviors. However, with first litters, approximately 40% of the OxtrFB/FB knockout dams experienced high pup mortality, compared to fewer than 10% of the Oxtr+/+ dams. We then went on to test whether or not this phenotype occurred in subsequent litters or when the dams were exposed to an environmental disturbance. We found that regardless of the degree of external disturbance, OxtrFB/FB females lost more pups on their first and second litters compared to wildtype females. Possible reasons for higher pup mortality in OxtrFB/FB females are discussed.

  10. Latent mortality of juvenile snapping turtles from the Upper Hudson River, New York, exposed maternally and via the diet to polychlorinated biphenyls (PCBs).

    PubMed

    Eisenreich, Karen M; Kelly, Shannon M; Rowe, Christopher L

    2009-08-01

    We conducted a factorial experiment to compare sublethal and lethal responses of juvenile snapping turtles exposed maternally and/or through the diet to polychlorinated biphenyls (PCBs) over 14 months posthatching. Maternal exposure did not affect embryonic development or hatching success. Thyrosomatic indices were not influenced by treatments, although hepatosomatic indices were lower in animals having been exposed to PCBs maternally relative to those having been exposed both maternally and via the diet. Dietary PCB exposure reduced metabolic rates of juveniles in two of three assays conducted. Approximately eight months after hatching, high rates of mortality began to emerge in individuals having been exposed maternally to PCBs, and mortality rate correlated with [PCB](total) in eggs. Prior to death, individuals that died experienced lower growth rates than those that survived, suggesting chronic effects prior to death. By 14 months posthatching, only 40% of juveniles derived from females in the contaminated area had survived, compared to 90% from the reference area. Such latent effects of maternally derived contaminants suggest that assessments of environmental impacts based upon shorter-term studies may provide very conservative estimates of the severity of effects, as they cannot capture responses that may emerge later in the life cycle. PMID:19731717

  11. Variation in embryonic mortality and maternal transcript expression among Atlantic cod (Gadus morhua) broodstock: a functional genomics study.

    PubMed

    Rise, Matthew L; Nash, Gordon W; Hall, Jennifer R; Booman, Marije; Hori, Tiago S; Trippel, Edward A; Gamperl, A Kurt

    2014-12-01

    Early life stage mortality is an important issue for Atlantic cod aquaculture, yet the impact of the cod maternal (egg) transcriptome on egg quality and mortality during embryonic development is poorly understood. In the present work, we studied embryonic mortality and maternal transcript expression using eggs from 15 females. Total mortality at 7days post-fertilization (7 dpf, segmentation stage) was used as an indice of egg quality. A 20,000 probe (20K) microarray experiment compared the 7hours post-fertilization (7 hpf, ~2-cell stage) egg transcriptome of the two lowest quality females (>90% mortality at 7 dpf) to that of the highest quality female (~16% mortality at 7 dpf). Forty-three microarray probes were consistently differentially expressed in both low versus high quality egg comparisons (25 higher expressed in low quality eggs, and 18 higher expressed in high quality eggs). The microarray experiment also identified many immune-relevant genes [e.g. interferon (IFN) pathway genes ifngr1 and ifrd1)] that were highly expressed in eggs of all 3 females regardless of quality. Twelve of the 43 candidate egg quality-associated genes, and ifngr1, ifrd1 and irf7, were included in a qPCR study with 7 hpf eggs from all 15 females. Then, the genes that were confirmed by qPCR to be greater than 2-fold differentially expressed between 7 hpf eggs from the lowest and highest quality females (dcbld1, ddc, and acy3 more highly expressed in the 2 lowest quality females; kpna7 and hacd1 more highly expressed in the highest quality female), and the 3 IFN pathway genes, were included in a second qPCR study with unfertilized eggs. While some maternal transcripts included in these qPCR studies were associated with extremes in egg quality, there was little correlation between egg quality and gene expression when all females were considered. Both dcbld1 and ddc showed greater than 100-fold differences in transcript expression between females and were potentially influenced by

  12. Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana.

    PubMed Central

    Smith, J. B.; Fortney, J. A.; Wong, E.; Amatya, R.; Coleman, N. A.; de Graft Johnson, J.

    2001-01-01

    OBJECTIVE: To estimate the maternal mortality ratio (MMR) by the sisterhood method in two districts of the Brong-Ahafo region of Ghana, and to determine the impact of different assumptions and analytical decisions on these estimates. METHODS: Indirect estimates of the MMR were calculated from data collected in 1995 by Family Health International (FHI) on 5202 women aged 15-49 years, using a household screen of randomly selected areas in the two districts. Other data from the nationally representative 1994 Ghana Infant, Child and Maternal Mortality Survey (ICMMS) and from the 1997 Kassena-Nankana District study were also used for comparison. FINDINGS: Based on the FHI data, the MMR was estimated to be 269 maternal deaths per 100,000 live births for both districts combined, a figure higher than ICMMS estimates. Biases during data collection may account for this difference, including the fact that biases underestimating mortality are more common than those overestimating it. Biases introduced during data analysis were also considered, but only the total fertility rate used to calculate the MMR seemed to affect the estimates significantly. CONCLUSIONS: The results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received attention. Users of this method should be aware of limitations when interpreting results. We recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of data. PMID:11417035

  13. Cues of maternal condition influence offspring selfishness.

    PubMed

    Wong, Janine W Y; Lucas, Christophe; Kölliker, Mathias

    2014-01-01

    The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia) if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism) and extracted and analyzed the females' cuticular hydrocarbons (CHC). Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons. PMID:24498046

  14. Cues of Maternal Condition Influence Offspring Selfishness

    PubMed Central

    Wong, Janine W. Y.; Lucas, Christophe; Kölliker, Mathias

    2014-01-01

    The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia) if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism) and extracted and analyzed the females’ cuticular hydrocarbons (CHC). Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons. PMID:24498046

  15. Biocultural perspectives on maternal mortality and obstetrical death from the past to the present.

    PubMed

    Stone, Pamela K

    2016-01-01

    Global efforts to improve maternal health are the fifth focus goal of the Millennium Development Goals adopted by the international community in 2000. While maternal mortality is an epidemic, and the death of a woman in childbirth is tragic, certain assumptions that frame the risk of death for reproductive aged women continue to hinge on the anthropological theory of the "obstetric dilemma." According to this theory, a cost of hominin selection to bipedalism is the reduction of the pelvic girdle; in tension with increasing encephalization, this reduction results in cephalopelvic disproportion, creating an assumed fragile relationship between a woman, her reproductive body, and the neonates she gives birth to. This theory, conceived in the 19th century, gained traction in the paleoanthropological literature in the mid-20th century. Supported by biomedical discourses, it was cited as the definitive reason for difficulties in human birth. Bioarchaeological research supported this narrative by utilizing demographic parameters that depict the death of young women from reproductive complications. But the roles of biomedical and cultural practices that place women at higher risk for morbidity and early mortality are often not considered. This review argues that reinforcing the obstetrical dilemma by framing reproductive complications as the direct result of evolutionary forces conceals the larger health disparities and risks that women face globally. The obstetrical dilemma theory shifts the focus away from other physiological and cultural components that have evolved in concert with bipedalism to ensure the safe delivery of mother and child. It also sets the stage for a framework of biological determinism and structural violence in which the reproductive aged female is a product of her pathologized reproductive body. But what puts reproductive aged women at risk for higher rates of morbidity and mortality goes far beyond the reproductive body. Moving beyond reproduction

  16. Psychobiological influences on maternal sensitivity in the context of adversity.

    PubMed

    Finegood, Eric D; Blair, Clancy; Granger, Douglas A; Hibel, Leah C; Mills-Koonce, Roger

    2016-07-01

    This study evaluated prospective longitudinal relations among an index of poverty-related cumulative risk, maternal salivary cortisol, child negative affect, and maternal sensitivity across the first 2 postpartum years. Participants included 1,180 biological mothers residing in rural and predominantly low-income communities in the United States. Multilevel growth curve analyses indicated that an index of cumulative risk was positively associated with maternal cortisol across the postpartum (study visits occurring at approximately 7, 15, and 24 months postpartum) over and above effects for African American ethnicity, time of day of saliva collection, age, parity status, having given birth to another child, contraceptive use, tobacco smoking, body mass index, and breastfeeding. Consistent with a psychobiological theory of mothering, maternal salivary cortisol was negatively associated with maternal sensitivity observed during parent-child interactions across the first 2 postpartum years over and above effects for poverty-related cumulative risk, child negative affect, as well as a large number of covariates associated with cortisol and maternal sensitivity. Child negative affect expressed during parent-child interactions was negatively associated with observed maternal sensitivity at late (24 months) but not early time points of observation (7 months) and cumulative risk was negatively associated with maternal sensitivity across the postpartum and this effect strengthened over time. Results advance our understanding of the dynamic, transactional, and psychobiological influences on parental caregiving behaviors across the first 2 postpartum years. (PsycINFO Database Record PMID:27337514

  17. Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?

    PubMed

    Kwast, B E

    1996-10-01

    The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality.

  18. Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?

    PubMed

    Kwast, B E

    1996-10-01

    The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality. PMID:8909956

  19. National review of maternity services 2008: women influencing change

    PubMed Central

    2011-01-01

    Background In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth. Methods A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women. Results Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors' traditional authority is questioned by strong consumer organisations and informed consumers. Conclusions Unified consumer influence advocating a move away from obstetric -led maternity care for all pregnant women appears to be synergistic with the ethos of corporate governance and a neoliberal approach to maternity service policy. The silent voice of one consumer group (women happy with their obstetric-led care) in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint. PMID:21762522

  20. Cholera in Pregnancy: A Systematic Review and Meta-Analysis of Fetal, Neonatal, and Maternal Mortality

    PubMed Central

    Tran, Nguyen-Toan; Taylor, Richard; Antierens, Annick; Staderini, Nelly

    2015-01-01

    Background Maternal infection with cholera may negatively affect pregnancy outcomes. The objective of this research is to systematically review the literature and determine the risk of fetal, neonatal and maternal death associated with cholera during pregnancy. Materials and Methods Medline, Global Health Library, and Cochrane Library databases were searched using the key terms cholera and pregnancy for articles published in any language and at any time before August 2013 to quantitatively summarize estimates of fetal, maternal, and neonatal mortality. 95% confidence intervals (CIs) were calculated for each selected study. Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period. Studies from the recent period (1991-2013) were compared with studies from 1969-1990. Relative risk (RR) estimates and 95% CIs were obtained by comparing mortality of selected recent studies with published national normative data from the closest year. Results The meta-analysis included seven studies that together involved 737 pregnant women with cholera from six countries. The pooled fetal death rate for 4 studies during 1991-2013 was 7.9% (95% CIs 5.3-10.4), significantly lower than that of 3 studies from 1969-1990 (31.0%, 95% CIs 25.2-36.8). There was no difference in fetal death rate by trimester. The pooled neonatal death rate for 1991-2013 studies was 0.8% (95% CIs 0.0-1.6), and 6.4% (95% CIs 0.0-20.8) for 1969-1990. The pooled maternal death rate for 1991-2013 studies was 0.2% (95% CIs 0.0-0.7), and 5.0% (95% CIs 0.0-16.0) for 1969-1990. Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3) was calculated for Haiti (2013), 1.8 (95% CIs 0.3-10.4) for Senegal (2007), and 2.6 (95% CIs 0.5-14.9) for Peru (1991); there were no significant differences in the RR for neonatal or maternal death. Conclusion Results are limited by the inconsistencies found across included studies but suggest that

  1. Treatment Factors That Influence Mortality in Acromegaly.

    PubMed

    McCabe, John; Ayuk, John; Sherlock, Mark

    2016-01-01

    Acromegaly is a rare condition characterized by excessive secretion of growth hormone (GH), which is almost always due to a pituitary adenoma. Acromegaly is associated with significant morbidity such as hypertension, type 2 diabetes, cardiomyopathy, obstructive sleep apnoea, malignancy and musculoskeletal abnormalities. Acromegaly has also been associated with increased mortality in several retrospective studies. This review will focus on the epidemiological data relating to mortality rates in acromegaly, the relationship between acromegaly and malignancy, the role of GH and insulin-like growth factor-I in assessing the risk of future mortality, and the impact of radiotherapy and hypopituitarism on mortality.

  2. Using Community Informants to Estimate Maternal Mortality in a Rural District in Pakistan: A Feasibility Study

    PubMed Central

    Shaikh, Mohammad Saleem; Qomariyah, Siti Nurul; Rashida, Gul; Khan, Mumraiz; Masood, Irfan

    2015-01-01

    Background. We aimed to assess the feasibility of using community-based informants' networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan. Methods. We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies. Results. In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births. Conclusion. It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys. PMID:25741446

  3. Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

    PubMed

    Bhardwaj, N; Hasan, S B; Zaheer, M

    1995-04-01

    A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p < 0.0001). Significantly, no perinatal or neonatal deaths occurred in women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

  4. The etiology of maternal mortality in developing countries: what do verbal autopsies tell us?

    PubMed Central

    Sloan, N. L.; Langer, A.; Hernandez, B.; Romero, M.; Winikoff, B.

    2001-01-01

    OBJECTIVE: To reassess the practical value of verbal autopsy data, which, in the absence of more definitive information, have been used to describe the causes of maternal mortality and to identify priorities in programmes intended to save women's lives in developing countries. METHODS: We reanalysed verbal autopsy data from a study of 145 maternal deaths that occurred in Guerrero, Querétaro and San Luis Potosí, Mexico, in 1995, taking into account other causes of death and the WHO classification system. The results were also compared with information given on imperfect death certificates. FINDINGS: The reclassification showed wide variations in the attribution of maternal deaths to single specific medical causes. CONCLUSION: The verbal autopsy methodology has inherent limitations as a means of obtaining histories of medical events. At best it may reconfirm the knowledge that mortality among poor women with little access to medical care is higher than that among wealthier women who have better access to such care. PMID:11584727

  5. Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

    PubMed

    Bhardwaj, N; Hasan, S B; Zaheer, M

    1995-04-01

    A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p < 0.0001). Significantly, no perinatal or neonatal deaths occurred in women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine. PMID:8635804

  6. Using human rights in maternal mortality programs: from analysis to strategy.

    PubMed

    Freedman, L P

    2001-10-01

    This article describes an approach to maternal mortality reduction that uses human rights not simply to denounce the injustice of death in pregnancy and childbirth, but also to guide the design and implementation of maternal mortality policies and programs. As a first principle, programs and policies need to prioritize measures that promote universal access to high quality emergency obstetric care services, which we know from health research are essential to saving women's lives. With that priority, human rights principles can be integrated into programs at the clinical, facility management, and national policy levels. For example, a human rights 'audit' can help identify ways to encourage respectful, non-discriminatory treatment of patients, providers and staff in the clinical setting. Human rights principles of entitlement and accountability can inform mechanisms of community participation designed to improve responsiveness and functioning of health facilities. Human rights principles can inform analysis of health sector reform and its impact on access to emergency obstetric care. Whether applied to the intricacies of human relationships within a facility or to the impact of international financial institutions on health systems, the ultimate role of human rights is to identify the workings of power that keep unacceptable levels of maternal morality as they are and to use the human rights vision of dignity and social justice to work for the re-arrangements of power necessary for change. PMID:11597619

  7. Poverty and maternal mortality in Nigeria: towards a more viable ethics of modern medical practice

    PubMed Central

    Lanre-Abass, Bolatito A

    2008-01-01

    Poverty is often identified as a major barrier to human development. It is also a powerful brake on accelerated progress toward the Millennium Development Goals. Poverty is also a major cause of maternal mortality, as it prevents many women from getting proper and adequate medical attention due to their inability to afford good antenatal care. This Paper thus examines poverty as a threat to human existence, particularly women's health. It highlights the causes of maternal deaths in Nigeria by questioning the practice of medicine in this country, which falls short of the ethical principle of showing care. Since high levels of poverty limit access to quality health care and consequently human development, this paper suggests ways of reducing maternal mortality in Nigeria. It emphasizes the importance of care ethics, an ethical orientation that seeks to rectify the deficiencies of medical practice in Nigeria, notably the problem of poor reproductive health services. Care ethics as an ethical orientation, attends to the important aspects of our shared lives. It portrays the moral agent (in this context the physician) as a self who is embedded in webs of relations with others (pregnant women). Also central to this ethical orientation is responsiveness in an interconnected network of needs, care and prevention of harm. This review concludes by stressing that many human relationships involve persons who are vulnerable, including pregnant women, dependent, ill and or frail, noting that the desirable moral response is that prescribed by care ethics, which thus has implications for the practice of medicine in Nigeria. PMID:18447920

  8. Reducing maternal morbidity and mortality in the developing world: a simple, cost-effective example

    PubMed Central

    Browning, Andrew; Menber, Birhanu

    2015-01-01

    Objectives To determine the impact of volunteer obstetricians and midwife teams on obstetric services in a rural hospital in Ethiopia. Methods The intervention was undertaken in Mota district hospital, a rural hospital in the Amhara region of Ethiopia, which is the only hospital for 1.2 million people. Before the placement of volunteer teams it had a rudimentary basic obstetric service, no blood transfusion service, and no operative delivery. The study prospectively analyzed delivery data before, during, and after the placement of volunteer obstetrician and midwife teams. The volunteers established emergency obstetric care, and trained and supervised local staff over a 3-year period. Measurable outcomes consisted of the number of women delivering, the number of referrals of pregnant women, the number of maternal deaths, and the number of referrals of obstetric fistula patients. Results With the establishment of the service the number of women attending hospital for delivery increased by 40%. In the hospital maternal mortality decreased from 7.1% to <0.5%, and morbidity, as measured by number of obstetric fistulae, decreased from 1.5% deliveries to 0.5% over the 3-year intervention period. The improvements were sustained after handing the project back to the government. Conclusion The placement of volunteer teams was an effective method of decreasing maternal mortality and morbidity. PMID:25678820

  9. Maternal and peer influences on drinking among Latino college students.

    PubMed

    Varvil-Weld, Lindsey; Turrisi, Rob; Hospital, Michelle M; Mallett, Kimberly A; Bámaca-Colbert, Mayra Y

    2014-01-01

    Previous research on college drinking has paid little attention to Latino students. Social development models (Catalano, Hawkins, & Miller, 1992) suggest that protective influences in one domain (e.g., mothers) can offset negative influences from other domains (e.g., peers) though this possibility has not been explored with respect to Latino college student drinking. The present study had two aims: 1) to determine whether four specific maternal influences (monitoring, positive communication, permissiveness, and modeling) and peer descriptive norms were associated with college drinking and consequences among Latino students, and 2) to determine whether maternal influences moderated the effect of peer norms on college drinking and consequences. A sample of 362 first-year students (69.9% female) completed an online assessment regarding their mothers' monitoring, positive communication, permissiveness, and modeling, peer descriptive norms, and drinking and related consequences. Main effects and two-way interactions (mother×peer) were assessed using separate hierarchical regression models for three separate outcomes: peak drinking, weekly drinking, and alcohol-related consequences. Maternal permissiveness and peer descriptive norms were positively associated with drinking and consequences. Maternal communication was negatively associated with consequences. Findings indicate that previously identified maternal and peer influences are also relevant for Latino students and highlight future directions that would address the dearth of research in this area.

  10. Maternal mortality from septic abortions in University Hospital, Kuala Lumpur from March 1968 to February 1974.

    PubMed

    Ng, K H; Sinnathuray, T A

    1975-09-01

    4 maternal deaths from abortion that took place during the 6-year period from March 1968 to February 1974 in the University Hospital, Kuala Lumpur are reviewed with focus on the avoidable causes and preventive aspects. The total maternal deaths from all causes for the 1699 admission was 13. The mortality rate from abortion during this period was 0.241/1000 pregnancies. The number of abortion cases admitted into the hospital during the 6-year period increased steadily. Of the 4 abortion deaths, 3 patients admitted to attempts at inducing abortion. 1 patient denied having induced abortion, although her husband felt that it could have occurred. All 4 cases of abortion deaths occurred in patients with septic abortions and were, theoretically, avoidable deaths. It is most important to prevent sepsis in a case of abortion. Patients with endotoxic shock are often given intravenous steroids in pharmacological doses every 4-6 hours.

  11. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe

    PubMed Central

    Bouvier-Colle, M-H; Mohangoo, AD; Gissler, M; Novak-Antolic, Z; Vutuc, C; Szamotulska, K; Zeitlin, J

    2012-01-01

    Objective To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. Design Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. Setting Twenty-five countries in the European Union and Norway. Population Women giving birth in participating countries in 2003 and 2004. Methods Application of a common collection of data by selecting specific International Classification of Disease codes from the ‘Pregnancy, childbirth and the puerperium’ chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. Main outcome measures Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. Results In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100 000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). Conclusions Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended. PMID:22571748

  12. Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study

    PubMed Central

    2011-01-01

    Background Ghana's maternal mortality ratio remains high despite efforts made to meet Millennium Development Goal 5. A number of studies have been conducted on maternal mortality in Ghana; however, little is known about how the causes of maternal mortality are distributed in different socio-demographic subgroups. Therefore the aim of this study was to assess and analyse the causes of maternal mortality according to socio-demographic factors in Ghana. Methods The causes of maternal deaths were assessed with respect to age, educational level, rural/urban residence status and marital status. Data from a five year retrospective survey was used. The data was obtained from Ghana Maternal Health Survey 2007 acquired from the database of Ghana Statistical Service. A total of 605 maternal deaths within the age group 12-49 years were analysed using frequency tables, cross-tabulations and logistic regression. Results Haemorrhage was the highest cause of maternal mortality (22.8%). Married women had a significantly higher risk of dying from haemorrhage, compared with single women (adjusted OR = 2.7, 95%CI = 1.2-5.7). On the contrary, married women showed a significantly reduced risk of dying from abortion compared to single women (adjusted OR = 0.2, 95%CI = 0.1-0.4). Women aged 35-39years had a significantly higher risk of dying from haemorrhage (aOR 2.6, 95%CI = 1.4-4.9), whereas they were at a lower risk of dying from abortion (aOR 0.3, 95% CI = 0.1-0.7) compared to their younger counterparts. The risk of maternal death from infectious diseases decreased with increasing maternal age, whereas the risk of dying from miscellaneous causes increased with increasing age. Conclusions The study shows evidence of variations in the causes of maternal mortality among different socio-demographic subgroups in Ghana that should not be overlooked. It is therefore recommended that interventions aimed at combating the high maternal mortality in Ghana should be both cause-specific as well as

  13. The impact of economic recession on maternal and infant mortality: lessons from history

    PubMed Central

    2010-01-01

    Background The effect of the recent world recession on population health has featured heavily in recent international meetings. Maternal health is a particular concern given that many countries were already falling short of their MDG targets for 2015. Methods We utilise 20th century time series data from 14 high and middle income countries to investigate associations between previous economic recession and boom periods on maternal and infant outcomes (1936 to 2005). A first difference logarithmic model is used to investigate the association between short run fluctuations in GDP per capita (individual incomes) and changes in health outcomes. Separate models are estimated for four separate time periods. Results The results suggest a modest but significant association between maternal and infant mortality and economic growth for early periods (1936 to 1965) but not more recent periods. Individual country data display markedly different patterns of response to economic changes. Japan and Canada were vulnerable to economic shocks in the post war period. In contrast, mortality rates in countries such as the UK and Italy and particularly the US appear little affected by economic fluctuations. Conclusions The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mechanisms that protect vulnerable populations from the effects of fluctuating national income. PMID:21106089

  14. Estimating mortality differences in developed countries from survey information on maternal and paternal orphanhood.

    PubMed

    Luy, Marc

    2012-05-01

    In general, the use of indirect methods is limited to developing countries. Developed countries are usually assumed to have no need to apply such methods because detailed demographic data exist. However, the potentialities of demographic analysis with direct methods are limited to the characteristics of available macro data on births, deaths, and migration. For instance, in many Western countries, official population statistics do not permit the estimation of mortality by socioeconomic status (SES) or migration background, or for estimating the relationship between parity and mortality. In order to overcome these shortcomings, I modify and extend the so-called orphanhood method for indirect estimation of adult mortality from survey information on maternal and paternal survival to allow its application to populations of developed countries. The method is demonstrated and tested with data from two independent Italian cross-sectional surveys by estimating overall and SES-specific life expectancy. The empirical applications reveal that the proposed method can be used successfully for estimating levels and trends of mortality differences in developed countries and thus offers new prospects for the analysis of mortality.

  15. Maternal Mortality in Colombia in 2011: A Two Level Ecological Study

    PubMed Central

    Cárdenas-Cárdenas, Luz Mery; Cotes-Cantillo, Karol; Chaparro-Narváez, Pablo Enrique; Fernández-Niño, Julián Alfredo; Paternina-Caicedo, Angel; Castañeda-Orjuela, Carlos; De la Hoz-Restrepo, Fernando

    2015-01-01

    Objective Maternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between and into departments (states) and also between municipalities. We examined socioeconomics variables at the municipal and departmental levels which could be associated to the municipal maternal mortality in Colombia. Methods A multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal and department level as the principal independent variables and other measures of the social and economic characteristics at municipal and departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index and Gini coefficient). The association between MMR and socioeconomic contextual conditions at municipal and departmental level was assessed using a multilevel Poisson regression model. Results The MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09-11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01-25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98-1.00), and significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97-0.99). Conclusion Poverty and transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion and formulation processes with a differential

  16. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

    PubMed Central

    2015-01-01

    Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care. PMID:27512460

  17. [Maternal mortality. Evolution of its study in Mexico over the past 25 years].

    PubMed

    Trejo Ramírez, C A

    1997-08-01

    Traditionally it has been said that pregnancy and delivery are natural, physiological processes that should develop without problems for the mother. However, both may produce severe complications, that may cause death of the woman with a variable frequency, according to several factors such as availability and quality of obstetrical care, as well as population characteristics, that are special one in our country, as most of it belongs to the so called open population, as they do not have medical services at Social Security Institutions, and of private medicine, and so, they belong to the lowest socio-economical condition, and because of this, mortality incidence is high, with rates between 90.30 and 57.15 for 100,000 births, which are quite different from the ones for developed countries, from 9 and 30 per 100,000 births; so, it can be said that Maternal Mortality rates for a certain country, show its development degree.

  18. Maternal and neonatal morbidity and mortality rate in caesarean section and vaginal delivery

    PubMed Central

    Ghahiri, Ataollah; Khosravi, Mehrnoush

    2015-01-01

    Background: The cesarean section is one of the most common procedures to prevent health-threatening risks to the mother and infant. Increasing rate of cesarean section attracted the attention of professionals and the overall objective of this study was to determine the frequency of maternal and neonatal morbidity and mortality rates in the two methods of delivery. Materials and Methods: In a comparative cohort study, 300 cases undergoing caesarean section and 300 cases with vaginal delivery were selected in two main hospitals of Isfahan, Iran during 2013 and 2014. Demographic characteristics and factors related to mortality and morbidity of mothers and infants were studied. Mothers were also recruited 6 weeks after delivery to ask for complications. Mothers and infants mortality and morbidity were studied and analyzed by SPSS 22 software. Results: Follow-up of deliveries up to 1-month after delivery suggested 2 cases of infant death (7%) in vaginal delivery group, while no case of infant death was reported in cesarean delivery group (P = 0.5). Incidence of fever was observed in first 10 days after delivery in 7 cases in the vaginal delivery group and 11 cases in the cesarean delivery group (2.3% vs. 3.7%, P = 0.4). Conclusion: Despite all the benefits of vaginal delivery compared with cesarean section, in many cases, especially in emergency cesarean section delivery can substantially reduce the maternal and neonatal mortality and morbidity. It is recommended to assess the complications of each method in all pregnant women about to give birth, and then decide on the method of delivery. PMID:26605232

  19. Can cash transfers improve determinants of maternal mortality? Evidence from the household and community programs in Indonesia.

    PubMed

    Kusuma, Dian; Cohen, Jessica; McConnell, Margaret; Berman, Peter

    2016-08-01

    Despite global efforts in maternal health, 303,000 maternal deaths still occurred globally in 2015. One explanation is a considerable inequality in maternal mortality and the sources such as nutritional status and health utilization. One strategy to fight health inequality due to poverty is conditional cash transfer (CCT). Taking advantage of two large clustered-randomized trials in Indonesia from 2007 to 2009, this paper provides evidence on the effects of household cash transfers (PKH) and community cash transfers (Generasi) on determinants of maternal mortality. The sample sizes are 14,000 households for PKH and 12,000 households for Generasi. After two years of implementation, difference-in-differences (DID) analyses show that the two programs can improve determinants of maternal mortality with Generasi provides positive impact in some aspects of determinants, but PKH does not. Generasi improves maternal health knowledge, reduces financial barriers to accessing health services and improves utilization of health services, increases utilization among higher-risk women, improves posyandu equipment, and increases nutritional intake. As for PKH, evidence shows its strongest effects only on utilization of health services. Both programs, however, are unlikely to have a large effect on maternal mortality due to design and implementation issues that might significantly reduce program effectiveness. While the programs improved utilization, they did so at community-based facilities not equipped with emergency obstetric care. In the midst of popularity of household cash transfer, our results show that community cash transfer offers a viable policy alternative to improve the determinants of maternal mortality by allowing more flexibility in activities and at lower cost by monitoring at community level.

  20. Iron endowment at birth: maternal iron status and other influences.

    PubMed

    Viteri, Fernando E

    2011-11-01

    The iron endowment at birth depends, in large part, on the newborn's birth weight and gestational age. These are determined by many factors, some of which are maternal characteristics, including the following: maternal iron stores at her own birth and during her own early life, maternal growth and development, maternal age at conception, intergenesic intervals, maternal body characteristics and iron status at conception and during early pregnancy, gestational body weight gain, and iron status throughout gestation, particularly at conception and early pregnancy, and gestational body weight gain. Although less studied, paternal influences on the initiation and progression of pregnancy and on maternal environmental exposures are also important. Even though tools for the quantitative evaluation of women's iron status are very well developed, the quantitative estimation of body iron in the newborn and young infant remains a challenge. This article describes the crucial role played by the placenta in protecting the embryo and the fetus. In addition, neonatal health, particularly early in pregnancy, is briefly addressed, as are some important aspects of antenatal nutritional interventions that include iron.

  1. Maternal use of cigarettes, pipes, and smokeless tobacco associated with higher infant mortality rates in Cambodia.

    PubMed

    Singh, Pramil N; Eng, Carlin; Yel, Daravuth; Kheam, They; Job, Jayakaran S; Kanal, Koum

    2013-09-01

    In the Western Pacific Region, rural women use loose tobacco in betel quid chewing and pipe smoking. We examined the relation between maternal use of tobacco and infant mortality (IM) in a national sample of 24 296 birth outcomes in adult women (n = 6013) in Cambodia. We found that (1) age-adjusted odds of IM were higher for maternal use of any tobacco (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 1.27-2.26); (2) age-adjusted odds of IM were higher for cigarette use (OR = 2.54; 95% CI = 1.54- 4.1), use of pipes (OR = 3.09; [95% CI = 1.86-5.11]), and betel quid chewing (OR = 1.55; 95% CI = 1.10-2.17); and (3) these associations remained after multivariable adjustment for environmental tobacco smoke, malnutrition, ethnicity, religion, marital status, education, income, occupation, and urban/rural dwelling. In addition to finding the established association with cigarettes, we also found that maternal use of smokeless tobacco and pipes was associated with higher rates of infant death in Cambodia.

  2. Maternal mortality in the developing world: why do mothers really die?

    PubMed

    Lewis, Gwyneth

    2008-09-01

    Every year some eight million women suffer preventable or remediable pregnancy-related complications and over half a million will die unnecessarily. Most of these deaths could be averted at little or no extra cost, even where resources are limited, but in order to take action, and develop and implement changes to maternity services to save mothers and newborns lives, a change in cultural attitudes and political will, as well as improvements in the provision of health and social care, is required. Further, to aid programme planners, more in-depth information than that which may already be available through national statistics on maternal mortality rates or death certificate data is urgently needed. What is required is an in-depth understanding of the clinical, social, cultural or any other underlying factors which lead to mothers' deaths. Such information can be obtained by using any of the five methodologies outlined in the World Health Organizations programme and philosophy for maternal death or disability reviews, 'Beyond the Numbers', briefly described here and which are now being introduced in a number of countries around the world. PMID:27630738

  3. Maternal mortality in the developing world: why do mothers really die?

    PubMed Central

    Lewis, Gwyneth

    2008-01-01

    Every year some eight million women suffer preventable or remediable pregnancy-related complications and over half a million will die unnecessarily. Most of these deaths could be averted at little or no extra cost, even where resources are limited, but in order to take action, and develop and implement changes to maternity services to save mothers and newborns lives, a change in cultural attitudes and political will, as well as improvements in the provision of health and social care, is required. Further, to aid programme planners, more in-depth information than that which may already be available through national statistics on maternal mortality rates or death certificate data is urgently needed. What is required is an in-depth understanding of the clinical, social, cultural or any other underlying factors which lead to mothers' deaths. Such information can be obtained by using any of the five methodologies outlined in the World Health Organizations programme and philosophy for maternal death or disability reviews, ‘Beyond the Numbers’, briefly described here and which are now being introduced in a number of countries around the world. PMID:27630738

  4. Oxidized fish oil in rat pregnancy causes high newborn mortality and increases maternal insulin resistance.

    PubMed

    Albert, Benjamin B; Vickers, Mark H; Gray, Clint; Reynolds, Clare M; Segovia, Stephanie A; Derraik, José G B; Lewandowski, Paul A; Garg, Manohar L; Cameron-Smith, David; Hofman, Paul L; Cutfield, Wayne S

    2016-09-01

    Fish oil is commonly taken by pregnant women, and supplements sold at retail are often oxidized. Using a rat model, we aimed to assess the effects of supplementation with oxidized fish oil during pregnancy in mothers and offspring, focusing on newborn viability and maternal insulin sensitivity. Female rats were allocated to a control or high-fat diet and then mated. These rats were subsequently randomized to receive a daily gavage treatment of 1 ml of unoxidized fish oil, a highly oxidized fish oil, or control (water) throughout pregnancy. At birth, the gavage treatment was stopped, but the same maternal diets were fed ad libitum throughout lactation. Supplementation with oxidized fish oil during pregnancy had a marked adverse effect on newborn survival at day 2, leading to much greater odds of mortality than in the control (odds ratio 8.26) and unoxidized fish oil (odds ratio 13.70) groups. In addition, maternal intake of oxidized fish oil during pregnancy led to increased insulin resistance at the time of weaning (3 wks after exposure) compared with control dams (HOMA-IR 2.64 vs. 1.42; P = 0.044). These data show that the consumption of oxidized fish oil is harmful in rat pregnancy, with deleterious effects in both mothers and offspring. PMID:27385731

  5. Morbidity and mortality of infants of diabetic mothers born at the Maternity Hospital, Kuala Lumpur.

    PubMed

    Boo, N Y

    1992-03-01

    A prospective study was carried out in the Maternity Hospital, Kuala Lumpur in 1989 to determine the morbidity and mortality of infants of diabetic mothers. Out of 24,856 neonates born during the study period, 54 neonates (2.2 per 1000 livebirths) were born to mothers who were diagnosed to have diabetes mellitus before the current pregnancy or who had impaired glucose tolerance test during the current pregnancy. Almost a third (29.6 percent) of these infants of diabetic mothers had birthweight of 4000 grams and above, and 37.0 percent of the 54 babies were large-for-gestational age. Hypoglycemia occurred in 9/54 (16.7 percent) of the neonates, respiratory distress syndrome in 5/54 (9.3 percent), shoulder dystocia in 7/54 (13.0 percent), and congenital abnormalities in 4/54 (7.4 percent). Three (5.6 percent) neonates died during the neonatal period. The results of this study suggest a need to intensify control of maternal diabetes mellitus during pregnancy in order to reduce the rates of morbidity and mortality of their infants.

  6. Trends in maternal mortality due to haemorrhage: two decades of Indian rural observations.

    PubMed

    Chhabra, S; Sirohi, Ritu

    2004-01-01

    Obstetric haemorrhage continues to be a major cause of maternal mortality. Our analysis of records of over a period of 20 years from April 1982 to March 2002 reveals that it was a contributory cause of maternal mortality in 19.9% of cases. The majority of deaths, (65%) had occurred within 24 hours of admission and in 47.5% of cases there was severe anaemia on admission; 17.5% had died due to an atonic PPH, which was the largest category, followed by ruptured uterus (15%), abruptio placenta (15%) and retained placenta (12.5%). Deaths due to obstetric haemorrhage because of a ruptured uterus, retained placenta and abortion have decreased from 22.22% between 1982 and 1987 to zero in the last 5 years and an increase was seen in deaths due to haemorrhage because of gestational trophoblastic neoplasia and ectopic pregnancy, from 1.69% to 4.87%, unclassified haemorrhage 1.96% to 7.31% and placenta praevia from zero between 1982 and 1987 to 4.87% between 1997 and 2002. PMID:14675979

  7. Extremes of maternal age and child mortality: analysis between 2000 and 2009☆

    PubMed Central

    Ribeiro, Fanciele Dinis; Ferrari, Rosângela Aparecida Pimenta; Sant'Anna, Flávia Lopes; Dalmas, José Carlos; Girotto, Edmarlon

    2014-01-01

    OBJECTIVE: To analyze the characteristics of infant mortality at the extremes of maternal age. METHOD: Retrospective, cross-sectional quantitative study using data from Live Birth Certificates, Death Certificates and from Child Death Investigation records in Londrina, Paraná, in the years of 2000-2009. RESULTS: During the 10-year study period , there were 176 infant deaths among mothers up to 19 years of age, and 113 deaths among mothers aged 35 years or more. The infant mortality rate among young mothers was 14.4 deaths per thousand births, compared to 12.9 deaths in the other age group. For adolescent mothers, the following conditions prevailed: lack of a stable partner (p<0.001), lack of a paid job (p<0.001), late start of prenatal care in the second trimester of pregnancy (p<0.001), fewer prenatal visits (p<0.001) and urinary tract infections (p<0.001). On the other hand, women aged 35 or more had a higher occurrence of hypertension during pregnancy (p<0.001), and of surgical delivery (p<0.001). Regarding the underlying cause of infant death, congenital anomalies prevailed in the group of older mothers (p=0.002), and external causes were predominant in the group of young mothers (p=0.019). CONCLUSION: Both age groups deserve the attention of social services for maternal and child health, especially adolescent mothers, who presented a higher combination of factors deemed hazardous to the child's health. PMID:25511003

  8. Maternal Affection Moderates Friend Influence on Schoolwork Engagement

    ERIC Educational Resources Information Center

    Marion, Donna; Laursen, Brett; Kiuru, Noona; Nurmi, Jari-Erik; Salmela-Aro, Katariina

    2014-01-01

    This study investigated friend influence over adolescent schoolwork engagement in 160 same-sex friend dyads (94 female dyads and 66 male dyads). Participants were approximately 16 years of age at the outset. Each friend described his or her own schoolwork engagement, school burnout, and perceptions of maternal affection. The results revealed that…

  9. Maternal Influences on Smoking Initiation among Urban Adolescent Girls

    ERIC Educational Resources Information Center

    Nichols, Tracy R.; Graber, Julia A.; Brooks-Gunn, Jeanne; Botvin, Gilbert J.

    2004-01-01

    This study examined associations between maternal social influences to smoke and girls' early smoking behaviors. Data were collected separately from 450 urban minority girls (65.7% Black, 21.5% Latina, and 12.8% other) and their mothers on smoking frequency as well as demographic and social factors hypothesized to promote smoking. Results showed…

  10. Measuring child mortality from maternity histories collected at time of childbirth. Case of the EMIS surveys.

    PubMed

    Mbacke, C S

    1991-01-01

    A researcher has developed a new research methodology to indirectly estimate infant mortality using data from conditional samples which usually are from hospitals or health centers. This methodology is different from other similar methodologies in that it groups mothers by parity instead of age or marital duration. Parity is used since it is more likely to be accurately mortality levels by the mean length of the birth interval. Mortality patterns are not sensitive to the length of the birth interval. He uses data from the 1983 EMIS follow up survey conducted in Bobodioulasso, Burkina Faso and 1919, 1924, and 1933 data from birth registration areas in the United States to demonstrate the new methodology. The methodology shows that the estimated infant mortality rate (IMR) remained basically the same between 1968-1974 in Bobodioulasso (199-122) and began to fall in 1975. By 1983, it had fallen to 88. These results reflect the estimate from the EMIS survey. The methodology demonstrates that, in the US, estimated trends in IMR agreed with observed IMRs. The new methodology derived IMRs fell in the US between 1919-1932 from 92.8-65.5. Since maternity clinics and hospitals in many Sub-Saharan African countries maintain records with answers to routine questions, the new methodology can analyze these data to determine infant mortality trends. Yet conditional samples are not necessarily representative of the whole population. Thus researchers could apply data from unconditional samples such as those from the World Fertility Survey and the Demographic and Health Surveys to a variety of indirect estimation methods discussed in this report to complement the estimated trends of the conditional samples.

  11. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries.

    PubMed

    Raj, Anita; Boehmer, Ulrike

    2013-04-01

    This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

  12. Applying the sisterhood method for estimating maternal mortality to a health facility-based sample: a comparison with results from a household-based sample.

    PubMed

    Danel, I; Graham, W; Stupp, P; Castillo, P

    1996-10-01

    Researchers compared maternal mortality estimates using the sisterhood method in a household survey conducted in November 1991 and in an outpatient health facility survey conducted in July 1992. Both surveys were conducted in Region I, a predominantly rural, mountainous area in northern Nicaragua. They analyzed data from 9232 interviews with adults younger than 49. The estimated lifetime risk of maternal death and the corresponding maternal mortality ratio were essentially identical for both the household and health facility surveys (0.145 and 0.144 [i.e., 1 in 69 of reproductive age died due to pregnancy-related events] and 243 and 241/100,000 live births, respectively). The estimates were similar for both surveys, even when the results were standardized for age, residence, and socioeconomic characteristics. An important limitation to the sisterhood method of estimating maternal mortality is that it estimates maternal mortality for a period about 10-12 years before the study and therefore cannot be used to assess the immediate effect of interventions to reduce maternal mortality. Nevertheless, in areas with poor maternal mortality surveillance or where no alternative exists to collecting population-based data, the sisterhood method can reliably estimate maternal mortality. These findings suggest that health facilities-based studies using the sisterhood method is a feasible, low-cost, and efficient method to estimate maternal mortality in certain settings at subnational levels. PMID:8921489

  13. Incidence and Predictors of Maternal Cardiovascular Mortality and Severe Morbidity in the Netherlands: A Prospective Cohort Study

    PubMed Central

    Huisman, Claartje M.; Zwart, Joost J.; Roos-Hesselink, Jolien W.; Duvekot, Johannes J.; van Roosmalen, Jos

    2013-01-01

    Objective To assess incidence and possible risk factors of severe maternal morbidity and mortality from cardiovascular disease in the Netherlands. Design A prospective population based cohort study. Setting All 98 maternity units in the Netherlands. Population All women delivering in the Netherlands between August 2004 and August 2006 (n = 371,021) Methods Cases of severe maternal morbidity and mortality from cardiovascular disease were prospectively collected during a two-year period in the Netherlands. Women with cardiovascular complications during pregnancy or postpartum who were admitted to the ward, intensive care or coronary care unit were included. Cardiovascular morbidity was defined as cardiomyopathy, valvular disease, ischaemic heart disease, arrhythmias or aortic dissection. All women delivering in the same period served as a reference cohort. Main outcome measures Incidence, case fatality rates and possible risk factors. Results Incidence of severe maternal morbidity due to cardiovascular disease was 2.3 per 10,000 deliveries (84/358,874). Maternal mortality rate from cardiovascular disease was 3.0 per 100,000 deliveries (11/358,874). Case fatality rate in women with severe maternal morbidity due to cardiovascular disease was 13% (11/84). Case fatality rate was highest in aortic dissection (83%). Pre-existing acquired or congenital heart disease was identified in 34% of women. Thirty-one percent of women were of advanced maternal age (>35 years of age) and 5 percent above 40 years of age. Possible risk factors for cardiovascular morbidity were caesarean section (either resulting in or as a result of cardiovascular disease), multiple pregnancy, prior caesarean section, non-Western ethnicity and obesity. Conclusions In the Netherlands cardiovascular disease is a rare cause of severe maternal morbidity with an incidence of 2.3 per 10,000 deliveries and a high case fatality rate of 13%. Cardiovascular complications develop mostly in women not known with

  14. Why are women so intelligent? The effect of maternal IQ on childhood mortality may be a relevant evolutionary factor.

    PubMed

    Charlton, Bruce G

    2010-03-01

    Humans are an unusual species because they exhibit an economic division of labour. Most theories concerning the evolution of specifically human intelligence have focused either on economic problems or sexual selection mechanisms, both of which apply more to men than women. Yet while there is evidence for men having a slightly higher average IQ, the sexual dimorphism of intelligence is not obvious (except at unusually high and low levels). However, a more female-specific selection mechanism concerns the distinctive maternal role in child care during the offspring's early years. It has been reported that increasing maternal intelligence is associated with reducing child mortality. This would lead to a greater level of reproductive success for intelligent women, and since intelligence is substantially heritable, this is a plausible mechanism by which natural selection might tend to increase female intelligence in humans. Any effect of maternal intelligence on improving child survival would likely be amplified by assortative mating for IQ by which people tend to marry others of similar intelligence - combining female maternal and male economic or sexual selection factors. Furthermore, since general intelligence seems to have the functional attribute of general purpose problem-solving and more rapid learning, the advantages of maternal IQ are likely to be greater as the environment for child-rearing is more different from the African hunter-gatherer society and savannah environment in which ancestral humans probably evolved. However, the effect of maternal IQ on child mortality would probably only be of major evolutionary significance in environments where childhood mortality rates were high. The modern situation is that population growth is determined mostly by birth rates; so in modern conditions, maternal intelligence may no longer have a significant effect on reproductive success; the effect of female IQ on reproductive success is often negative. Nonetheless, in the

  15. Why are women so intelligent? The effect of maternal IQ on childhood mortality may be a relevant evolutionary factor.

    PubMed

    Charlton, Bruce G

    2010-03-01

    Humans are an unusual species because they exhibit an economic division of labour. Most theories concerning the evolution of specifically human intelligence have focused either on economic problems or sexual selection mechanisms, both of which apply more to men than women. Yet while there is evidence for men having a slightly higher average IQ, the sexual dimorphism of intelligence is not obvious (except at unusually high and low levels). However, a more female-specific selection mechanism concerns the distinctive maternal role in child care during the offspring's early years. It has been reported that increasing maternal intelligence is associated with reducing child mortality. This would lead to a greater level of reproductive success for intelligent women, and since intelligence is substantially heritable, this is a plausible mechanism by which natural selection might tend to increase female intelligence in humans. Any effect of maternal intelligence on improving child survival would likely be amplified by assortative mating for IQ by which people tend to marry others of similar intelligence - combining female maternal and male economic or sexual selection factors. Furthermore, since general intelligence seems to have the functional attribute of general purpose problem-solving and more rapid learning, the advantages of maternal IQ are likely to be greater as the environment for child-rearing is more different from the African hunter-gatherer society and savannah environment in which ancestral humans probably evolved. However, the effect of maternal IQ on child mortality would probably only be of major evolutionary significance in environments where childhood mortality rates were high. The modern situation is that population growth is determined mostly by birth rates; so in modern conditions, maternal intelligence may no longer have a significant effect on reproductive success; the effect of female IQ on reproductive success is often negative. Nonetheless, in the

  16. Too poor to live? A case study of vulnerability and maternal mortality in Burkina Faso.

    PubMed

    Storeng, Katerini T; Drabo, Seydou; Filippi, Véronique

    2013-03-01

    This paper examines the concept of vulnerability in the context of maternal morbidity and mortality in Burkina Faso, an impoverished country in West Africa. Drawing on a longitudinal cohort study into the consequences of life-threatening or 'near miss' obstetric complications, we provide an in-depth case study of one woman's experience of such morbidity and its aftermath. We follow Kalizeta's trajectory from her near miss and the stillbirth of her child to her death from pregnancy-related hypertension after a subsequent delivery less than two years later, in order to examine the impact of severe and persistent illness and catastrophic health expenditure on her health and on her family's everyday life. Kalizeta's case illustrates how vulnerability in health emerges and is maintained or exacerbated over time. Even where social arrangements are supportive, structural impediments, including unaffordable and inadequate healthcare, can severely limit individual resilience to mitigate the negative social and economic consequences of ill health.

  17. The effect of maternal and child health and family planning services on mortality: is prevention enough?

    PubMed Central

    Fauveau, V; Wojtyniak, B; Chakraborty, J; Sarder, A M; Briend, A

    1990-01-01

    OBJECTIVE--To examine the impact on mortality of a child survival strategy, mostly based on preventive interventions. DESIGN--Cross sectional comparison of cause specific mortality in two communities differing in the type, coverage, and quality of maternal and child health and family planning services. In the intervention area the services were mainly preventive, community based, and home delivered. SUBJECTS--Neonates, infants, children, and mothers in two contiguous areas of rural Bangladesh. INTERVENTIONS--In the intervention area community health workers provided advice on contraception and on feeding and weaning babies; distributed oral rehydration solution, vitamin A tablets for children under 5, and ferrous fumarate and folic acid during pregnancy; immunised children; trained birth attendants in safe delivery and when to refer; treated minor ailments; and referred seriously ill people and malnourished children to a central clinic. MAIN OUTCOME MEASURES--Overall and age and cause specific death rates, obtained by a multiple step "verbal autopsy" process. RESULTS--During the two years covered by the study overall mortality was 17% lower among neonates, 9% lower among infants aged 1-5 months, 30% lower among children aged 6-35 months, and 19% lower among women living in the study area than in those living in the control area. These differences were mainly due to fewer deaths from neonatal tetanus, measles, persistent diarrhoea with severe malnutrition among children, and fewer abortions among women. CONCLUSIONS--The programme was effective in preventing some deaths. In addition to preventive components such as tetanus and measles immunisation, health and nutrition education, and family planning, curative services are needed to reduce mortality further. PMID:2390566

  18. Confronting maternal mortality, controlling birth in Nepal: the gendered politics of receiving biomedical care at birth.

    PubMed

    Brunson, Jan

    2010-11-01

    One way of reducing maternal mortality in developing countries is to ensure that women have a referral system at the local level that includes access to emergency obstetric care. Using a 13-month ethnographic study from 2003 to 2005 of women's social positions and maternal health in a semi-urban community of Hindu-caste women in the Kathmandu Valley, this paper identifies impediments to receiving obstetric care in a context where the infrastructure and services are in place. As birth in Nepal predominantly takes place at home, this paper identifies the following areas for potential improvement in order to avoid the loss of women's lives during childbirth: the frequency of giving birth unaided, minimal planning for birth or obstetric complications, and delayed responses at the household level to obstetric emergencies. Focusing particularly on the last item, this study concludes that women do not have the power to demand biomedical services or emergency care, and men still viewed birth as the domain of women and remained mostly uninvolved in the process. As the cultural construction of birth shifts from a "natural" phenomenon that did not require human regulation toward one that is located within the domain of biomedical expertise and control, local acceptance of a biomedical model does not necessarily lead to the utilization of services if neither women nor men are in a culturally-defined position to act.

  19. Widowers' accounts of maternal mortality among women of low socioeconomic status in Nigeria.

    PubMed

    Nwokocha, Ezebunwa Ethelbert

    2012-09-01

    The research is based on information collected on 50 deceased Nigerian women of low socioeconomic status in different locations of the country including Lagos, Ibadan, Kaduna, Zaria, Minna, Enugu, and Port-Harcourt among others. They had some common characteristics such as low levels of education, involvement in petty trading and were clients of a microfinance bank as small loan receivers. Primary data were generated mainly through verbal autopsy with widowers employing in-depth interviews and key informant interviews. In addition, unobtrusive observation was carried out in these locations to ascertain in some instances the distance between the deceased homes and health facilities patronised by the women. Secondary data were specific to death certificates of the deceased supplied by the widowers. Both ethnographic summaries and content analysis were employed in data analysis to account for contextual differences, especially in a multicultural society like Nigeria. The findings implicated several issues that are taken for granted at the micro-family and macro-society levels. It specifically revealed that small loans alone are not sufficient to empower poor women to make meaningful contributions to their own reproductive health in a patriarchal society like Nigeria. Results also indicated that cultural differences as well as rural-urban dichotomy were not proximate determinants of maternal behaviour; the latter rather finds expression in low socioeconomic status. Consequently, policy relevant recommendations that could contribute to significant maternal mortality reduction were proffered.

  20. An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India

    PubMed Central

    Ng, Marie; Misra, Archana; Diwan, Vishal; Agnani, Manohar; Levin-Rector, Alison; De Costa, Ayesha

    2014-01-01

    Background The Indian Janani Suraksha Yojana (JSY) program is a demand-side program in which the state pays women a cash incentive to deliver in an institution, with the aim of reducing maternal mortality. The JSY has had 54 million beneficiaries since inception 7 years ago. Although a number of studies have demonstrated the effect of JSY on coverage, few have examined the direct impact of the program on maternal mortality. Objective To study the impact of JSY on maternal mortality in Madhya Pradesh (MP), one of India's largest provinces. Design By synthesizing data from various sources, district-level maternal mortality ratios (MMR) from 2005 to 2010 were estimated using a Bayesian spatio-temporal model. Based on these, a mixed effects multilevel regression model was applied to assess the impact of JSY. Specifically, the association between JSY intensity, as reflected by 1) proportion of JSY-supported institutional deliveries, 2) total annual JSY expenditure, and 3) MMR, was examined. Results The proportion of all institutional deliveries increased from 23.9% in 2005 to 55.9% in 2010 province-wide. The proportion of JSY-supported institutional deliveries rose from 14% (2005) to 80% (2010). MMR declines in the districts varied from 2 to 35% over this period. Despite the marked increase in JSY-supported delivery, our multilevel models did not detect a significant association between JSY-supported delivery proportions and changes in MMR in the districts. The results from the analysis examining the association between MMR and JSY expenditure are similar. Conclusions Our analysis was unable to detect an association between maternal mortality reduction and the JSY in MP. The high proportion of institutional delivery under the program does not seem to have converted to lower mortality outcomes. The lack of significant impact could be related to supply-side constraints. Demand-side programs like JSY will have a limited effect if the supply side is unable to deliver care

  1. The Potential Impact of Changes in Fertility on Infant, Child, and Maternal Mortality. World Bank Staff Working Papers No. 698 and Population and Development Series No. 23.

    ERIC Educational Resources Information Center

    Trussell, James; Pebley, Anne R.

    The relationship between changes in the timing and quantity of fertility, such as those that might result from an effective family planning program in developing countries, and changes in child and maternal mortality is examined. Results from five multivariate studies estimate the changes in mortality that might occur from altering maternal age,…

  2. Influence of Maternal Obesity and Gestational Weight Gain on Maternal and Foetal Lipid Profile.

    PubMed

    Cinelli, Giulia; Fabrizi, Marta; Ravà, Lucilla; Ciofi Degli Atti, Marta; Vernocchi, Pamela; Vallone, Cristina; Pietrantoni, Emanuela; Lanciotti, Rosalba; Signore, Fabrizio; Manco, Melania

    2016-01-01

    Fatty acids (FAs) are fundamental for a foetus's growth, serving as an energy source, structural constituents of cellular membranes and precursors of bioactive molecules, as well as being essential for cell signalling. Long-chain polyunsaturated FAs (LC-PUFAs) are pivotal in brain and visual development. It is of interest to investigate whether and how specific pregnancy conditions, which alter fatty acid metabolism (excessive pre-pregnancy body mass index (BMI) or gestational weight gain (GWG)), affect lipid supply to the foetus. For this purpose, we evaluated the erythrocyte FAs of mothers and offspring (cord-blood) at birth, in relation to pre-pregnancy BMI and GWG. A total of 435 mothers and their offspring (237 males, 51%) were included in the study. Distribution of linoleic acid (LA) and α-linolenic acid (ALA), and their metabolites, arachidonic acid, dihomogamma linoleic (DGLA) and ecosapentanoic acid, was significantly different in maternal and foetal erythrocytes. Pre-pregnancy BMI was significantly associated with maternal percentage of MUFAs (Coeff: -0.112; p = 0.021), LA (Coeff: -0.033; p = 0.044) and DHA (Coeff. = 0.055; p = 0.0016); inadequate GWG with DPA (Coeff: 0.637; p = 0.001); excessive GWG with docosaexahenoic acid (DHA) (Coeff. = -0.714; p = 0.004). Moreover, pre-pregnancy BMI was associated with foetus percentage of PUFAs (Coeff: -0.172; p = 0.009), omega 6 (Coeff: -0.098; p = 0.015) and DHA (Coeff: -0.0285; p = 0.036), even after adjusting for maternal lipids. Our findings show that maternal GWG affects maternal but not foetal lipid profile, differently from pre-pregnancy BMI, which influences both. PMID:27314385

  3. Influence of Maternal Obesity and Gestational Weight Gain on Maternal and Foetal Lipid Profile

    PubMed Central

    Cinelli, Giulia; Fabrizi, Marta; Ravà, Lucilla; Ciofi degli Atti, Marta; Vernocchi, Pamela; Vallone, Cristina; Pietrantoni, Emanuela; Lanciotti, Rosalba; Signore, Fabrizio; Manco, Melania

    2016-01-01

    Fatty acids (FAs) are fundamental for a foetus’s growth, serving as an energy source, structural constituents of cellular membranes and precursors of bioactive molecules, as well as being essential for cell signalling. Long-chain polyunsaturated FAs (LC-PUFAs) are pivotal in brain and visual development. It is of interest to investigate whether and how specific pregnancy conditions, which alter fatty acid metabolism (excessive pre-pregnancy body mass index (BMI) or gestational weight gain (GWG)), affect lipid supply to the foetus. For this purpose, we evaluated the erythrocyte FAs of mothers and offspring (cord-blood) at birth, in relation to pre-pregnancy BMI and GWG. A total of 435 mothers and their offspring (237 males, 51%) were included in the study. Distribution of linoleic acid (LA) and α-linolenic acid (ALA), and their metabolites, arachidonic acid, dihomogamma linoleic (DGLA) and ecosapentanoic acid, was significantly different in maternal and foetal erythrocytes. Pre-pregnancy BMI was significantly associated with maternal percentage of MUFAs (Coeff: −0.112; p = 0.021), LA (Coeff: −0.033; p = 0.044) and DHA (Coeff. = 0.055; p = 0.0016); inadequate GWG with DPA (Coeff: 0.637; p = 0.001); excessive GWG with docosaexahenoic acid (DHA) (Coeff. = −0.714; p = 0.004). Moreover, pre-pregnancy BMI was associated with foetus percentage of PUFAs (Coeff: −0.172; p = 0.009), omega 6 (Coeff: −0.098; p = 0.015) and DHA (Coeff: −0.0285; p = 0.036), even after adjusting for maternal lipids. Our findings show that maternal GWG affects maternal but not foetal lipid profile, differently from pre-pregnancy BMI, which influences both. PMID:27314385

  4. Maternal iron – infection interactions and neonatal mortality, with an emphasis on developing countries

    PubMed Central

    Brabin, Loretta; Brabin, Bernard J.; Gies, Sabine

    2013-01-01

    Infection is a major cause of neonatal death in developing countries. We address the question whether host iron status affects maternal and/or neonatal infection risk, potentially contributing to neonatal death. We summarize the iron acquisition mechanisms described for pathogens causing stillbirth, preterm birth, and congenital infection. There is in vitro evidence that iron availability influences severity and chronicity of infections that cause these outcomes. The risk in vivo is unknown as relevant studies of maternal iron supplementation have not assessed infection risk. Reducing iron deficiency anemia among women is beneficial and should improve the iron stores of babies, but there is evidence that iron status in young children predicts malaria risk and possibly invasive bacterial diseases. Caution with maternal iron supplementation is indicated in iron-replete women who have high infection exposure, although distinguishing iron-replete and iron-deficient women is currently difficult. Further research is indicated to investigate infection risk in relation to iron status in mothers and babies in order to avoid iron intervention strategies that result in detrimental birth outcomes for some groups of women. PMID:23865798

  5. Maternal adaptive immunity influences the intestinal microflora of suckling mice.

    PubMed

    Diaz, Rosa L; Hoang, Lisa; Wang, Jiafang; Vela, Jose L; Jenkins, Shannon; Aranda, Richard; Martín, Martín G

    2004-09-01

    The microflorae in the intestine of breast-fed infants are distinct from those that typically populate the intestine of formula-fed infants. Although the acquisition of passive immunity through breast-feeding may play a critical role in influencing the pattern of bacterial colonization of the gut, the precise mechanisms underlying the differences in the commensal microflorae of breast and formula-fed children have not been established. We hypothesized that the assemblage of commensal microflorae in suckling and weaned mice may be influenced by the maternal adaptive immune system. To test this hypothesis, we analyzed the intestinal microflorae of mice reared in the presence (wild-type) or absence of an intact maternal immune system (T- and B-cell deficient). Several types of bacteria (Lactobacillus, Enterococcus, Clostridium perfringens, Bifidobacterium, and Bacteroides) were isolated and enumerated from both the small and large intestine of 10-, 18-, 25- and 40- to 60-d old mice using selective media. The densities of bacteria were significantly lower in the small intestine of weaned mice that were reared by wild-type (WT) compared with immunodeficient (ID) dams. However, the microflorae were generally more abundant in the large intestine of suckling pups reared by WT compared with ID dams. Our results indicate that intestinal microflorae change throughout the suckling phase of development and that the maternal adaptive immune system influences the pattern and abundance of bacteria within the gut in an age- and site-specific manner.

  6. An option for measuring maternal mortality in developing countries: a survey using community informants

    PubMed Central

    2010-01-01

    Background The maternal mortality ratio (MMR) remains high in most developing countries. Local, recent estimates of MMR are needed to motivate policymakers and evaluate interventions. But, estimating MMR, in the absence of vital registration systems, is difficult. This paper describes an efficient approach using village informant networks to capture maternal death cases (Maternal Deaths from Informants/Maternal Death Follow on Review or MADE-IN/MADE-FOR) developed to address this gap, and examines its validity and efficiency. Methods MADE-IN used two village informant networks - heads of neighbourhood units (RTs) and health volunteers (Kaders). Informants were invited to attend separate network meetings - through the village head (for the RT) and through health centre for the kaders. Attached to the letter was a form with written instructions requesting informants list deaths of women of reproductive age (WRA) in the village during the previous two years. At a 'listing meeting' the informants' understanding on the form was checked, informants could correct their forms, and then collectively agreed a consolidated list. MADE-FOR consisted of visits relatives of likely pregnancy related deaths (PRDs) identified from MADE-IN, to confirm the PRD status and gather information about the cause of death. Capture-recapture (CRC) analysis enabled estimation of coverage rates of the two networks, and of total PRDs. Results The RT network identified a higher proportion of PRDs than the kaders (estimated 0.85 vs. 0.71), but the latter was easier and cheaper to access. Assigned PRD status amongst identified WRA deaths was more accurate for the kader network, and seemingly for more recent deaths, and for deaths from rural areas. Assuming information on live births from an existing source to calculate the MMR, MADE-IN/MADE-FOR cost only $0.1 (US) per women-year risk of exposure, substantially cheaper than alternatives. Conclusions This study shows that reliable local, recent

  7. Maternal mortality and derivations from the WHO near-miss tool: An institutional experience over a decade in Southern India

    PubMed Central

    Halder, Ajay; Jose, Ruby; Vijayselvi, Reeta

    2014-01-01

    Objective Preceding the use of World Health Organization (WHO) near-miss approach in our institute for the surveillance of Severe Maternal Outcome (SMO), we pilot-tested the tool on maternal death cases that took place over the last 10 years in order to establish its feasibility and usefulness at the institutional level. Material and Methods This was a retrospective review of maternal deaths in Christian Medical College Vellore, India, over a decade. Cases were recorded and analyzed using the WHO near-miss tool. The International Classification of Diseases, 10th Revision was used to define and classify maternal mortality. Results There were 98,139 total births and 212 recorded maternal deaths. Direct causes of mortality constituted 46.96% of total maternal deaths, indirect causes constituted 51.40%, and unknown cases constituted 1.9%. Nonobstetrical cause (48.11%) is the single largest group. Infections (19.8%) other than puerperal sepsis remain an important group, with pulmonary tuberculosis, scrub typhus, and malaria being the leading ones. According to the WHO near-miss criteria, cardiovascular and respiratory dysfunctions are the most frequent organ dysfunctions. Incidence of coagulation dysfunction is seen highest in obstetrical hemorrhage (64%). All women who died had at least one organ dysfunction; 90.54% mothers had two- and 38.52% had four- or more organ involvement. Conclusion The screening questions of the WHO near-miss tool are particularly instrumental in obtaining a comprehensive assessment of the problem beyond the International Classification of Diseases-Maternal Mortality and establish the need for laboratory-based identification of organ dysfunctions and prompt availability of critical care facilities. The process indicators, on the other hand, inquire about the basic interventions that are more or less widely practiced and therefore give no added information at the institutional level. PMID:25584030

  8. Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria.

    PubMed

    Wall, L L

    1998-12-01

    Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.

  9. How should we measure maternal mortality in the developing world? A comparison of household deaths and sibling history approaches.

    PubMed Central

    Hill, Kenneth; El Arifeen, Shams; Koenig, Michael; Al-Sabir, Ahmed; Jamil, Kanta; Raggers, Han

    2006-01-01

    OBJECTIVE: A reduction in the maternal mortality ratio (MMR) is one of six health-related Millennium Development Goals (MDGs). However, there is no consensus about how to measure MMR in the many countries that do not have complete registration of deaths and accurate ascertainment of cause of death. In this study, we compared estimates of pregnancy-related deaths and maternal mortality in a developing country from three different household survey measurement approaches: a module collecting information on deaths of respondents' sisters; collection of information about recent household deaths with a time-of-death definition of maternal deaths; and a verbal autopsy instrument to identify maternal deaths. METHODS: We used data from a very large nationally-representative household sample survey conducted in Bangladesh in 2001. A total of 104 323 households were selected for participation, and 99 202 households (95.1% of selected households, 98.8% of contacted households) were successfully interviewed. FINDINGS: The sisterhood and household death approaches gave very similar estimates of all-cause and pregnancy-related mortality; verbal autopsy gave an estimate of maternal deaths that was about 15% lower than the pregnancy-related deaths. Even with a very large sample size, however, confidence intervals around mortality estimates were similar for all approaches and exceeded +/- 15%. CONCLUSION: Our findings suggest that with improved training for survey data collectors, both the sisterhood and household deaths methods are viable approaches for measuring pregnancy-related mortality. However, wide confidence intervals around the estimates indicate that routine sample surveys cannot provide the information needed to monitor progress towards the MDG target. Other approaches, such as inclusion of questions about household deaths in population censuses, should be considered. PMID:16583075

  10. Mortality, Temporary Sterilization, and Maternal Effects of Sublethal Heat in Bed Bugs

    PubMed Central

    Rukke, Bjørn Arne; Aak, Anders; Edgar, Kristin Skarsfjord

    2015-01-01

    Adult bed bugs were exposed to the sublethal temperatures 34.0°C, 35.5°C, 37.0°C, 38.5°C, or 40.0°C for 3, 6, or 9 days. The two uppermost temperatures induced 100% mortality within 9 and 2 days, respectively, whereas 34.0°C had no observable effect. The intermediate temperatures interacted with time to induce a limited level of mortality but had distinct effects on fecundity, reflected by decreases in the number of eggs produced and hatching success. Adult fecundity remained low for up to 40 days after heat exposure, and the time until fertility was restored correlated with the temperature-sum experienced during heat exposure. Three or 6 days of parental exposure to 38.5°C significantly lowered their offspring’s feeding and moulting ability, which consequently led to a failure to continue beyond the third instar. Eggs that were deposited at 22.0°C before being exposed to 37.0°C for 3 or 6 days died, whereas eggs that were exposed to lower temperatures were not significantly affected. Eggs that were deposited during heat treatment exhibited high levels of mortality also at 34.0°C and 35.5°C. The observed negative effects of temperatures between 34.0°C and 40.0°C may be utilized in pest management, and sublethal temperature exposure ought to be further investigated as an additional tool to decimate or potentially eradicate bed bug populations. The effect of parental heat exposure on progeny demonstrates the importance of including maternal considerations when studying bed bug environmental stress reactions. PMID:25996999

  11. Mortality, temporary sterilization, and maternal effects of sublethal heat in bed bugs.

    PubMed

    Rukke, Bjørn Arne; Aak, Anders; Edgar, Kristin Skarsfjord

    2015-01-01

    Adult bed bugs were exposed to the sublethal temperatures 34.0°C, 35.5°C, 37.0°C, 38.5°C, or 40.0°C for 3, 6, or 9 days. The two uppermost temperatures induced 100% mortality within 9 and 2 days, respectively, whereas 34.0°C had no observable effect. The intermediate temperatures interacted with time to induce a limited level of mortality but had distinct effects on fecundity, reflected by decreases in the number of eggs produced and hatching success. Adult fecundity remained low for up to 40 days after heat exposure, and the time until fertility was restored correlated with the temperature-sum experienced during heat exposure. Three or 6 days of parental exposure to 38.5°C significantly lowered their offspring's feeding and moulting ability, which consequently led to a failure to continue beyond the third instar. Eggs that were deposited at 22.0°C before being exposed to 37.0°C for 3 or 6 days died, whereas eggs that were exposed to lower temperatures were not significantly affected. Eggs that were deposited during heat treatment exhibited high levels of mortality also at 34.0°C and 35.5°C. The observed negative effects of temperatures between 34.0°C and 40.0°C may be utilized in pest management, and sublethal temperature exposure ought to be further investigated as an additional tool to decimate or potentially eradicate bed bug populations. The effect of parental heat exposure on progeny demonstrates the importance of including maternal considerations when studying bed bug environmental stress reactions. PMID:25996999

  12. Gender-Based Disparities in Infant and Child Mortality Based on Maternal Exposure to Spousal Violence

    PubMed Central

    Silverman, Jay G.; Decker, Michele R.; Cheng, Debbie M.; Wirth, Kathleen; Saggurti, Niranjan; McCauley, Heather L.; Falb, Kathryn L.; Donta, Balaiah; Raj, Anita

    2014-01-01

    Objectives To examine associations between intimate partner violence (IPV) against Indian women and risk of death among their infants and children, as well as related gender-based disparities. Design Analyses of nationally representative data to estimate adjusted hazard ratios (aHRs) and attributable risks for infant and child mortality based on child gender and on IPV against mothers. Setting India. Participants Women aged 15 to 49 years (n=59 467) across all 29 Indian states participating in the Indian National Family Health Survey 3 provided information about 158 439 births and about infant and child mortality occurring during the 20 years before the survey. Main Outcome Measures Maternal IPV and infant and child (<5 years) mortality among boy vs girl children. Results Infant mortality was greater among infants whose mothers experienced IPV (79.2 of 1000 births) vs those whose mothers did not experience IPV (59.1 of 1000 births) (aHR, 1.09; 95% confidence interval [CI], 1.03–1.15); this effect was significant only for girls (1.15; 1.07–1.24; for boys, 1.04; 0.97–1.11). Child mortality was also greater among children whose mothers experienced IPV (103.6 of 1000 births) vs those whose mothers did not experience IPV (74.8 per 1000 births) (aHR, 1.10; 95% CI, 1.05–1.15); again, this effect was significant only for girls (1.14; 1.07–1.21; for boys, 1.05; 0.99–1.12). An estimated 58 021 infant girl deaths and 89 264 girl child deaths were related to spousal violence against wives annually, or approximately 1.2 million female infant deaths and 1.8 million girl deaths in India between December 1985 and August 2005. Conclusion Intimate partner violence against women should be considered an urgent priority within programs and policies aimed at maximizing survival of children in India, particularly those attempting to increase the survival of girls 5 years and younger. PMID:21199976

  13. Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

    PubMed Central

    Alfonso, Y. Natalia; Adam, Taghreed; Kuruvilla, Shyama; Schweitzer, Julian

    2016-01-01

    Introduction From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across

  14. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan

    PubMed Central

    Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki

    2016-01-01

    Objective To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Design Descriptive study. Setting Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Participants Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). Main outcome measures The preventability and problems in each maternal death. Results Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1–3 h. Conclusions A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. PMID:27000786

  15. Impact of Janani Suraksha Yojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India.

    PubMed

    Gupta, Sanjeev K; Pal, Dinesh K; Tiwari, Rajesh; Garg, Rajesh; Shrivastava, Ashish K; Sarawagi, Radha; Patil, Rajkumar; Agarwal, Lokesh; Gupta, Prashant; Lahariya, Chandrakant

    2012-12-01

    The Government of India initiated a cash incentive scheme--Janani Suraksha Yojana (JSY)--to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India. PMID:23304913

  16. Ancestry dependent DNA methylation and influence of maternal nutrition.

    PubMed

    Mozhui, Khyobeni; Smith, Alicia K; Tylavsky, Frances A

    2015-01-01

    There is extensive variation in DNA methylation between individuals and ethnic groups. These differences arise from a combination of genetic and non-genetic influences and potential modifiers include nutritional cues, early life experience, and social and physical environments. Here we compare genome-wide DNA methylation in neonatal cord blood from African American (AA; N = 112) and European American (EA; N = 91) participants of the CANDLE Study (Conditions Affecting Neurocognitive Development and Learning in Early Childhood). Our goal is to determine if there are replicable ancestry-specific methylation patterns that may implicate risk factors for diseases that have differential prevalence between populations. To identify the most robust ancestry-specific CpG sites, we replicate our results in lymphoblastoid cell lines from Yoruba African and CEPH European panels of HapMap. We also evaluate the influence of maternal nutrition--specifically, plasma levels of vitamin D and folate during pregnancy--on methylation in newborns. We define stable ancestry-dependent methylation of genes that include tumor suppressors and cell cycle regulators (e.g., APC, BRCA1, MCC). Overall, there is lower global methylation in African ancestral groups. Plasma levels of 25-hydroxy vitamin D are also considerably lower among AA mothers and about 60% of AA and 40% of EA mothers have concentrations below 20 ng/ml. Using a weighted correlation analysis, we define a network of CpG sites that is jointly modulated by ancestry and maternal vitamin D. Our results show that differences in DNA methylation patterns are remarkably stable and maternal micronutrients can exert an influence on the child epigenome. PMID:25742137

  17. Assessing maternal risk for fetal-infant mortality: a population-based study to prioritize risk reduction in a healthy start community.

    PubMed

    Kothari, Catherine L; Wendt, Annie; Liggins, Oemeeka; Overton, Jacqueline; Sweezy, Luz del Carmen

    2011-01-01

    Study goals were to distinguish between maternal risk factors for fetal versus infant mortality, and to identify which maternal characteristics contributed the greatest risk of mortality overall. This case-control retrospective study abstracted data on more than forty maternal characteristics from 261 prenatal and delivery records: all 26 fetal deaths, all 40 infant deaths and 195 randomly selected surviving births in a high-mortality Healthy Start community. Bivariate and multivariate analyses were conducted. The fetal-mortality population was significantly more likely than the infant-mortality population to have no insurance (P = .047), inadequate prenatal care (P = .039) and previous fetal death (P = .021). Comparing the combined mortality population with the surviving sample, two tiers of risk emerged: Rare-but-lethal risks, including no prenatal care (P < .001) and Child-Protective-Service involvement (P = .001), and common-and-dangerous risks, including inadequate maternal weight gain (OR = 13.55), drug or alcohol abuse (OR = 8.67), obesity (OR = 2.77) and anemia (OR = 3.61). Both fetal and infant mortality groups must be considered when identifying maternal risks. Inadequate prenatal weight gain, obesity and anemia contribute as much to feto-infant mortality as substance abuse. Public health efforts to improve maternal nutrition and healthy weight should be redoubled. PMID:20082128

  18. Maternal influence on the decision to adopt Norplant.

    PubMed

    Rickert, V I; Hendon, A E; Davis, P; Kozlowski, K J

    1995-05-01

    A prospective study of 121 Norplant acceptors 12-21 years old recruited from a hospital-based adolescent gynecology service in Arkansas confirmed the importance of maternal influence on the acceptance process, even when state law does not mandate parental consent. These adolescents completed a questionnaire indicating the relative roles of various significant others in providing information about Norplant and influencing the decision-making process. The adolescent's mother was cited as the most important decision source by 45 (37%) young women; another 33 (27%) identified a health care provider. Although Arkansas does not require parental notification, 74 (63%) had told their mother of their decision to use Norplant. Maternally influenced adolescents were significantly more likely than those who identified health care professionals, girlfriends, and boyfriends as decisive to have obtained specific information about Norplant from their mother, to be former oral contraceptive users, and to have a consistent sexual partner. Overall, 99 (82%) adolescents reported they intended to use Norplant for at least two years. Although 44 (36%) expressed concerns about Norplant's cost, only two indicated this was a factor in their decision. The findings of this study offer reassurance to health care providers who seek to protect patient confidentiality yet encourage parent-teen communication about reproductive health. PMID:7662684

  19. A 10-year review of maternal mortality in Chon Buri Hospital, Thailand.

    PubMed

    Pinchun, P; Chullapram, T

    1993-06-01

    1. The overall maternal mortality rate (MMR) in Chon Buri Hospital in the 10-yr period from 1982-1991 was 51.1/100,000 livebirths. 2. The top causes of death were abortion related complications, pregnancy induced hypertension, puerperal infection and postpartum hemorrhage. 3. What we have done is to improve the quantity and quality of obstetric and medical care, solve the problem of vital statistics reports in our hospital, contact doctor in nearby hospitals in referral and interhospital OB-GYN conferences to meet and discuss both knowledge and management problems. 4. What we still faced in the last 4-yr were deaths from abortion related complications, puerperal sepsis and postpartum hemorrhage. Most of the deaths were preventable. 5. So what we have to target to lessen the MMR is to improve the obstetric and medical care, improve the quality of medical personnel in our area in KAP aspect (knowledge, attitude, practice) especially in the field of family planning to prevent unwanted pregnancies, proper prevention and management of postpartum hemorrhage, and prevention and treatment of puerperal and postabortal infection.

  20. Maternal endometrial oedema may increase perinatal mortality of cloned and transgenic piglets.

    PubMed

    Schmidt, M; Winter, K D; Dantzer, V; Li, J; Kragh, P M; Du, Y; Lin, L; Liu, Y; Vajta, G; Sangild, P T; Callesen, H; Agerholm, J S

    2011-01-01

    The perinatal mortality of cloned animals is a well-known problem. In the present retrospective study, we report on mortality of cloned transgenic or non-transgenic piglets produced as part of several investigations. Large White (LW) sows (n = 105) received hand-made cloned LW or minipig blastocysts and delivered either spontaneously or after prostaglandin induction followed by either Caesarean section or vaginal birth. The overall pregnancy rate was 62%, with 26% of pregnancies terminating before term. This resulted in 48 deliveries. The terminated pregnancies consisted of 12 abortions that occurred at 35 ± 2 days gestation and five sows that went to term without returning to heat and then by surgery showed the uterus without fetal content. The gestation length was for sows with LW piglets that delivered by Caesarean section or vaginally was 115.7 ± 0.3 and 117.6 ± 0.4 days, respectively. In sows with minipiglets, the gestation length for those delivered by Caesarean section or vaginally 114.4 ± 0.2 and 115.5 ± 0.3 days, respectively. Of the 34 sows that delivered vaginally, 28 gave birth after induction, whereas 6 farrowed spontaneously. Of the 14 sows that delivered after Caesarean section and in the five empty sows, the endometrium and placenta showed severe oedema. Piglet mortality following vaginal delivery was higher than after Caesarean section (31% v. 10%, respectively; P < 0.001). When vaginal delivery occurred spontaneously, the stillborn rate was greater than after induced delivery (56% v. 24%, respectively; P < 0.0001). Internal organ weights were recorded for seven cloned LW piglets and six normal piglets. The relative weight of the heart, liver, kidneys and small intestine was found to be reduced in the cloned piglets (P < 0.05). The present study demonstrates extensive endometrial oedema in sows pregnant with cloned and transgenic piglets, as well as in empty recipients, at term. The growth of certain organs in some of the cloned piglets was

  1. Analysis of maternal and abortion-related mortality in Mexico over the last two decades, 1990-2008.

    PubMed

    Schiavon, Raffaela; Troncoso, Erika; Polo, Gerardo

    2012-09-01

    To document the relative contribution of abortion-related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990-2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion-related deaths per 100,000 abortion-related hospitalizations, expressed as a modified abortion case-fatality rate. During 2000-2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100,000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico.

  2. Dynamic influence of maternal and pup traits on maternal care during lactation in an income breeder, the antarctic fur seal.

    PubMed

    McDonald, Birgitte I; Goebel, Michael E; Crocker, Daniel E; Costa, Daniel P

    2012-01-01

    Life-history theory predicts that selection will favor optimal levels of parental effort that balance benefits of current reproduction with costs to survival and future reproduction. The optimal level of effort depends on parental traits, offspring traits, and provisioning strategy. Additionally, how these factors influence effort may differ depending on the stage of reproduction. The relative importance of maternal and offspring traits on energy allocation to offspring was investigated in known-age Antarctic fur seals Arctocephalus gazella across four stages of reproduction, using birth mass and milk-consumption measurements. Maternal traits were important during three of the four stages investigated, with larger females giving birth to larger pups and investing more in pups during perinatal and molt stages. Pup mass influenced maternal effort during the premolt stage, and provisioning strategy influenced postnatal maternal effort at all stages. Energy provided to the offspring during an attendance visit was positively related to the duration of the foraging-trip/visit cycle; however, when investment was controlled for trip/visit cycle duration, the overall rate of energy transfer was similar across trip durations. In addition to strong effects of maternal mass, pup traits affected energy allocation, suggesting that pup demand is important in determining maternal care. These findings emphasize the importance of considering state variables in life-history studies and suggest that timing of measurements of effort in species with long provisioning periods may influence conclusions and our ability to make comparisons of reproductive effort among species.

  3. Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis

    PubMed Central

    Kikuchi, Kimiyo; Enuameh, Yeetey; Yasuoka, Junko; Nanishi, Keiko; Shibanuma, Akira; Gyapong, Margaret; Owusu-Agyei, Seth; Oduro, Abraham Rexford; Asare, Gloria Quansah; Hodgson, Abraham; Jimba, Masamine

    2015-01-01

    Background Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. Methods We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality. Results Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%). Conclusions Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The

  4. The African Development Bank and women's health: a cross-national analysis of structural adjustment and maternal mortality.

    PubMed

    Coburn, Carolyn; Restivo, Michael; Shandra, John M

    2015-05-01

    We conduct a cross-national analysis to test the hypothesis that African Development Bank (AfDB) structural adjustment lending adversely impacts maternal mortality in Sub-Saharan Africa. We analyze data for thirty-five Sub-Saharan African nations with up to four time points (1990, 1995, 2000, and 2005) with generalized least squares random effects regression models and modified two-step Heckman models that correct for potential endogeneity regarding whether or not a Sub-Saharan African nations receives an AfDB structural adjustment loan. We find support for our hypothesis that indicates that Sub-Saharan African nations that receive an AfDB structural adjustment loan tend to have higher levels of maternal mortality than Sub-Saharan African nations that do not receive such a loan. This finding remains stable even when controlling for endogeneity. We conclude by talking about the theoretical and methodological implications along with possible directions for future research.

  5. Regionalization and Local Hospital Closure in Norwegian Maternity Care—The Effect on Neonatal and Infant Mortality

    PubMed Central

    Grytten, Jostein; Monkerud, Lars; Skau, Irene; Sørensen, Rune

    2014-01-01

    Objective To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out. Data The Medical Birth Registry of Norway provided detailed medical information for all births in Norway. Study Design Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated. Principal Finding Neonatal and infant mortality were not affected by the type of hospital where the delivery took place. Conclusion A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries. PMID:24476021

  6. The Role of Obstetrics/Gynecology Hospitalists in Reducing Maternal Mortality.

    PubMed

    Stevens, Tobey A; Swaim, Laurie S; Clark, Steven L

    2015-09-01

    The United States experienced a 6.1% annual increase in the maternal death rate from 2000 to 2013. Maternal deaths from hemorrhage and complications of preeclampsia are significant contributors to the maternal death rate. Many of these deaths are preventable. By virtue of their continuous care of laboring patients, active involvement in hospital safety initiatives, and immediate availability, obstetric hospitalists are uniquely positioned to evaluate patients, initiate care, and coordinate a multidisciplinary effort. In cases of significant maternal hemorrhage, hypertensive crisis, and acute pulmonary edema, the availability of an obstetrics hospitalist may facilitate improved patient safety and fewer maternal deaths.

  7. Investigation of the causes of maternal mortality using root cause analysis in Isfahan, Iran in 2013-2014

    PubMed Central

    Beigi, Marjan; Bahreini, Somaye; Valiani, Mahboubeh; Rahimi, Mojtaba; Danesh-Shahraki, Azar

    2015-01-01

    Background: Many maternal deaths caused are due to preventable causes during pregnancy and childbirth. Therefore, the detailed analysis of the root causes provides developing a plan and appropriate interventions to prevent these deaths occurring in the health system. This study aims to determine the causes of maternal mortality using root cause analysis (RCA) method. Materials and Methods: This research is a descriptive explorative study. The data were collected from the files in the maternal health center and the interviews conducted with relevant personnel. The causes of maternal mortality and related reasons were determined by experts’ team opinions and through a standard checklist of RCA. Causes consisted of the factors related to health services (human factors and structural factors), maternal family and social status, and maternal disease status. For each of these factors, analysis was performed to determine the root. In the end, interventional suggestions were developed to prevent the recurrence of similar deaths. Results: Causes were classified into human factors, and structural factors in the area of planning and management and social status of mothers. The results showed that human factors were composed of lack of knowledge and skills in the medical team, unfamiliarity with their duties, lack of health care–based on protocols, etc. Structural factors included lack of follow-up after discharge and inadequate supervision of inspectors on academic qualified doctors. Maternal social and family status factor included lack of referral the mothers’ to the health care center. Conclusions: Based on the RCA process, the most fundamental factor in creating these deaths was management errors at the level of universities and the Ministry of Health. These errors included inadequate supervision of medical education, failure to identify and introduce the instructions and guidelines related to the care of pregnant mothers by the health workers and experts, and lack

  8. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  9. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    PubMed

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region. PMID:26934625

  10. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care

    PubMed Central

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries. To create a major change in Haiti’s health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic “community care grids” to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis. We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti’s health care system will be among the leaders in that region. PMID:26934625

  11. Factors influencing prereproductive mortality in the isolated and preindustrial western Mediterranean population of La Alpujarra, 1900-1950.

    PubMed

    Luna, F; Moral, P; Alonso, V; Fernandez-Santander, A

    2007-08-01

    We study the effects of several variables on the prereproductive mortality pattern in the isolated and rural population of La Alpujarra, located on the western Mediterranean coast (southeast Spain), in the first half of the 20th century. The study is a retrospective analysis from a total sample of 2,200 deliveries, 2,085 of which were born alive and 171 of which did not survive to the 20th birthday. The potential influences of birthdate of children, twinning, firstborn, parental inbreeding, and sex on Alpujarran mortality were analyzed through logistic regression. Parity, family size, and birth interval effects were estimated through the difference between observed and expected mortality rates. In every case four age groups of mortality were considered because of the large influence of child growth: neonatal (less than 1 month of life), postneonatal infant (between 1 month and 1 year old), childhood (1-5 years old), and youth (5-20 years old). The Alpujarran prereproductive mortality pattern can be summarized as the result of three main risk factors: biodemographic, biomechanical, and social and health determinants. In general, every factor showed a decreased effect as children grew. The most significant determinants were birthdate of children, which is more related to increased mother's awareness of child care than to health improvement, and family size associated with decreasing alimentary resources as the sibling number increased. Male mortality was higher than female mortality in children older than 1 year but not for infant mortality, possibly as a result of a reproductive behavior favorable to males. Although firstborn status and twinning appeared associated with high mortality, maternal age and birth interval were related to low risk, but these influences always ceased after the first month of life. Parental inbreeding did not show any effect on infant, childhood, or youth mortality.

  12. Under-five mortality and maternal HIV status in Tanzania: analysis of trends between 2003 and 2012 using AIDS Indicator Survey data

    PubMed Central

    Arunda, Malachi Ochieng; Choudhry, Vikas; Ekman, Björn; Asamoah, Benedict Oppong

    2016-01-01

    Background Mortality among children under five remains a significant health challenge across sub-Saharan Africa. HIV/AIDS is one of the leading contributors to the relatively slow decline in under-five mortality in this region. In Tanzania, HIV prevalence among under-five children is high and 90% of all infections are due to mother-to-child transmission. Objectives The study aimed to examine the association between maternal HIV-positive status and under-five mortality in Tanzania. It also aimed to estimate the proportions and trends of under-five mortality attributable to maternal HIV/AIDS in Tanzania between 2003 and 2012. Design Binomial logistic regression was used to analyze cross-sectional survey data from the Tanzania AIDS Indicator Surveys to examine the association between maternal HIV positivity and under-five mortality between 2003 and 2012. Results After controlling for confounders, the adjusted odds ratios were 1.5 (95% CI 1.1–1.9) in 2003–2004, 4.6 (95% CI 2.7–7.8) in 2007–2008, and 2.4 (95% CI 1.2–4.6) in 2011–2012. The maternal HIV-attributable mortality risk percent of under-five children was 3.7 percent in 2003–2004, 11.3 percent in 2007–2008 and 5.6% in 2011–2012. Conclusion Maternal HIV positivity is associated with under-five mortality in Tanzania, making maternal HIV serostatus a relevant determinant of whether a child will survive up to five years of age or not. The impact of maternal HIV/AIDS attributable mortality risk has a significant contribution to the overall under-five mortality in Tanzania. The continued monitoring of HIV and mortality trends is important for policy development and design of interventions. PMID:27329937

  13. What is the cause of the decline in maternal mortality in India? Evidence from time series and cross-sectional analyses.

    PubMed

    Goli, Srinivas; Jaleel, Abdul C P

    2014-05-01

    Summary Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (-1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (-0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=-0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between 'increase in institutional deliveries' and 'decline in maternal mortality ratio' suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health

  14. Obstructive Sleep Apnea and Severe Maternal-Infant Morbidity/Mortality in the United States, 1998-2009

    PubMed Central

    Louis, Judette M.; Mogos, Mulubrhan F.; Salemi, Jason L.; Redline, Susan; Salihu, Hamisu M.

    2014-01-01

    Study Objectives: A recent trend in increasing rates of severe maternal morbidity and mortality despite quality improvements has been noted. The goal of this study is to estimate the national prevalence of obstructive sleep apnea (OSA) in pregnant women and examine associations between OSA and pregnancy-related morbidities, including in-hospital maternal mortality. Design: A retrospective, cross-sectional analysis. Setting: A nationally representative sample of maternal hospital discharges from 1998-2009. Patients or Participants: The analytic sample included 55,781,965 pregnancy-related inpatient hospital discharges. Interventions: N/A. Measurements and Results: The Nationwide Inpatient Sample (NIS) database was used to identify hospital stays for women who were pregnant or gave birth. Among these women, we determined length of hospital stay, in-hospital mortality, and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify OSA and other outcome measures. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between OSA and each outcome. The overall rate of OSA was 3.0 per 10,000; however, the rate climbed substantially from 0.7 in 1998 to 7.3 in 2009, with an average annual increase of 24%. After controlling for obesity and other potential confounders, OSA was associated with increased odds of pregnancy-related morbidities including preeclampsia (OR, 2.5; 95% CI, 2.2–2.9), eclampsia (OR, 5.4; 95% CI, 3.3–8.9), cardiomyopathy (OR, 9.0; 95% CI, 7.5–10.9), and pulmonary embolism (OR, 4.5; 95% CI, 2.3–8.9). Women with OSA experienced a more than fivefold increased odds of in-hospital mortality (95% CI, 2.4–11.5). The adverse effects of OSA on selected outcomes were exacerbated by obesity. Conclusions: Obstructive sleep apnea is associated with severe maternal morbidity, cardiovascular morbidity, and in

  15. Persistence of Hemorrhage and Hypertensive Disorders of Pregnancy (HDP) as the Main Causes of Maternal Mortality: Emergence of Medical Errors in Iranian Healthcare System

    PubMed Central

    FARROKH-ESLAMLOU, Hamidreza; AGHLMAND, Siamak; OSHNOUEI, Sima

    2014-01-01

    Abstract Background This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system. Methods In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System (MMSS) which were covered all maternal deaths. The “Three delays model” was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP. Results There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio (MMR) in the province was 32.8 per 100 000 live births (95% CI, 32.64—32.88). The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP. Conclusion A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals. PMID:26060702

  16. Maternal characteristics influence response to DHA during pregnancy.

    PubMed

    Gould, J F; Anderson, A J; Yelland, L N; Gibson, R A; Makrides, M

    2016-05-01

    We explored the degree to which maternal and offspring outcomes resulting from consuming prenatal docosahexaenoic acid (DHA, 800mg/day) in a clinical trial were influenced by maternal characteristics. Among non-smokers, women who received DHA had heavier babies (adjusted mean difference (MD)=99g 95% CI 45-153, p<0.01; interaction p=0.01) and fewer low birth weight babies than control women (adjusted relative risk=0.43 95% CI 0.25-0.74, p<0.01; interaction p=0.01). From women who had not completed further education, children in the DHA group had higher cognitive scores at 18 months compared with control children (adjusted MD=3.15 95% CI 0.93-5.37, p=0.01; interaction p<0.01). Conversely, the children of women who completed further education in the DHA group had lower language scores than control children (adjusted MD -2.82 95% CI -4.90 to -0.73, p=0.01; interaction p=0.04). Our results support the notion that responsiveness to prenatal DHA may depend on the characteristics of specific population subgroups. PMID:27154359

  17. Early life-stage mortality in zebrafish (Danio rerio) following maternal exposure to polychlorinated biphenyls and estrogen

    SciTech Connect

    Westerlund, L.; Billsson, K.; Andersson, P.L.; Tysklind, M.; Olsson, P.E.

    2000-06-01

    In the present study, specific polychlorinated biphenyl (PCB) congeners were examined for embryo and early life stage mortality in zebrafish (Danio rerio). A set of eight PCBs and two hydroxylated PCBs and 17{beta}-estradiol were tested. Of the compounds tested, 4{prime}-OH-PCB30 (hydroxylated polychlorinated biphenyl) and PCB104 were found to be highly toxic to embryos following maternal exposure and transfer to the oocyte. It was also observed that 17{beta}-estradiol exposure resulted in a high incidence of embryo mortality. Analysis of estrogen receptor levels during embryonic development showed increased mRNA (ribonucleic acid) levels from the 1K stage to 50% epiboly. Following injection of the different compounds, the estrogen receptor mRNA levels were also analyzed in adult male fish to determine if there was a correlation between embryo mortality and estrogenicity of the studied PCBs. The two PCBs that were highly embryo toxic were observed to be estrogenic.

  18. Influences on Maternal Responsiveness to Developmentally Delayed Preschoolers.

    ERIC Educational Resources Information Center

    Lojkasek, Mirek; And Others

    1990-01-01

    Evaluation of maternal responsiveness of 109 preschoolers with disabilities (Down Syndrome, neurological impairment, and developmental delay) in free play situations found that parental age, mother's support, and child responsiveness contributed to maternal responsiveness. (Author/DB)

  19. Human-caused mortality influences spatial population dynamics: pumas in landscapes with varying mortality risks

    USGS Publications Warehouse

    Newby, Jesse R.; Mills, L. Scott; Ruth, Toni K.; Pletscher, Daniel H.; Mitchell, Michael S.; Quigley, Howard B.; Murphy, Kerry M.; DeSimone, Rich

    2013-01-01

    An understanding of how stressors affect dispersal attributes and the contribution of local populations to multi-population dynamics are of immediate value to basic and applied ecology. Puma (Puma concolor) populations are expected to be influenced by inter-population movements and susceptible to human-induced source–sink dynamics. Using long-term datasets we quantified the contribution of two puma populations to operationally define them as sources or sinks. The puma population in the Northern Greater Yellowstone Ecosystem (NGYE) was largely insulated from human-induced mortality by Yellowstone National Park. Pumas in the western Montana Garnet Mountain system were exposed to greater human-induced mortality, which changed over the study due to the closure of a 915 km2 area to hunting. The NGYE’s population growth depended on inter-population movements, as did its ability to act as a source to the larger region. The heavily hunted Garnet area was a sink with a declining population until the hunting closure, after which it became a source with positive intrinsic growth and a 16× increase in emigration. We also examined the spatial and temporal characteristics of individual dispersal attributes (emigration, dispersal distance, establishment success) of subadult pumas (N = 126). Human-caused mortality was found to negatively impact all three dispersal components. Our results demonstrate the influence of human-induced mortality on not only within population vital rates, but also inter-population vital rates, affecting the magnitude and mechanisms of local population’s contribution to the larger metapopulation.

  20. Maternal Age at Holocaust Exposure and Maternal PTSD Independently Influence Urinary Cortisol Levels in Adult Offspring

    PubMed Central

    Bader, Heather N.; Bierer, Linda M.; Lehrner, Amy; Makotkine, Iouri; Daskalakis, Nikolaos P.; Yehuda, Rachel

    2014-01-01

    Background: Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal posttraumatic stress disorder (PTSD) appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression. Method: Ninety-five Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 h urinary cortisol was assayed by RIA. Offspring completed the parental PTSD questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence, or adulthood and examined in relation to offspring psychobiology. Results: Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not. Conclusion: Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased

  1. Maternal smoking in pregnancy and its influence on childhood asthma

    PubMed Central

    2016-01-01

    Maternal smoking in pregnancy (MSP) is a large modifiable risk factor for pregnancy related mortality and morbidity and also the most important known modifiable risk factor for asthma. This review summarises the effects of MSP throughout infancy, childhood and adolescence with regards to asthma (development and severity). Firstly, the direct damage caused by nicotine on fetal lung development, fetal growth and neuronal differentiation is discussed, as well as the indirect effects of nicotine on placental functioning. Secondly, the effects of MSP on later immune functioning resulting in increased infection rate are summarised and details are given on the effects of MSP modulating airway hyperreactivity, reducing lung function and therefore increasing asthma morbidity. Furthermore, epigenetic effects are increasingly being recognised. These can also result in transgenerational detrimental effects induced by cigarette smoke. In summary, the causal relationship between MSP and asthma development is well documented and presents a major health problem for generations to come. The high prevalence of MSP is alarming and epigenetic effects of nicotine on immune functioning potentiate this danger. A considerable part of the increase in asthma prevalence worldwide is due to MSP. PMID:27730206

  2. Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

    PubMed

    Krupp, Karl; Madhivanan, Purnima

    2009-01-01

    Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services - interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India--Gujarat and Tamil Nadu--have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five. PMID:19250542

  3. 'Big push' to reduce maternal mortality in Uganda and Zambia enhanced health systems but lacked a sustainability plan.

    PubMed

    Kruk, Margaret E; Rabkin, Miriam; Grépin, Karen Ann; Austin-Evelyn, Katherine; Greeson, Dana; Masvawure, Tsitsi Beatrice; Sacks, Emma Rose; Vail, Daniel; Galea, Sandro

    2014-06-01

    In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.

  4. 'Big push' to reduce maternal mortality in Uganda and Zambia enhanced health systems but lacked a sustainability plan.

    PubMed

    Kruk, Margaret E; Rabkin, Miriam; Grépin, Karen Ann; Austin-Evelyn, Katherine; Greeson, Dana; Masvawure, Tsitsi Beatrice; Sacks, Emma Rose; Vail, Daniel; Galea, Sandro

    2014-06-01

    In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control. PMID:24889956

  5. Causes and risk factors for maternal mortality in rural Tanzania--case of Rufiji Health and Demographic Surveillance Site (HDSS).

    PubMed

    Illah, Evance; Mbaruku, Godfrey; Masanja, Honorati; Kahn, Kathleen

    2013-09-01

    Complications of childbirth and pregnancy are leading causes of death among women of reproductive age. Developing countries account for 99% of maternal deaths. The aim of this study was to explore levels, causes and risk factors associated with maternal mortality in rural Tanzania. Longitudinal data (2002-2006) from Rufiji HDSS was used where a total of 26 427 women aged 15-49 years were included in the study; 64 died and there were 15 548 live births. Cox proportional hazards regression was used to assess the risk factors associated with maternal deaths. MMR was 412 per 100 000 live births. The main causes of death were haemorrhage (28%), eclampsia (19%) and puerperal sepsis (8%). An increased risk of 154% for maternal death was found for women aged 30-39 versus 15-19 years (HR=2.54, 95% CI=1.001-6.445). Married women had a protective effect of 62% over unmarried ones (HR=0.38, 95% CI=0.176-0.839).

  6. Activism: working to reduce maternal mortality through civil society and health professional alliances in sub-Saharan Africa.

    PubMed

    Ray, Sunanda; Madzimbamuto, Farai; Fonn, Sharon

    2012-06-01

    Partnerships between civil society groups campaigning for reproductive and human rights, health professionals and others could contribute more to the strengthening of health systems needed to bring about declines in maternal deaths in Africa. The success of the HIV treatment literacy model developed by the Treatment Action Campaign in South Africa provides useful lessons for activism on maternal mortality, especially the combination of a right-to-health approach with learning and capacity building, community networking, popular mobilisation and legal action. This paper provides examples of these from South Africa, Botswana, Kenya and Uganda. Confidential enquiries into maternal deaths can be powerful instruments for change if pressure to act on their recommendations is brought to bear. Shadow reports presented during UN human rights country assessments can be used in a similar way. Public protests and demonstrations over avoidable deaths have succeeded in drawing attention to under-resourced services, shortages of supplies, including blood for transfusion, poor morale among staff, and lack of training and supervision. Activists could play a bigger role in holding health services, governments, and policy-makers accountable for poor maternity services, developing user-friendly information materials for women and their families, and motivating appropriate human resources strategies. Training and support for patients' groups, in how to use health facility complaints procedures is also a valuable strategy. PMID:22789081

  7. Activism: working to reduce maternal mortality through civil society and health professional alliances in sub-Saharan Africa.

    PubMed

    Ray, Sunanda; Madzimbamuto, Farai; Fonn, Sharon

    2012-06-01

    Partnerships between civil society groups campaigning for reproductive and human rights, health professionals and others could contribute more to the strengthening of health systems needed to bring about declines in maternal deaths in Africa. The success of the HIV treatment literacy model developed by the Treatment Action Campaign in South Africa provides useful lessons for activism on maternal mortality, especially the combination of a right-to-health approach with learning and capacity building, community networking, popular mobilisation and legal action. This paper provides examples of these from South Africa, Botswana, Kenya and Uganda. Confidential enquiries into maternal deaths can be powerful instruments for change if pressure to act on their recommendations is brought to bear. Shadow reports presented during UN human rights country assessments can be used in a similar way. Public protests and demonstrations over avoidable deaths have succeeded in drawing attention to under-resourced services, shortages of supplies, including blood for transfusion, poor morale among staff, and lack of training and supervision. Activists could play a bigger role in holding health services, governments, and policy-makers accountable for poor maternity services, developing user-friendly information materials for women and their families, and motivating appropriate human resources strategies. Training and support for patients' groups, in how to use health facility complaints procedures is also a valuable strategy.

  8. Influences on maternal responsivity in mothers of children with fragile X syndrome.

    PubMed

    Sterling, Audra M; Warren, Steven F; Brady, Nancy; Fleming, Kandace

    2013-07-01

    This study investigated the influence of maternal and child variables on the maternal responsivity of 55 mothers with young children with fragile X syndrome. Data included video observations of mother-child interactions in four different contexts, standardized assessments with the children, and standardized questionnaires for the mothers. The video observations were coded for child communication acts; maternal responsivity was coded at two levels: a more general measure and a behavior-by-behavior measure. Results indicated that child developmental level and language ability strongly influenced behavior-by-behavior responsivity, while maternal IQ was the strongest predictor of both general and behavior-by-behavior responsivity, after controlling for child developmental level.

  9. Frequency of Maternal Mortality in Urban and Rural Areas of Iranshahr County (Southeast of Iran) in 2009-2013: A Retrospective Study

    PubMed Central

    Zareban, Iraj; Jamalzae, Abdul-Qaffar; Darban, Fatemeh; Bakhshani, Khadejeh Dehghan; Balouchi, Abbas

    2016-01-01

    Introduction Maternal mortality is one of the threatening factors of human life and the overall status index of women’s health in any society. Death of a mother causes irreversible damage to a family and a society. This study aims at examining the causes of maternal mortality in urban and rural areas. Aim The purpose of this study was to determine the frequney and causes of maternal mortality in urban and rural areas in southeast of Iran in 2009-2013. Materials and Methods This was a retrospective descriptive study and its research population includes the entire pregnant woman who died in Iranshahr County between April 2009 and March 2013. An eight-section questionnaire was used for collecting data. The first section was based on the hospital records of pregnant woman including mother’s demographic data and the following sections were completed based on their health records. Results The frequency of maternal mortality during birth in the study period was 34 (of 4857). The study individuals were between 13 and 40-year-old with the mean age of 30±6.4. Maximum maternal mortality occurred in 2012. Haemorrhage was the most common cause of maternal death (38.2%). Conclusion As haemorrhage was the most common cause of death of pregnant women in this study, it seems necessary to improve care for woman and reduce haemorrhage and its complications during pregnancy period. PMID:27656510

  10. SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan.

    PubMed

    Ahmadi, Qudratullah; Danesh, Homayoon; Makharashvili, Vasil; Mishkin, Kathryn; Mupfukura, Lovemore; Teed, Hillary; Huff-Rousselle, Maggie

    2016-07-01

    This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25950757

  11. SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan.

    PubMed

    Ahmadi, Qudratullah; Danesh, Homayoon; Makharashvili, Vasil; Mishkin, Kathryn; Mupfukura, Lovemore; Teed, Hillary; Huff-Rousselle, Maggie

    2016-07-01

    This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Integrating interventions on maternal mortality and morbidity and HIV: a human rights-based framework and approach.

    PubMed

    Fried, Susanna; Harrison, Brianna; Starcevich, Kelly; Whitaker, Corinne; O'Konek, Tiana

    2012-12-15

    Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both. Shared structural drivers include gender inequality; gender-based violence (including sexual violence); economic disempowerment; and stigma and discrimination in access to services or opportunities based on gender and HIV. Further, shared system-related drivers also contribute to a lack of effective access to acceptable, high-quality health services and other development resources from birth forward. HIV and MMM are connected in both outcomes and solutions: in sub-Saharan Africa, HIV is the leading cause of maternal death, while the most recent global report on HIV identifies prevention of unintended pregnancy and access to contraception as two of the most important HIV-related prevention efforts.1 Both are central to reducing unsafe abortion--another leading cause of maternal death globally, and particularly in Africa. A human rights-based framework helps to identify these shared determinants. A human rights-based approach works to establish the health-related human rights standards to which all women are entitled, as well to outline the indivisible and intersecting human rights principles which inform and guide efforts to prevent, protect from, respond to, and provide remedy for human rights violations-in this case related to HIV and maternal mortality and morbidity.The Millennium Declaration and Development Goals (MDGs) help to both set quantifiable goals for achieving the components identified within the human rights-based framework and document the international consensus that no single goal--such as those addressing HIV and MMM--can be achieved without progress on all development goals.

  13. Maternal and best friends' influences on meal-skipping behaviours.

    PubMed

    Pearson, Natalie; Williams, Lauren; Crawford, David; Ball, Kylie

    2012-09-01

    Skipping meals is particularly common during adolescence and can have a detrimental effect on multiple aspects of adolescent health. Understanding the correlates of meal-skipping behaviours is important for the design of nutrition interventions. The present study examined maternal and best friends' influences on adolescent meal-skipping behaviours. Frequency of skipping breakfast, lunch and dinner was assessed using a Web-based survey completed by 3001 adolescent boys and girls from years 7 and 9 of secondary schools in Victoria, Australia. Perceived best friend and maternal meal skipping, modelling of healthy eating (eating healthy food, limiting junk food, eating fruit and vegetables) and weight watching were assessed. Best friend and maternal factors were differentially associated with meal-skipping behaviours. For example, boys and girls who perceived that their best friend often skipped meals were more likely to skip lunch (OR = 2·01, 95 % CI 1·33, 3·04 and OR = 1·93, 95 % CI 1·41, 2·65; P < 0·001). Boys and girls who perceived that their mother often skipped meals were more likely to skip breakfast (OR = 1·48, 95 % CI 1·01, 2·15; P < 0·05 and OR = 1·93, 95 % CI 1·42, 2·59; P < 0·001) and lunch (OR = 2·05, 95 % CI 1·35, 3·12 and OR = 2·02, 95 % CI 1·43, 2·86; P < 0·001). Educating adolescents on how to assess and interpret unhealthy eating behaviours that they observe from significant others may be one nutrition promotion strategy to reduce meal-skipping behaviour. The involvement of mothers may be particularly important in such efforts. Encouraging a peer subculture that promotes regular consumption of meals and educates adolescents on the detrimental impact of meal-skipping behaviour on health may also offer a promising nutrition promotion strategy. PMID:22289518

  14. The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993.

    PubMed Central

    Peña, R; Wall, S; Persson, L A

    2000-01-01

    OBJECTIVES: This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education. METHODS: A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10,867 women aged 15 to 49 years in León, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups. RESULTS: IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households. CONCLUSIONS: Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality. PMID:10630139

  15. Cause of Death in Women of Reproductive Age in Rural Nepal Obtained Through Community-Based Surveillance: Is Reducing Maternal Mortality the Right Priority for Women's Health Programs?

    PubMed

    Pyakurel, Ram; Sharma, Nirmala; Paudel, Deepak; Coghill, Anna; Sinden, Laura; Bost, Liberty; Larkin, Melissa; Burrus, Carla Jean; Roy, Khrist

    2015-01-01

    We used a community surveillance system to gather information regarding pregnancy outcomes and the cause of death for women of reproductive age (WRA) in Kanchanpur, Nepal. A total of 784 mother groups participated in the collection of pregnancy outcomes and mortality data. Of the 273 deaths among WRA, the leading causes of death reported were chronic diseases (94, 34.4%) poisoning, snake bites, and suicide (grouped together; 55, 20.1%), and accidents (29, 10.6%), while maternal mortality accounted for 7%. Nevertheless, the calculated maternal mortality ratio was quite high (259.3 per 100,000 live births).

  16. High Maternal Body Mass Index in Early Pregnancy and Risks of Stillbirth and Infant Mortality-A Population-Based Sibling Study in Sweden.

    PubMed

    Lindam, Anna; Johansson, Stefan; Stephansson, Olof; Wikström, Anna-Karin; Cnattingius, Sven

    2016-07-15

    In a population-based case-control study, we investigated whether familial confounding influenced the associations between maternal overweight/obesity and risks of stillbirth and infant mortality by including both population and sister controls. Using nationwide data from the Swedish Medical Birth Register (1992-2011), we included all primiparous women with singleton births who also had a sister with a first birth during that time period. We used logistic regression analyses to calculate odds ratios (and 95% confidence intervals) adjusted for maternal age, height, smoking habits, education, and time period (5-year groups) of child's birth. Body mass index (BMI) was calculated as weight (kg)/height (m)(2) Compared with population controls with a normal BMI (18.5-24.9), stillbirth risk increased with increasing BMI (BMI 25-29.9: odds ratio (OR) = 1.51 (95% confidence interval (CI): 1.21, 1.89); BMI 30-34.9: OR = 1.77 (95% CI: 1.24, 2.50); BMI ≥35: OR = 3.16 (95% CI: 2.10, 4.76)). The sister case-control analyses revealed similar results. Offspring of obese women (BMI ≥30) had an increased risk of infant mortality when population controls were used (OR = 2.41, 95% CI: 1.83, 3.16), and an even higher risk was obtained when sister controls were used (OR = 4.04, 95% CI: 2.25, 7.25). We conclude that obesity in early pregnancy is associated with increased risks of stillbirth and infant mortality independently of genetic and early environmental risk factors shared within families. PMID:27358265

  17. Emergency obstetrical complications in a rural African setting (Kayes, Mali): the link between travel time and in-hospital maternal mortality.

    PubMed

    Pirkle, Catherine McLean; Fournier, Pierre; Tourigny, Caroline; Sangaré, Karim; Haddad, Slim

    2011-10-01

    The West African country of Mali implemented referral systems to increase spatial access to emergency obstetrical care and lower maternal mortality. We test the hypothesis that spatial access- proxied by travel time during the rainy and dry seasons- is associated with in-hospital maternal mortality. Effect modification by caesarean section is explored. All women treated for emergency obstetrical complications at the referral hospital in Kayes, Mali were considered eligible for study. First, we conducted descriptive analyses of all emergency obstetrical complications treated at the referral hospital between 2005 and 2007. We calculated case fatality rates by obstetric diagnosis and travel time. Key informant interviews provided travel times. Medical registers provided clinical and demographic data. Second, a matched case-control study assessed the independent effect of travel time on maternal mortality. Stratification was used to explore effect modification by caesarean section. Case fatality rates increased with increasing travel time to the hospital. After controlling for age, diagnosis, and date of arrival, a travel time of four or more hours was significantly associated with in-hospital maternal mortality (OR: 3.83; CI: 1.31-11.27). Travel times between 2 and 4 h were associated with increased odds of maternal mortality (OR 1.88), but the relationship was not significant. The effect of travel time on maternal mortality appears to be modified by caesarean section. Poor spatial access contributes to maternal mortality even in women who reach a health facility. Improving spatial access will help women arrive at the hospital in time to be treated effectively.

  18. Maternal Influences on Asian American-Pacific Islander Adolescents' Perceived Maternal Sexual Expectations and Their Sexual Initiation

    ERIC Educational Resources Information Center

    Kao, Tsui-Sui Annie; Loveland-Cherry, Carol; Guthrie, Barbara

    2010-01-01

    Maternal influences on adolescents' sexual initiation have been examined over two time points in 433 Asian American-Pacific Islander (AAPI) adolescents in a secondary analysis of the Add Health data set using structural equation modeling. A longitudinal model built on a preliminary qualitative study is used to examine the fit between data and…

  19. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial.

    PubMed Central

    Taha, T. E.; Biggar, R. J.; Broadhead, R. L.; Mtimavalye, L. A.; Justesen, A. B.; Liomba, G. N.; Chiphangwi, J. D.; Miotti, P. G.

    1997-01-01

    OBJECTIVE: To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally. DESIGN: Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. SETTING: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi. SUBJECTS: A total of 6965 women giving birth in a six month period and their 7160 babies. INTERVENTION: Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. MAIN OUTCOME MEASURES: Effects of the intervention on neonatal and maternal morbidity and mortality. RESULTS: 3635 women giving birth to 3743 babies were enrolled in the intervention phase and 3330 women giving birth to 3417 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3743 (16.9%) v 661/3417 (19.3%), P < 0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1000 live births, P < 0.0002), overall neonatal mortality (28.6 v 36.9 per 1000 live births, P < 0.06), and mortality due to infectious causes (2.4 v 7.3 per 1000 live births, P < 0.005). Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P < 0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P = 0.02) and duration of hospitalisation (Wilcoxon P = 0.008). CONCLUSIONS: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality. PMID:9253269

  20. Maternal HIV infection influences the microbiome of HIV-uninfected infants.

    PubMed

    Bender, Jeffrey M; Li, Fan; Martelly, Shoria; Byrt, Erin; Rouzier, Vanessa; Leo, Marguerite; Tobin, Nicole; Pannaraj, Pia S; Adisetiyo, Helty; Rollie, Adrienne; Santiskulvong, Chintda; Wang, Shaun; Autran, Chloe; Bode, Lars; Fitzgerald, Daniel; Kuhn, Louise; Aldrovandi, Grace M

    2016-07-27

    More than 1 million HIV-exposed, uninfected infants are born annually to HIV-positive mothers worldwide. This growing population of infants experiences twice the mortality of HIV-unexposed infants. We found that although there were very few differences seen in the microbiomes of mothers with and without HIV infection, maternal HIV infection was associated with changes in the microbiome of HIV-exposed, uninfected infants. Furthermore, we observed that human breast milk oligosaccharides were associated with bacterial species in the infant microbiome. The disruption of the infant's microbiome associated with maternal HIV infection may contribute to the increased morbidity and mortality of HIV-exposed, uninfected infants.

  1. Maternal HIV infection influences the microbiome of HIV-uninfected infants.

    PubMed

    Bender, Jeffrey M; Li, Fan; Martelly, Shoria; Byrt, Erin; Rouzier, Vanessa; Leo, Marguerite; Tobin, Nicole; Pannaraj, Pia S; Adisetiyo, Helty; Rollie, Adrienne; Santiskulvong, Chintda; Wang, Shaun; Autran, Chloe; Bode, Lars; Fitzgerald, Daniel; Kuhn, Louise; Aldrovandi, Grace M

    2016-07-27

    More than 1 million HIV-exposed, uninfected infants are born annually to HIV-positive mothers worldwide. This growing population of infants experiences twice the mortality of HIV-unexposed infants. We found that although there were very few differences seen in the microbiomes of mothers with and without HIV infection, maternal HIV infection was associated with changes in the microbiome of HIV-exposed, uninfected infants. Furthermore, we observed that human breast milk oligosaccharides were associated with bacterial species in the infant microbiome. The disruption of the infant's microbiome associated with maternal HIV infection may contribute to the increased morbidity and mortality of HIV-exposed, uninfected infants. PMID:27464748

  2. Maternal characteristics and clinical diagnoses influence obstetrical outcomes in Indonesia.

    PubMed

    Adisasmita, Asri; Smith, Carl V; El-Mohandes, Ayman A E; Deviany, Poppy Elvira; Ryon, Judith J; Kiely, Michele; Rogers-Bloch, Quail; Gipson, Reginald F

    2015-07-01

    This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective AOR 5.41, 95 % CI 2.64-11.08; prospective AOR 10.45, 95 % CI 5.59-19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05-3.57; prospective AOR 3.26, 95 % CI 1.79-5.94). Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34-20.13), and prospectively for poverty (AOR 2.17, 95 % CI 1.33-3.54) and delivering outside the hospital (AOR 2.04, 95 % CI 1.08-3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns.

  3. Pre-reproductive maternal enrichment influences rat maternal care and offspring developmental trajectories: behavioral performances and neuroplasticity correlates.

    PubMed

    Cutuli, Debora; Caporali, Paola; Gelfo, Francesca; Angelucci, Francesco; Laricchiuta, Daniela; Foti, Francesca; De Bartolo, Paola; Bisicchia, Elisa; Molinari, Marco; Farioli Vecchioli, Stefano; Petrosini, Laura

    2015-01-01

    Environmental enrichment (EE) is a widely used paradigm for investigating the influence of complex stimulations on brain and behavior. Here we examined whether pre-reproductive exposure to EE of female rats may influence their maternal care and offspring cognitive performances. To this aim, from weaning to breeding age enriched females (EF) were reared in enriched environments. Females reared in standard conditions were used as controls. At 2.5 months of age all females were mated and reared in standard conditions with their offspring. Maternal care behaviors and nesting activity were assessed in lactating dams. Their male pups were also behaviorally evaluated at different post-natal days (pnd). Brain BDNF, reelin and adult hippocampal neurogenesis levels were measured as biochemical correlates of neuroplasticity. EF showed more complex maternal care than controls due to their higher levels of licking, crouching and nest building activities. Moreover, their offspring showed higher discriminative (maternal odor preference T-maze, pnd 10) and spatial (Morris Water Maze, pnd 45; Open Field with objects, pnd 55) performances, with no differences in social abilities (Sociability test, pnd 35), in comparison to controls. BDNF levels were increased in EF frontal cortex at pups' weaning and in their offspring hippocampus at pnd 21 and 55. No differences in offspring reelin and adult hippocampal neurogenesis levels were found. In conclusion, our study indicates that pre-reproductive maternal enrichment positively influences female rats' maternal care and cognitive development of their offspring, demonstrating thus a transgenerational transmission of EE benefits linked to enhanced BDNF-induced neuroplasticity. PMID:25814946

  4. Pre-reproductive maternal enrichment influences rat maternal care and offspring developmental trajectories: behavioral performances and neuroplasticity correlates

    PubMed Central

    Cutuli, Debora; Caporali, Paola; Gelfo, Francesca; Angelucci, Francesco; Laricchiuta, Daniela; Foti, Francesca; De Bartolo, Paola; Bisicchia, Elisa; Molinari, Marco; Farioli Vecchioli, Stefano; Petrosini, Laura

    2015-01-01

    Environmental enrichment (EE) is a widely used paradigm for investigating the influence of complex stimulations on brain and behavior. Here we examined whether pre-reproductive exposure to EE of female rats may influence their maternal care and offspring cognitive performances. To this aim, from weaning to breeding age enriched females (EF) were reared in enriched environments. Females reared in standard conditions were used as controls. At 2.5 months of age all females were mated and reared in standard conditions with their offspring. Maternal care behaviors and nesting activity were assessed in lactating dams. Their male pups were also behaviorally evaluated at different post-natal days (pnd). Brain BDNF, reelin and adult hippocampal neurogenesis levels were measured as biochemical correlates of neuroplasticity. EF showed more complex maternal care than controls due to their higher levels of licking, crouching and nest building activities. Moreover, their offspring showed higher discriminative (maternal odor preference T-maze, pnd 10) and spatial (Morris Water Maze, pnd 45; Open Field with objects, pnd 55) performances, with no differences in social abilities (Sociability test, pnd 35), in comparison to controls. BDNF levels were increased in EF frontal cortex at pups' weaning and in their offspring hippocampus at pnd 21 and 55. No differences in offspring reelin and adult hippocampal neurogenesis levels were found. In conclusion, our study indicates that pre-reproductive maternal enrichment positively influences female rats' maternal care and cognitive development of their offspring, demonstrating thus a transgenerational transmission of EE benefits linked to enhanced BDNF-induced neuroplasticity. PMID:25814946

  5. Pre-reproductive maternal enrichment influences rat maternal care and offspring developmental trajectories: behavioral performances and neuroplasticity correlates.

    PubMed

    Cutuli, Debora; Caporali, Paola; Gelfo, Francesca; Angelucci, Francesco; Laricchiuta, Daniela; Foti, Francesca; De Bartolo, Paola; Bisicchia, Elisa; Molinari, Marco; Farioli Vecchioli, Stefano; Petrosini, Laura

    2015-01-01

    Environmental enrichment (EE) is a widely used paradigm for investigating the influence of complex stimulations on brain and behavior. Here we examined whether pre-reproductive exposure to EE of female rats may influence their maternal care and offspring cognitive performances. To this aim, from weaning to breeding age enriched females (EF) were reared in enriched environments. Females reared in standard conditions were used as controls. At 2.5 months of age all females were mated and reared in standard conditions with their offspring. Maternal care behaviors and nesting activity were assessed in lactating dams. Their male pups were also behaviorally evaluated at different post-natal days (pnd). Brain BDNF, reelin and adult hippocampal neurogenesis levels were measured as biochemical correlates of neuroplasticity. EF showed more complex maternal care than controls due to their higher levels of licking, crouching and nest building activities. Moreover, their offspring showed higher discriminative (maternal odor preference T-maze, pnd 10) and spatial (Morris Water Maze, pnd 45; Open Field with objects, pnd 55) performances, with no differences in social abilities (Sociability test, pnd 35), in comparison to controls. BDNF levels were increased in EF frontal cortex at pups' weaning and in their offspring hippocampus at pnd 21 and 55. No differences in offspring reelin and adult hippocampal neurogenesis levels were found. In conclusion, our study indicates that pre-reproductive maternal enrichment positively influences female rats' maternal care and cognitive development of their offspring, demonstrating thus a transgenerational transmission of EE benefits linked to enhanced BDNF-induced neuroplasticity.

  6. Maternal Mortality from Obstructed Labor: A MANDATE Analysis of the Ability of Technology to Save Lives in Sub-Saharan Africa.

    PubMed

    Harrison, Margo S; Griffin, Jennifer B; McClure, Elizabeth M; Jones, Bonnie; Moran, Katelin; Goldenberg, Robert L

    2016-07-01

    Objective The aim of the study is to evaluate clinical interventions to significantly reduce maternal mortality from prolonged labor, obstructed labor, and prolonged obstructed labor (PL/OL/POL) in sub-Saharan Africa (SSA). Methods A mathematical model-Maternal and Neonatal Directed Assessment of Technology ("MANDATE")-was created for SSA with estimated prevalence for PL/OL/POL and case fatality rates from hemorrhage, infection, and uterine rupture. Based on a literature review and expert opinion, the model was populated with estimated likelihoods of the current healthcare system ability to diagnose, transfer, and treat women with these conditions. Impact on maternal mortality of improved diagnosis, transfer, and delivery to relieve PL/OL/POL was assessed. Results Without current technologies, the model estimated 8,464 maternal deaths annually in SSA from these conditions. Imputing current diagnosis, transfer, and treatment of PL/OL/POL, an estimated 7,033 maternal deaths occur annually from these complications. With improved PL/OL/POL diagnosis and improved transfer, 1,700 and 740 lives could be saved, respectively. Improved diagnosis, transfer, and treatment for PL/OL/POL reduce the mortality rate to 864 maternal deaths annually, saving 6,169 lives. If improved transfusion and antibiotic use were added, only 507 women per year would die from PL/OL/POL in SSA. Conclusion In SSA, increasing diagnostics, transfer to higher care, and operative delivery could substantially reduce maternal mortality from PL/OL/POL. Synopsis A computerized model of obstructed labor in SSA was created to explore the interventions necessary to reduce maternal mortality from this condition. PMID:27031054

  7. Epigenetics: Behavioral Influences on Gene Function, Part I: Maternal Behavior Permanently Affects Adult Behavior in Offspring

    ERIC Educational Resources Information Center

    Ogren, Marilee P.; Lombroso, Paul J.

    2008-01-01

    The article highlights the field of epigenetics and its relevance in determining the effects of maternal nurturing on behavioral patterns in offsprings. Results concluded that maternal behavior influences the offspring's behavior to stress in adulthood and the effects are transgenerational through epigenetic mechanisms.

  8. Influences on Maternal Responsivity in Mothers of Children with Fragile X Syndrome

    ERIC Educational Resources Information Center

    Sterling, Audra M.; Warren, Steven F.; Brady, Nancy; Fleming, Kandace

    2013-01-01

    This study investigated the influence of maternal and child variables on the maternal responsivity of 55 mothers with young children with fragile X syndrome. Data included video observations of mother-child interactions in four different contexts, standardized assessments with the children, and standardized questionnaires for the mothers. The…

  9. Psychobiological Influences on Maternal Sensitivity in the Context of Adversity

    ERIC Educational Resources Information Center

    Finegood, Eric D.; Blair, Clancy; Granger, Douglas A.; Hibel, Leah C.; Mills-Koonce, Roger

    2016-01-01

    This study evaluated prospective longitudinal relations among an index of poverty-related cumulative risk, maternal salivary cortisol, child negative affect, and maternal sensitivity across the first 2 postpartum years. Participants included 1,180 biological mothers residing in rural and predominantly low-income communities in the United States.…

  10. Spatial-temporal dynamics and structural determinants of child and maternal mortality in a rural, high HIV burdened South African population, 2000–2014: a study protocol

    PubMed Central

    Tlou, B; Sartorius, B; Tanser, F

    2016-01-01

    Introduction Child (infant and under-5) and maternal mortality rates are key indicators for assessing the health status of populations. South Africa's maternal and child mortality rates are high, and the country mirrors the continental trend of slow progress towards its Millennium Development Goals. Rural areas are often more affected regarding child and maternal mortalities, specifically in areas with a high HIV burden. This study aims to understand the factors affecting child and maternal mortality in the Africa Centre Demographic Surveillance Area (DSA) from 2003 to 2014 towards developing tailored interventions to reduce the deaths in resource poor settings. This will be done by identifying child and maternal mortality ‘hotspots’ and their associated risk factors. Methods and analysis This retrospective study will use data for 2003–2014 from the Africa Centre Demographic Information System (ACDIS) in rural KwaZulu-Natal Province, South Africa. All homesteads in the study area have been mapped to an accuracy of <2 m, all deaths recorded and the assigned cause of death established using a verbal autopsy interview. Advanced spatial-temporal clustering techniques (both regular (Kulldorff) and irregular (FleXScan)) will be used to identify mortality ‘hotspots’. Various advanced statistical modelling approaches will be tested and used to identify significant risk factors for child and maternal mortality. Differences in attributability and risk factors profiles in identified ‘hotspots’ will be assessed to enable tailored intervention guidance/development. This multicomponent study will enable a refined intervention model to be developed for typical rural populations with a high HIV burden. Ethics Ethical approval was received from the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BE 169/15). PMID:27421296

  11. “Without a mother”: caregivers and community members’ views about the impacts of maternal mortality on families in KwaZulu-Natal, South Africa

    PubMed Central

    2015-01-01

    Background Maternal mortality in South Africa is high and a cause for concern especially because the bulk of deaths from maternal causes are preventable. One of the proposed reasons for persistently high maternal mortality is HIV which causes death both indirectly and directly. While there is some evidence for the impact of maternal death on children and families in South Africa, few studies have explored the impacts of maternal mortality on the well-being of the surviving infants, older children and family. This study provides qualitative insight into the consequences of maternal mortality for child and family well-being throughout the life-course. Methods This qualitative study was conducted in rural and peri-urban communities in Vulindlela, KwaZulu-Natal. The sample included 22 families directly affected by maternal mortality, 15 community stakeholders and 7 community focus group discussions. These provided unique and diverse perspectives about the causes, experiences and impacts of maternal mortality. Results and discussion Children left behind were primarily cared for by female family members, even where a father was alive and involved. The financial burden for care and children’s basic needs were largely met through government grants (direct and indirectly targeted at children) and/or through an obligation for the father or his family to assist. The repercussions of losing a mother were felt more by older children for whom it was harder for caregivers to provide educational supervision and emotional or psychological support. Respondents expressed concerns about adolescent’s educational attainment, general behaviour and particularly girl’s sexual risk. Conclusion These results illuminate the high costs to surviving children and their families of failing to reduce maternal mortality in South Africa. Ensuring social protection and community support is important for remaining children and families. Additional qualitative evidence is needed to explore

  12. Antenatal Care as a Means of Increasing Birth in the Health Facility and Reducing Maternal Mortality: A Systematic Review

    PubMed Central

    Berhan, Yifru; Berhan, Asres

    2014-01-01

    Background Although there is a general agreement on the importance of antenatal care to improve the maternal and perinatal health, little is known about its importance to improve health facility delivery in developing countries. The objective of this study was to assess the association of antenatal care with birth in health facility. Methods A systematic review with meta-analysis of Mantel-Haenszel odds ratios was conducted by including seventeen small scale studies that compared antenatal care and health facility delivery between 2003 and 2013. Additionally, national survey data of African countries which included antenatal care, health facility delivery and maternal mortality in their report were included. Data were accessed via a computer based search from MEDLINE, African Journals Online, HINARI and Google Scholar databases. Results The regression analysis of antenatal care with health facility delivery revealed a positive correlation. The pooled analysis also demonstrated that woman attending antenatal care had more than 7 times increased chance of delivering in a health facility. The comparative descriptive analysis, however, demonstrated a big gap between the proportion of antenatal care and health facility delivery by the same individuals (27%–95% vs 4%–45%). Antenatal care and health facility delivery had negative correlation with maternal mortality. Conclusion The present regression and meta-analysis has identified the relative advantage of having antenatal care to give birth in health facilities. However, the majority of women who had antenatal care did not show up to a health facility for delivery. Therefore, future research needs to give emphasis to identifying barriers to health facility delivery despite having antenatal care follow up. PMID:25489186

  13. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study

    PubMed Central

    Nandi, Arijit; Hajizadeh, Mohammad; Harper, Sam; Koski, Alissa; Strumpf, Erin C.; Heymann, Jody

    2016-01-01

    Background Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. Methods and Findings We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y), neonatal (<28 d), and post-neonatal (between 28 d and 1 y after birth) mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. Conclusions More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015

  14. Maternal distress influences young children's family representations through maternal view of child behavior and parent-child interactions.

    PubMed

    Yoo, Yeon Soo; Popp, Jill; Robinson, JoAnn

    2014-02-01

    Distress of a parent is a key influence on the quality of the child's experience in the family. We hypothesized that maternal distress would spill over into more negative views of their children's behaviors and less emotional availability in their relationships. Further, we investigated whether these cumulative experiences contributed to children's emerging narratives about mothers and family life. In this longitudinal study, mothers of young twin children reported their distress on three occasions in relation to: self, the marital relationship, and the family climate. Mothers also reported on their children's externalizing behavior problems. Mother-child interaction was observed focusing on maternal sensitivity and child responsivity. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for family conflict and cohesion themes. Actor-partner interdependence model methods of dyadic data analysis accounted for the inclusion of both twins in the analysis. Results from structural equation models supported the hypothesized cumulative experience of maternal distress on children's family life representations for both family conflict and family cohesion. A family environment in which children are exposed to persistent maternal distress early in life may have cumulative effects, influencing how mothers interact with and view their children's behavior at later developmental stages. Moreover, exposure to repeated distress for longer periods of time may contribute to an intergenerational continuity of distress for the child that may become rooted in negative affective bias in their own view of family relationships.

  15. Maternal Distress Influences Young Children's Family Representations Through Maternal View of Child Behavior and Parent-Child Interactions

    PubMed Central

    Yoo, Yeon Soo; Popp, Jill; Robinson, JoAnn

    2014-01-01

    Objective Distress of a parent is a key influence on the quality of the child's experience in the family. We hypothesized that maternal distress would spill over into more negative views of their children's behaviors and less emotional availability in their relationships. Further, we investigated whether these cumulative experiences contributed to children's emerging narratives about mothers and family life. Method In this longitudinal study, mothers of young twin children reported their distress on three occasions in relation to: self, the marital relationship, and the family climate. Mothers also reported on their children's externalizing behavior problems. Mother-child interaction was observed focusing on maternal sensitivity and child responsivity. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for family conflict and cohesion themes. APIM methods of dyadic data analysis accounted for the inclusion of both twins in the analysis. Results Results from structural equation models supported the hypothesized cumulative experience of maternal distress on children's family life representations for both family conflict and family cohesion. Conclusion A family environment in which children are exposed to persistent maternal distress early in life may have cumulative effects, influencing how mothers interact with and view their children's behavior at later developmental stages. Moreover, exposure to repeated distress for longer periods of time may contribute to an intergenerational continuity of distress for the child that may become rooted in negative affective bias in their own view of family relationships. PMID:23568672

  16. A longitudinal investigation of maternal influences on the development of child hostile attributions and aggression.

    PubMed

    Healy, Sarah J; Murray, Lynne; Cooper, Peter J; Hughes, Claire; Halligan, Sarah L

    2015-01-01

    Aggression in children is associated with an enhanced tendency to attribute hostile intentions to others. However, limited information is available regarding the factors that contribute to the development of such hostile attribution tendencies. We examined factors that contribute to individual differences in child hostile attributions and aggression, focusing on potential pathways from maternal hostile attributions via negative parenting behavior. We conducted a longitudinal study of 98 mothers and children (47 male, 51 female), recruited from groups experiencing high and low levels of psychosocial adversity. Maternal hostile attributions, observed parenting, and child behaviour were assessed at 18 months and 5 years child age, and child hostile attributions were also examined at 5 years. Independent assessments of maternal and child processes were utilized where possible. Analyses provided support for a direct influence of maternal hostile attributions on the development of child hostile attributions and aggressive behaviour. Maternal hostile attributions were also associated with negative parenting behaviour, which in turn influenced child adjustment. Even taking account of possible parenting influences and preexisting child difficulties, hostile attributions in the mother showed a direct link with child aggression at 5 years. Maternal hostile attributions were themselves related to psychosocial adversity. We conclude that maternal hostile attributions are prevalent in high-risk samples and are related to less optimal parenting behaviour, child hostile attributions, and child aggression. Targeting hostile maternal cognitions may be a useful adjunct to parenting programs.

  17. Effects of Maternal Cervical Incompetence on Morbidity and Mortality of Preterm Neonates with Birth weight Less than 2000g

    PubMed Central

    Hua, Wang; Wei, Zhang; Ling, Fan; Song, Yu; Jian-Rong, Ma; Ping, Wang

    2014-01-01

    Objective: This study aimed to determine the impact of maternal cervical incompetence (with or without McDonald cerclage) on mortality and morbidity of preterm infant with birth weight <2000g. Methods: 581 neonates were eligible for this study, 79 with cervical incompetence and 502 without it (control). Incidences of neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), severe asphyxia, small for gestational age (SGA), early-onset sepsis (EOS), and mortality were compared between the two groups. Findings: Mean gestational age was earlier in cervical incompetence group than in control (30.2±2.1 vs 30.7±1.9, P<0.05). Except lower frequency of SGA, there were no significant differences in the incidences of RDS, BPD, ROP, PVL, IVH, NEC, EOS, severe asphyxia and mortality between the two groups. Infants with no cerclage had a higher prevalence of RDS (21/66 vs 9/13, P<0.05) compared to cerclage group due to lower mean gestational age (30.68±2.1 vs 28.6±1.4, P<0.01) and birth weight (1519.5±274.6 vs 1205.8±204.4, P<0.001), and clinical neonatal outcomes of the elective cerclage were similar to emergency cerclage in cervical incompetence groups. Conclusion: Maternal cervical incompetence was not associated with postnatal adverse neonatal outcomes. Lower mean gestational age was a major risk associated with higher prevalence of RDS in preterm neonates with no McDonald cerclage, and emergency cerclage did not predict poor clinical neonatal outcomes. PMID:26019783

  18. Maternal bereavement: the heightened mortality of mothers after the death of a child.

    PubMed

    Espinosa, Javier; Evans, William N

    2013-07-01

    Using a 9-year follow-up of 69,224 mothers aged 20-50 from the National Longitudinal Mortality Survey, we investigate whether there is heightened mortality of mothers after the death of a child. Results from Cox proportional hazard models indicate that the death of a child produces a statistically significant hazard ratio of 2.3. There is suggestive evidence that the heightened mortality is concentrated in the first two years after the death of a child. We find no difference in results based on mother's education or marital status, family size, the child's cause of death or the gender of the child.

  19. FIMR and other mortality reviews as public health tools for strengthening maternal and child health systems in communities: where do we need to go next?

    PubMed

    Hutchins, Ellen; Grason, Holly; Handler, Arden

    2004-12-01

    This article examines FIMR in relationship to two other maternal and child health mortality reviews--child fatality review (CFR) and maternal mortality review (MMR), and explores how their approaches to reviewing deaths can complement one another. Identifying opportunities for collaboration among these case review methodologies may lead to greater efficiencies at the local and state levels and strengthen the case review approach as a public health tool for improving maternal and child health outcomes. To enable comparative analysis, a table was constructed that identifies the purpose, structure, and process features of each case review approach. This was followed by an examination of two possible ways to improve maternal and child mortality review processes in states: 1) better coordination; and 2) improving each individual process through adapting and adopting promising practices from the others. A discussion is also provided of the state Title V role in facilitating both the coordination of reviews and the process of sharing best practices. Given the similarities that exist among the three MCH mortality reviews, it is important to view each review as one component of a larger system of maternal and child health death reviews. Implementing widely the recommendations generated by these reviews may increase the likelihood of improvements in services and systems on behalf of women and children. PMID:15623148

  20. Maternal reading skills and child mortality in Nigeria: a reassessment of why education matters.

    PubMed

    Smith-Greenaway, Emily

    2013-10-01

    Mother's formal schooling-even at the primary level-is associated with lower risk of child mortality, although the reasons why remain unclear. This study examines whether mother's reading skills help to explain the association in Nigeria. Using data from the Demographic and Health Survey, the analysis demonstrates that women's reading skills increase linearly with years of primary school; however, many women with several years of formal school are unable to read at all. The results further show that mother's reading skills help to explain the relationship between mother's formal schooling and child mortality, and that mother's reading skills are highly associated with child mortality. The study highlights the need for more data on literacy and for more research on whether and how mother's reading skills lower child mortality in other contexts.

  1. Social autopsy of neonatal mortality suggests needed improvements in maternal and neonatal interventions in Balaka and Salima districts of Malawi

    PubMed Central

    Koffi, Alain K.; Mleme, Tiope; Nsona, Humphreys; Banda, Benjamin; Amouzou, Agbessi; Kalter, Henry D.

    2015-01-01

    Background The Every Newborn Action Plan calls for reducing the neonatal mortality rates to fewer than 10 deaths per 1000 live births in all countries by 2035. The current study aims to increase our understanding of the social and modifiable factors that can be addressed or reinforced to improve and accelerate the decline in neonatal mortality in Malawi. Methods The data come from the 2013 Verbal and Social Autopsy (VASA) study that collected data in order to describe the biological causes and the social determinants of deaths of children under 5 years of age in Balaka and Salima districts of Malawi. This paper analyses the social autopsy data of the neonatal deaths and presents results of a review of the coverage of key interventions along the continuum of normal maternal and newborn care and the description of breakdowns in the care provided for neonatal illnesses within the Pathway to Survival framework. Results A total of 320 neonatal deaths were confirmed from the VASA survey. While one antenatal care (ANC) visit was high at 94%, the recommended four ANC visits was much lower at 41% and just 17% of the mothers had their urines tested during the pregnancy. 173 (54%) mothers of the deceased newborns had at least one labor/delivery complication that began at home. The caregivers of 65% (n = 75) of the 180 newborns that were born at home or born and left a health facility alive perceived them to be severely ill at the onset of their illness, yet only 44% (n = 80) attempted and 36% (n = 65)could reach the first health provider after an average of 91 minutes travel time. Distance, lack of transport and cost emerged as the most important constraints to formal care–seeking during delivery and during the newborn fatal illness. Conclusions This study suggests that maternal and neonatal health organizations and the local government of Malawi should increase the demand for key maternal and child health interventions, including the recommended 4 ANC visits

  2. Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

    PubMed Central

    2013-01-01

    Background A number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality. Methods We used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births. Results Our results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied. Conclusions This study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth. PMID:24564721

  3. Long-term maternal morbidity and mortality associated with ischemic placental disease.

    PubMed

    Adams, Tracy; Yeh, Corinne; Bennett-Kunzier, Nadia; Kinzler, Wendy L

    2014-04-01

    Ischemic placental disease can have long-term maternal health implications. In this article, we discuss the three conditions of ischemic placental disease (preeclampsia, fetal growth restriction, and abruption placenta) and its associated long-term maternal morbidity. Retrospective observational studies comparing pregnancies complicated by ischemic placental disease to uncomplicated pregnancies suggest an increased long-term risk of hypertension, cardiovascular death, metabolic syndrome, and cerebrovascular disease. This association is much stronger in women who had an indicated-preterm delivery due to ischemic placental disease. It is important to adequately counsel women who are diagnosed with these conditions about their future health risks. Increased awareness of the potential health risks and multidisciplinary collaboration remains paramount to instituting the appropriate screening and preventative strategies (i.e., behavior modification) for affected women.

  4. Infant Mortality

    MedlinePlus

    ... Infant Mortality Infant Mortality: What is CDC Doing? Sudden Infant Death Syndrome Teen Pregnancy Contraception CDC Contraceptive Guidance for ... and low birth weight Maternal complications of pregnancy Sudden Infant Death Syndrome (SIDS) Injuries (e.g., suffocation). The top ...

  5. Maternal body condition influences magnitude of anti-predator response in offspring.

    PubMed

    Bennett, Amanda M; Murray, Dennis L

    2014-11-01

    Organisms exhibit plasticity in response to their environment, but there is large variation even within populations in the expression and magnitude of response. Maternal influence alters offspring survival through size advantages in growth and development. However, the relationship between maternal influence and variation in plasticity in response to predation risk is unknown. We hypothesized that variation in the magnitude of plastic responses between families is at least partly due to maternal provisioning and examined the relationship between maternal condition, egg provisioning and magnitude of plastic response to perceived predation risk (by dragonfly larvae: Aeshna spp.) in northern leopard frogs (Lithobates pipiens). Females in better body condition tended to lay more (clutch size) larger (egg diameter) eggs. Tadpoles responded to predation risk by increasing relative tail depth (morphology) and decreasing activity (behaviour). We found a positive relationship between morphological effect size and maternal condition, but no relationship between behavioural effect size and maternal condition. These novel findings suggest that limitations imposed by maternal condition can constrain phenotypic variation, ultimately influencing the capacity of populations to respond to environmental change. PMID:25253460

  6. Maternal body condition influences magnitude of anti-predator response in offspring

    PubMed Central

    Bennett, Amanda M.; Murray, Dennis L.

    2014-01-01

    Organisms exhibit plasticity in response to their environment, but there is large variation even within populations in the expression and magnitude of response. Maternal influence alters offspring survival through size advantages in growth and development. However, the relationship between maternal influence and variation in plasticity in response to predation risk is unknown. We hypothesized that variation in the magnitude of plastic responses between families is at least partly due to maternal provisioning and examined the relationship between maternal condition, egg provisioning and magnitude of plastic response to perceived predation risk (by dragonfly larvae: Aeshna spp.) in northern leopard frogs (Lithobates pipiens). Females in better body condition tended to lay more (clutch size) larger (egg diameter) eggs. Tadpoles responded to predation risk by increasing relative tail depth (morphology) and decreasing activity (behaviour). We found a positive relationship between morphological effect size and maternal condition, but no relationship between behavioural effect size and maternal condition. These novel findings suggest that limitations imposed by maternal condition can constrain phenotypic variation, ultimately influencing the capacity of populations to respond to environmental change. PMID:25253460

  7. Maternal nutrition, health, and survival.

    PubMed

    Christian, Parul

    2002-05-01

    The burden of maternal morbidity and mortality in developing countries is high. Each year, 600,000 women die from pregnancy-related causes and 62 million women suffer from morbidity and complications of pregnancy. The extent to which maternal nutrition can improve maternal health and survival is not well understood. Excluding deaths due to induced abortions, the other four main causes of maternal mortality (preeclampsia, hemorrhage, obstructed labor, and infection) may be amenable to nutrition interventions. The role of calcium in reducing the incidence of preeclampsia and hypertension is promising, but more research in deficient populations is urgently needed. Antenatal iron supplementation, although frequently recommended to prevent anemia during pregnancy, has had little program success. Severe anemia may be an important cause of maternal mortality, but convincing evidence is lacking on the health consequences of mild-to-moderate maternal anemia. Knowledge of the etiology of anemia is important in identifying effective strategies for combating it. Other vitamins such as folate, B12, and vitamin A may enhance the effect of iron supplementation in populations where multiple nutrition deficiencies exist. Maternal night blindness is widespread in South Asian women. In Nepal, this condition is associated with markedly increased risks of vitamin A deficiency, anemia, morbidity, and maternal and infant mortality. These findings need to be replicated elsewhere in South Asia. One study has shown vitamin A and beta carotene supplementation to reduce maternal mortality and morbidity. These findings need testing in different settings with emphasis on investigating the mechanisms of the effect. The area of prepregnancy nutrition and its influence on prolonged and obstructed labor is wide open for investigation. The scope for research in the area of maternal nutrition and health is large and the onus is on nutritionists to bring to the forefront the role of nutrition in

  8. Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

    PubMed Central

    Chola, Lumbwe; McGee, Shelley; Tugendhaft, Aviva; Buchmann, Eckhart; Hofman, Karen

    2015-01-01

    Introduction Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa. Methods The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030. Results If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers. Conclusion Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception. PMID:26076482

  9. Fitness drivers in the threatened Dianthus guliae Janka (Caryophyllaceae): disentangling effects of growth context, maternal influence and inbreeding depression.

    PubMed

    Gargano, D; Gullo, T; Bernardo, L

    2011-01-01

    We studied inbreeding depression, growth context and maternal influence as constraints to fitness in the self-compatible, protandrous Dianthus guliae Janka, a threatened Italian endemic. We performed hand-pollinations to verify outcomes of self- and cross-fertilisation over two generations, and grew inbred and outbred D. guliae offspring under different conditions - in pots, a common garden and field conditions (with/without nutrient addition). The environment influenced juvenile growth and flowering likelihood/rate, but had little effect on inbreeding depression. Significant interactions among genetic and environmental factors influenced female fertility. Overall, genetic factors strongly affected both early (seed mass, seed germination, early survival) and late (seed/ovule ratio) life-history traits. After the first pollination experiment, we detected higher mortality in the selfed progeny, which is possibly a consequence of inbreeding depression caused by over-expression of early-acting deleterious alleles. The second pollination induced a strong loss of reproductive fitness (seed production, seed mass) in inbred D. guliae offspring, regardless of the pollination treatment (selfing/crossing); hence, a strong (genetic) maternal influence constrained early life-history traits of the second generation. Based on current knowledge, we conclude that self-compatibility does not prevent the detrimental effects of inbreeding in D. guliae populations, and may increase the severe extinction risk if out-crossing rates decrease.

  10. Influence of the support offered to breastfeeding by maternity hospitals

    PubMed Central

    Passanha, Adriana; Benício, Maria Helena D’Aquino; Venâncio, Sônia Isoyama; dos Reis, Márcia Cristina Guerreiro

    2015-01-01

    ABSTRACT OBJECTIVE To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals. PMID:26759966

  11. A global social contract to reduce maternal mortality: the human rights arguments and the case of Uganda.

    PubMed

    Ooms, Gorik; Mulumba, Moses; Hammonds, Rachel; Latif Laila, Abdul; Waris, Attiya; Forman, Lisa

    2013-11-01

    Progress towards Millennium Development Goal 5a, reducing maternal deaths by 75% between 1990 and 2015, has been substantial; however, it has been too slow to hope for its achievement by 2015, particularly in sub-Saharan Africa, including Uganda. This suggests that both the Government of Uganda and the international community are failing to comply with their right-to-health-related obligations towards the people of Uganda. This country case study explores some of the key issues raised when assessing national and international right-to-health-related obligations. We argue that to comply with their shared obligations, national and international actors will have to take steps to move forward together. The Government of Uganda should not expect additional international assistance if it does not live up to its own obligations; at the same time, the international community must provide assistance that is more reliable in the long run to create the 'fiscal space' that the Government of Uganda needs to increase recurrent expenditure for health - which is crucial to addressing maternal mortality. We propose that the 'Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa', adopted by the African Union in July 2012, should be seen as an invitation to the international community to conclude a global social contract for health.

  12. Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens

    PubMed Central

    Jat, Tej Ram; Deo, Prakash R.; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel

    2015-01-01

    Background Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery–related dimensions of maternal deaths in rural central India using a human rights lens. Design Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the ‘three delays’ framework and were examined by using a human rights lens. Results All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. Conclusions The study highlighted various socio-cultural and service delivery–related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their

  13. Does Maternal Employment Influence Poor Children's Social Development?

    ERIC Educational Resources Information Center

    Fuller, Bruce; Caspary, Gretchen; Kagan, Sharon Lynn; Gauthier, Christiane; Hnang, Danny Shih-Cheng; Carroll, Judith; McCarthy, Jan

    2002-01-01

    This study examined the relation between young children's social development and maternal employment among women who entered welfare-to-work programs. Structural equation models provided evidence that indicators of economic security, such as food security and job quality indicators, but not recent employment per se, operated through parenting…

  14. Maternal Adiposity Negatively Influences Infant Brain White Matter Development

    PubMed Central

    Ou, Xiawei; Thakali, Keshari M.; Shankar, Kartik; Andres, Aline; Badger, Thomas M.

    2015-01-01

    Objective To study potential effects of maternal body composition on central nervous system (CNS) development of newborn infants. Methods Diffusion tensor imaging (DTI) was used to evaluate brain white matter development in 2 week old, full-term, appropriate for gestational age (AGA) infants from uncomplicated pregnancies of normal-weight (BMI<25 at conception) or obese (BMI ≥30 at conception) and otherwise healthy mothers. Tract-based spatial statistics (TBSS) analyses were used for voxel-wise group comparison of fractional anisotropy (FA), a sensitive measure of white matter integrity. DNA methylation analyses of umbilical cord tissue focused on genes known to be important in CNS development were also performed. Results Newborns from obese women had significantly lower FA values in multiple white matter regions than those born of normal-weight mothers. Global and regional FA values negatively correlated (P<0.05) with maternal fat mass percentage. Linear regression analysis followed by gene ontology enrichment showed that methylation status of 68 CpG sites representing 57 genes with GO terms related to CNS development was significantly associated with maternal adiposity status. Conclusions These results suggest a negative association between maternal adiposity and white matter development in offspring. PMID:25919924

  15. Maternal Stress and Affect Influence Fetal Neurobehavioral Development.

    ERIC Educational Resources Information Center

    DiPietro, Janet A.; Hilton, Sterling C.; Hawkins, Melissa; Costigan, Kathleen A.; Pressman, Eva K.

    2002-01-01

    Investigated associations between maternal psychological and fetal neurobehavioral functioning with data provided at 24, 30, and 36 weeks gestation. Found that fetuses of women who were more affectively intense, appraised their lives as more stressful, and reported more pregnancy-specific hassles were more active across gestation. Fetuses of women…

  16. Maternal Influences on Youth Responses to Peer Stress

    ERIC Educational Resources Information Center

    Abaied, Jamie L.; Rudolph, Karen D.

    2011-01-01

    Understanding how youths develop particular styles of responding to stress is critical for promoting effective coping. This research examined the prospective, interactive contribution of maternal socialization of coping and peer stress to youth responses to peer stress. A sample of 144 early adolescents (mean age = 12.44 years, SD = 1.22) and…

  17. The Influence of Perception on Maternal Sensitivity in Foster Care

    ERIC Educational Resources Information Center

    Ponciano, Leslie

    2012-01-01

    This study examined the association between perceptions of children's care needs and maternal sensitivity with 76 dyads in foster care. Foster mothers were more sensitive to typically developing children perceived as requiring easier care and were less sensitive to children with developmental delays. Adopting foster mothers were sensitive with…

  18. Maternal adiposity negatively influences infant brain white matter development

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objective: To study potential effects of maternal body composition on central nervous system (CNS) development of newborn infants. Methods: Diffusion tensor imaging was used to evaluate brain white matter development in 2-week-old, full-term, appropriate for gestational age infants from uncomplicat...

  19. Maternal pre-gravid body mass index and adiposity influence umbilical cord gene expression at term in AGA infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    While maternal obesity is associated with unfavorable maternal and fetal outcomes, the influence of maternal obesity on fetal gene expression is less clear. Umbilical cords (UC) from 12 lean (pre-gravid BMI < 25) and 10 overweight/obese (OB, pre-gravid BMI =25) women without gestational diabetes wer...

  20. Availability and quality of emergency obstetric care, an alternative strategy to reduce maternal mortality: experience of Tongji Hospital, Wuhan, China.

    PubMed

    Bangoura, Ismael Fatou; Hu, Jian; Gong, Xun; Wang, Xuanxuan; Wei, Jingjing; Zhang, Wenbin; Zhang, Xiang; Fang, Pengqian

    2012-04-01

    The burden of maternal mortality (MM) and morbidity is especially high in Asia. However, China has made significant progress in reducing MM over the past two decades, and hence maternal death rate has declined considerably in last decade. To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital, Wuhan, China, this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009. Two baseline periods of equal length were used for the comparison of variables. A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations, either 71.35% of all activities. No maternal death was recorded. Mean age of women was 29.31 years with a wide range of 14-52 years. About 96.26% of women had higher levels of schooling, university degrees and above and received the education of secondary school or college. About 3.74% received primary education at period two (P2) from 2005 to 2009, which was significantly higher than that of period one (P1) from 2000 to 2004 (P<0.05) (OR: 0.586; 95% CI: 0.442 to 0.776). About 65.69% were employed as skilled or professional workers at P2, which was significantly higher than that of P1 (P<0.05). About 34.31% were unskilled workers at P2, which was significantly higher than that of P1 (P<0.05). Caesarean section was performed for 9,930 women (88.48%) and the percentage of the procedure increased significantly from 19.25% at P1 to 69.23% at P2 (P<0.05). We were led to conclude that, despite the progress, significant gaps in the performance of maternal health services between rural and urban areas remain. However, MM reduction can be achieved in China. Priorities must include, but not limited to the following: secondary healthcare development, health policy and management, strengthening primary healthcare services. PMID:22528213

  1. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

    PubMed Central

    Saggurti, Niranjan; Winter, Michael; Labonte, Alan; Decker, Michele R; Balaiah, Donta; Silverman, Jay G

    2010-01-01

    Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers). Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg). Results The majority of births (73%; 13 042/19 302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India. PMID:20093277

  2. Do embryos influence maternal investment? Evaluating maternal-fetal coadaptation and the potential for parent-offspring conflict in a placental fish.

    PubMed

    Schrader, Matthew; Travis, Joseph

    2009-11-01

    The evolution of matrotrophy introduces the potential for genomic conflicts between mothers and embryos. These conflicts are hypothesized to accelerate the evolution of reproductive isolation and to influence the evolution of life-history traits, reproductive structures, and genomic imprinting. These hypotheses assume offspring can influence the amount of maternal investment they receive and that there is a trade-off between maternal investment into individual offspring and maternal survival or fecundity. We used field data and laboratory crosses to test whether these assumptions are met in the matrotrophic poeciliid fish Heterandria formosa. Comparisons of life histories between two natural populations demonstrated a trade-off between the level of maternal investment into individual embryos and maternal fecundity. Laboratory crosses between individuals from these populations revealed that offspring genotype exerts an influence on the level of maternal investment and affects maternal fecundity through higher rates of embryo abortion and lower numbers of full-term offspring. Our results show that the prerequisites for parent-offspring conflict to be a potent evolutionary force in poeciliid fish are present in H. formosa. However, determining whether this conflict has shaped maternal investment in nature will require disentangling any effects of conflict from those of several ecological factors that are themselves correlated with the expected intensity of conflict.

  3. The National Rural Health Mission in India: its impact on maternal, neonatal, and infant mortality.

    PubMed

    Nagarajan, Shyama; Paul, Vinod K; Yadav, Namrata; Gupta, Shuchita

    2015-10-01

    The National Rural Health Mission (NRHM) has been a watershed in the history of India's health sector. As a previously unattempted investment, governance, and mobilization effort, the NRHM succeeded in injecting new energy into India's public health system. A huge expansion of infrastructure and human resources is the hallmark of the NRHM action. Demand-side initiatives led to enhanced utilization of public health facilities, especially for facility births. The impact is visible. The Mission has brought Millennium Development Goals 4 and 5 within India's grasp. Acceleration in infant and neonatal mortality reduction is especially notable. The NRHM has created conditions for the country to move toward universal health coverage. PMID:26385051

  4. Maternal influences on fetal microbial colonization and immune development.

    PubMed

    Romano-Keeler, Joann; Weitkamp, Jörn-Hendrik

    2015-01-01

    While critical for normal development, the exact timing of establishment of the intestinal microbiome is unknown. For example, although preterm labor and birth have been associated with bacterial colonization of the amniotic cavity and fetal membranes for many years, the prevailing dogma of a sterile intrauterine environment during normal term pregnancies has been challenged more recently. While found to be a key contributor of evolution in the animal kingdom, maternal transmission of commensal bacteria may also constitute a critical process during healthy pregnancies in humans with yet unclear developmental importance. Metagenomic sequencing has elucidated a rich placental microbiome in normal term pregnancies likely providing important metabolic and immune contributions to the growing fetus. Conversely, an altered microbial composition during pregnancy may produce aberrant metabolites impairing fetal brain development and life-long neurological outcomes. Here we review the current understanding of microbial colonization at the feto-maternal interface and explain how normal gut colonization drives a balanced neonatal mucosal immune system, while dysbiosis contributes to aberrant immune function early in life and beyond. We discuss how maternal genetics, diet, medications, and probiotics inform the fetal microbiome in preparation for perinatal and postnatal bacterial colonization.

  5. Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013

    PubMed Central

    Fritz, Jimena; Olvera, Marisela; Torres, Luis M.; Lozano, Rafael

    2016-01-01

    Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01). A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition. PMID:27310260

  6. Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013.

    PubMed

    Lamadrid-Figueroa, Hector; Montoya, Alejandra; Fritz, Jimena; Olvera, Marisela; Torres, Luis M; Lozano, Rafael

    2016-01-01

    Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01). A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition. PMID:27310260

  7. Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013.

    PubMed

    Lamadrid-Figueroa, Hector; Montoya, Alejandra; Fritz, Jimena; Olvera, Marisela; Torres, Luis M; Lozano, Rafael

    2016-01-01

    Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01). A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition.

  8. Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool.

    PubMed

    Jiang, Zhen; Guo, Su Fang; Scherpbier, Robert W; Wen, Chun Mei; Xu, Xiao Chao; Guo, Yan

    2015-08-01

    China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China. PMID:26383598

  9. Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool.

    PubMed

    Jiang, Zhen; Guo, Su Fang; Scherpbier, Robert W; Wen, Chun Mei; Xu, Xiao Chao; Guo, Yan

    2015-08-01

    China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.

  10. Diet-induced changes in maternal gut microbiota and metabolomic profiles influence programming of offspring obesity risk in rats.

    PubMed

    Paul, Heather A; Bomhof, Marc R; Vogel, Hans J; Reimer, Raylene A

    2016-01-01

    Maternal obesity and overnutrition during pregnancy and lactation can program an increased risk of obesity in offspring. In this context, improving maternal metabolism may help reduce the intergenerational transmission of obesity. Here we show that, in Sprague-Dawley rats, selectively altering obese maternal gut microbial composition with prebiotic treatment reduces maternal energy intake, decreases gestational weight gain, and prevents increased adiposity in dams and their offspring. Maternal serum metabolomics analysis, along with satiety hormone and gut microbiota analysis, identified maternal metabolic signatures that could be implicated in programming offspring obesity risk and highlighted the potential influence of maternal gut microbiota on maternal and offspring metabolism. In particular, the metabolomic signature of insulin resistance in obese rats normalized when dams consumed the prebiotic. In summary, prebiotic intake during pregnancy and lactation improves maternal metabolism in diet-induced obese rats in a manner that attenuates the detrimental nutritional programming of offspring associated with maternal obesity. Overall, these findings contribute to our understanding of the maternal mechanisms influencing the developmental programming of offspring obesity and provide compelling pre-clinical evidence for a potential strategy to improve maternal and offspring metabolic outcomes in human pregnancy.

  11. Diet-induced changes in maternal gut microbiota and metabolomic profiles influence programming of offspring obesity risk in rats

    PubMed Central

    Paul, Heather A.; Bomhof, Marc R.; Vogel, Hans J.; Reimer, Raylene A.

    2016-01-01

    Maternal obesity and overnutrition during pregnancy and lactation can program an increased risk of obesity in offspring. In this context, improving maternal metabolism may help reduce the intergenerational transmission of obesity. Here we show that, in Sprague-Dawley rats, selectively altering obese maternal gut microbial composition with prebiotic treatment reduces maternal energy intake, decreases gestational weight gain, and prevents increased adiposity in dams and their offspring. Maternal serum metabolomics analysis, along with satiety hormone and gut microbiota analysis, identified maternal metabolic signatures that could be implicated in programming offspring obesity risk and highlighted the potential influence of maternal gut microbiota on maternal and offspring metabolism. In particular, the metabolomic signature of insulin resistance in obese rats normalized when dams consumed the prebiotic. In summary, prebiotic intake during pregnancy and lactation improves maternal metabolism in diet-induced obese rats in a manner that attenuates the detrimental nutritional programming of offspring associated with maternal obesity. Overall, these findings contribute to our understanding of the maternal mechanisms influencing the developmental programming of offspring obesity and provide compelling pre-clinical evidence for a potential strategy to improve maternal and offspring metabolic outcomes in human pregnancy. PMID:26868870

  12. Maternal body size influences offspring immune configuration in an oviparous snake

    PubMed Central

    Brown, Gregory P.

    2016-01-01

    Like most ectothermic vertebrates, keelback snakes (Tropidonophis mairii) do not exhibit parental care. Thus, offspring must possess an immune system capable of dealing with challenges such as pathogens, without assistance from an attendant parent. We know very little about immune system characteristics of neonatal reptiles, including the magnitude of heritability and other maternal influences. To identify sources of variation in circulating white blood cell (WBC) concentrations and differentials, we examined blood smears from 246 hatchling snakes and their field-caught mothers. WBC concentrations were lower in hatchlings than in adults, and hatchlings had more basophils and fewer azurophils than adults. A hatchling keelback's WBC differential was also influenced by its sex and body size. Although hatchling WBC measures exhibited negligible heritability, they were strongly influenced by maternal body size and parasite infection (but not by maternal body condition, relative clutch mass or time in captivity). Larger mothers produced offspring with more azurophils and fewer lymphocytes. The mechanisms and consequences of WBC variation are currently unknown, but if these maternal effects enhance offspring fitness, the impact of maternal body size on reproductive success may be greater than expected simply from allometric increases in the numbers and sizes of progeny. PMID:27069670

  13. Maternal body size influences offspring immune configuration in an oviparous snake.

    PubMed

    Brown, Gregory P; Shine, Richard

    2016-03-01

    Like most ectothermic vertebrates, keelback snakes (Tropidonophis mairii) do not exhibit parental care. Thus, offspring must possess an immune system capable of dealing with challenges such as pathogens, without assistance from an attendant parent. We know very little about immune system characteristics of neonatal reptiles, including the magnitude of heritability and other maternal influences. To identify sources of variation in circulating white blood cell (WBC) concentrations and differentials, we examined blood smears from 246 hatchling snakes and their field-caught mothers. WBC concentrations were lower in hatchlings than in adults, and hatchlings had more basophils and fewer azurophils than adults. A hatchling keelback's WBC differential was also influenced by its sex and body size. Although hatchling WBC measures exhibited negligible heritability, they were strongly influenced by maternal body size and parasite infection (but not by maternal body condition, relative clutch mass or time in captivity). Larger mothers produced offspring with more azurophils and fewer lymphocytes. The mechanisms and consequences of WBC variation are currently unknown, but if these maternal effects enhance offspring fitness, the impact of maternal body size on reproductive success may be greater than expected simply from allometric increases in the numbers and sizes of progeny. PMID:27069670

  14. Is there a greater maternal than paternal influence on offspring adiposity in India?

    PubMed

    Corsi, Daniel J; Subramanian, S V; Ackerson, Leland K; Davey Smith, George

    2015-10-01

    Previous research has provided conflicting evidence regarding fetal roots of adiposity in India. To compare the strength of association between maternal and paternal body mass indexes (BMIs) corrected for height with offspring BMI in India to examine the potential for intrauterine mechanisms to influence offspring adiposity in India, we analysed a sample of 16,528 mother-father-offspring trios from the 2005 to 2006 Indian National Family Health Survey. Children were aged 0-59 months with parents aged 15-49 years (mothers) and 15-54 years (fathers). Linear and logistic regression models, specified in multiple ways, were used to estimate associations between parental BMI* (BMI redefined by power term x (kg/m(x)) to be independent from height), and child BMI/top decile of child BMI. Higher values of maternal BMI and paternal BMI were associated with higher values of offspring BMI. In comparing the effects of maternal BMI and paternal BMI, however, no consistent differences were found in the strength of these parental influences on offspring BMI. In the fully adjusted linear model, the standardised coefficient was 0.131 (95% CI 0.110 to 0.154) for maternal BMI* and 0.079 (95% CI 0.056 to 0.103) for paternal BMI*; with evidence of heterogeneity between maternal-offspring and paternal-offspring associations (p=0.005). This was not robust in the unstandardised regression (β=0.056, 95% CI 0.044 to 0.067 for maternal BMI and β=0.039, 95% CI 0.025 to 0.053 for paternal BMI, p=0.093). Mixed results indicate that compared with paternal BMI, maternal BMI did not have a consistently stronger influence on offspring BMI in India.

  15. Maternal and offspring pools of osteocalcin influence brain development and functions.

    PubMed

    Oury, Franck; Khrimian, Lori; Denny, Christine A; Gardin, Antoine; Chamouni, Alexandre; Goeden, Nick; Huang, Yung-yu; Lee, Hojoon; Srinivas, Prashanth; Gao, Xiao-Bing; Suyama, Shigetomo; Langer, Thomas; Mann, John J; Horvath, Tamas L; Bonnin, Alexandre; Karsenty, Gerard

    2013-09-26

    The powerful regulation of bone mass exerted by the brain suggests the existence of bone-derived signals modulating this regulation or other functions of the brain. We show here that the osteoblast-derived hormone osteocalcin crosses the blood-brain barrier, binds to neurons of the brainstem, midbrain, and hippocampus, enhances the synthesis of monoamine neurotransmitters, inhibits GABA synthesis, prevents anxiety and depression, and favors learning and memory independently of its metabolic functions. In addition to these postnatal functions, maternal osteocalcin crosses the placenta during pregnancy and prevents neuronal apoptosis before embryos synthesize this hormone. As a result, the severity of the neuroanatomical defects and learning and memory deficits of Osteocalcin(-/-) mice is determined by the maternal genotype, and delivering osteocalcin to pregnant Osteocalcin(-/-) mothers rescues these abnormalities in their Osteocalcin(-/-) progeny. This study reveals that the skeleton via osteocalcin influences cognition and contributes to the maternal influence on fetal brain development.

  16. Maternal genotype influences behavioral development of 3×Tg-AD mouse pups.

    PubMed

    Blaney, Caitlin E; Gunn, Rhian K; Stover, Kurt R; Brown, Richard E

    2013-09-01

    Transgenic mice are a valuable tool in the investigation of neurodegenerative disorders such as Alzheimer's disease. The triple transgenic mouse (3×Tg-AD) is a model of Alzheimer's disease that possesses age-related amyloid beta plaques, neurofibrillary tangles and cell death as well as cognitive decline. Because maternal effects may interact with pup genotype in determining behavior phenotypes, we used a cross-fostering paradigm to investigate the effects of maternal genotype on behavioral development of the 3×Tg-AD mouse model and its wildtype control (B6129S1F2) from 2 to 24 days of age. Developmental patterns of behavior were influenced by both pup and maternal genotype. The 3×Tg-AD mice were delayed in sensory reflexes, showed less activity and poorer habituation to a novel object, but showed advanced development of motor reflexes compared to wildtype pups. While there were no differences in levels of maternal care between transgenic and control mothers, maternal genotype affected the development of several pup reflexes (body weight, hindlimb grasp reflex, loss of crossed extensor reflex, vibrissae response, righting reflex) and the number of horizontal and vertical beam breaks in an open field. This study is the first to examine neurobehavioral development and maternal behavior in a mouse model of Alzheimer's disease, and highlights the importance of investigating the consequences of early environmental experience as well as genetic manipulation on behavioral development. PMID:23711927

  17. Factors influencing estimation of pesticide-related wildlife mortality

    USGS Publications Warehouse

    Vyas, N.B.

    1999-01-01

    Free-ranging wildlife is regularly exposed to pesticides and can serve as a sentinel for human and environmental health. Therefore a comprehensive pesticide hazard assessment must incorporate the effects of actual applications on free-ranging wildlife. Mortality is the most readily reported wildlife effect, and the significance of these data can be realized only when placed in context with the factors that affect the gathering of this type of information. This paper reviews the variables that affect the collection of wildlife mortality data. Data show that most effects on wildlife are not observed, and much of observed mortality is not reported. Delays in reporting or in the response to a report and exposure to multiple stressors distort the exposure-effect relationship and can result in uncertainty in determining the cause of death. The synthesis of information strongly indicates that the actual number of affected animals exceeds the number recovered

  18. Comparing local perspectives on women’s health with statistics on maternal mortality: an ethnobotanical study in Bénin and Gabon

    PubMed Central

    2014-01-01

    Background According to the World Health Organization (WHO), reproductive health problems are the leading cause of morbidity and mortality for women in Africa. In spite of this scenario and the importance of plants in African health care, limited research has been conducted linking maternal health and plant-based medicine. The objective of our research was to examine how closely Beninese and Gabonese women’s health perspectives, medicinal plant knowledge, and plant use practices reflect the statistical causes of maternal mortality. Methods In Bénin (2011) and Gabon (2012), we conducted 87 ethnobotanical questionnaires with the corresponding collection of 800 botanical specimens. We used free-listing analysis, citation frequency and species counts to determine women’s top health concerns. We also interviewed 18 biomedical healthcare providers in national hospitals and local clinics. Results Informants’ perceptions of the main causes of maternal suffering included malaria, infertility, and menstruation and pregnancy concerns. Women were knowledgeable on plants to treat the top causes of maternal morbidity, but knew more plants for conditions such as anemia, infertility, breast milk production, and the maintenance of menstruation and pregnancy. The biomedical staff recognized the role of traditional medicine in their patients’ lives and expressed concern for herbal remedies to facilitate birth, but were restricted by national policies on advising on medicinal plant use. Conclusions Plants serve as an entry point to understanding Beninese and Gabonese women’s perceptions of common health concerns and local health management strategies. Plant use practices in both countries did not closely parallel the top statistical causes of maternal mortality, but highlighted key issues such as menstruation and infertility as salient health concerns for women. More research is needed on the role of plants in women's gynecological healthcare. PMID:24679004

  19. Unsafe abortion as a birth control method: maternal mortality risks among unmarried cambodian migrant women on the Thai-Cambodia border.

    PubMed

    Hegde, Shalika; Hoban, Elizabeth; Nevill, Annemarie

    2012-11-01

    Reproductive health research and policies in Cambodia focus on safe motherhood programs particularly for married women, ignoring comprehensive fertility regulation programs for unmarried migrant women of reproductive age. Maternal mortality risks arising due to unsafe abortion methods practiced by unmarried Cambodian women, across the Thai-Cambodia border, can be considered as a public health emergency. Since Thailand has restrictive abortion laws, Cambodian migrant women who have irregular migration status in Thailand experimented with unsafe abortion methods that allowed them to terminate their pregnancies surreptitiously. Unmarried migrant women choose abortion as a preferred birth control method seeking repeat "unsafe" abortions instead of preventing conception. Drawing on the data collected through surveys, in-depth interviews, and document analysis in Chup Commune (pseudonym), Phnom Penh, and Bangkok, the authors describe the public health dimensions of maternal mortality risks faced by unmarried Cambodian migrant women due to various unsafe abortion methods employed as birth control methods.

  20. Could introducing vacuum delivery into the education curriculum of community midwives in Yemen improve maternal and neonatal mortality and morbidity outcomes?

    PubMed

    Kizler, Rose; Hollins Martin, Caroline J

    2013-03-01

    At present in Yemen the neonatal mortality rate stands at 12%. A contributing factor is that when abnormalities arise during labour in rural areas, there is an absence of trained medical staff to manage complications. Consequently, childbearing women are expected to travel long distances to hospitals to receive Essential Obstetric Care (EOC). This paper presents a debate over whether vacuum delivery should be introduced into the education curriculum of community midwifery courses in Yemen. It is proposed that this fundamental change to both the educational system and the community midwives role could facilitate a reduction in maternal and neonatal mortality and morbidity figures in Yemen.

  1. The Influence of Interactive Context on Prelinguistic Vocalizations and Maternal Responses

    ERIC Educational Resources Information Center

    Gros-Louis, Julie; West, Meredith J.; King, Andrew P.

    2016-01-01

    Many studies have documented influences of maternal responsiveness on cognitive and language development. Given the bidirectionality of interactions in caregiver-infant dyads, it is important to understand how infant behavior elicits variable responses. Prior studies have shown that mothers respond differentially to features of prelinguistic…

  2. Current Life Concerns of Early Adolescents and Their Mothers: Influence of Maternal HIV.

    ERIC Educational Resources Information Center

    Brackis-Cott, Elizabeth; Mellins, Claude Ann; Block, Megan

    2003-01-01

    This study examined influences of maternal HIV on concerns among inner-city minority families. Findings indicated that beyond concerns reported by early adolescent children of HIV-negative mothers, concerns of children of HIV-positive mothers included mothers' sickness and death, adult responsibilities, and uncertainty about their futures.…

  3. Influence of Maternal Work Patterns and Socioeconomic Status on Gen Y Lifestyle Choice

    ERIC Educational Resources Information Center

    Bosco, Susan M.; Bianco, Candy A.

    2005-01-01

    This article examines the lifestyle balance between career and family desired by the next generation of workers and whether these desires have been influenced by socioeconomic variables and maternal work patterns. The individuals who will enter the workforce in the next several years are the first generation in which most mothers worked outside…

  4. Association between coverage of maternal and child health interventions, and under-5 mortality: a repeated cross-sectional analysis of 35 sub-Saharan African countries

    PubMed Central

    Corsi, Daniel J.; Subramanian, S. V.

    2014-01-01

    Background Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this paper, we investigate the role of coverage of maternal and child health (MNCH) interventions in contributing to declines in child mortality in sub-Saharan Africa. Design Data are from 81 Demographic and Health Surveys from 35 sub-Saharan African countries. Using ecological time-series and child-level regression models, we estimated the effect of MNCH interventions (summarized by the percent composite coverage index, or CCI) on child mortality with in the first 5 years of life net of temporal trends and covariates at the household, maternal, and child levels. Results At the ecologic level, a unit increase in standardized CCI was associated with a reduction in under-5 child mortality rate (U5MR) of 29.0 per 1,000 (95% CI: −43.2, −14.7) after adjustment for survey period effects and country-level per capita gross domestic product (pcGDP). At the child level, a unit increase in standardized CCI was associated with an odds ratio of 0.86 for child mortality (95% CI: 0.82–0.90) after adjustment for survey period effect, country-level pcGDP, and a set of household-, maternal-, and child-level covariates. Conclusions MNCH interventions are important in reducing U5MR, while the effects of economic growth in sub-Saharan Africa remain weak and inconsistent. Improved coverage of proven life-saving interventions will likely contribute to further reductions in U5MR in sub-Saharan Africa. PMID:25190448

  5. Influence of unrecorded alcohol consumption on liver cirrhosis mortality

    PubMed Central

    Lachenmeier, Dirk W; Monakhova, Yulia B; Rehm, Jürgen

    2014-01-01

    Unrecorded alcohol includes illegally distributed alcohol as well as homemade or surrogate alcohol which is unintended for consumption by humans (e.g., cosmetics containing alcohol). The highest unrecorded alcohol consumption occurs in Eastern Europe and some of these countries have an over proportional liver cirrhosis mortality. Compounds besides ethanol have been hypothesized as being responsible for this observation. On the other hand, chemical investigations were unable to prove that unrecorded alcohol regularly contains contaminants above toxicological thresholds. However, illegally produced spirits regularly contain higher percentages of alcohol (above 45% by volume), but for considerably less costs compared with licit beverages, potentially causing more problematic patterns of drinking. In this review, it is investigated whether patterns of drinking rather than product composition can explain the liver cirrhosis mortality rates. Statistical examination of World Health Organization country data shows that the originally detected correlation of the percentage of unrecorded alcohol consumption and liver cirrhosis mortality rates disappears when the data is adjusted for the prevalence of heavy episodic drinking. It may be concluded that there is currently a lack of data to demonstrate causality between the composition of illicit spirits (e.g., higher levels of certain contaminants in home-produced products) and liver toxicity on a population scale. Exceptions may be cases of poisoning with antiseptic liquids containing compounds such as polyhexamethyleneguanidine, which were reported to be consumed as surrogate alcohol in Russia, leading to an outbreak of acute cholestatic liver injury, histologically different from conventional alcoholic liver disease. PMID:24966592

  6. Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study

    PubMed Central

    Smith, Lucy K; Manktelow, Bradley N; Draper, Elizabeth S; Boyle, Elaine M; Johnson, Samantha J; Field, David J

    2014-01-01

    Objective To investigate temporal trends in multiple birth rates and associated stillbirth and neonatal mortality by socioeconomic deprivation and maternal age in England. Design Population cohort study. Setting England. Participants All live births and stillbirths (1 January 1997 to 31 December 2008). Main outcome measures Multiple maternity rate, stillbirth and neonatal death rate by year of birth, decile of socioeconomic deprivation and maternal age. Results The overall rate of multiple maternities increased over time (+0.64% per annum 95% CI (0.47% to 0.81%)) with an increase in twin maternities (+0.85% per annum 95% CI (0.67% to 1.0%)) but a large decrease in triplet and higher order maternities (−8.32% per annum 95% CI (−9.39% to −7.25%)). Multiple maternities were significantly lower in the most deprived areas, and this was most evident in the older age groups. Women over 40 years of age from the most deprived areas had a 34% lower rate of multiple births compared with similar aged women from the most deprived areas (rate ratio (RR) 0.66 95% CI (0.61 to 0.73)). Multiple births remain at substantially higher risk of neonatal mortality (RR 6.30 95% CI (6.07 to 6.53)). However, for stillbirths, while twins remain at higher risk, this has decreased over time (1997–2000: RR 2.89 (2.69 to 3.10); 2005–2008: RR 2.22 95% CI (2.06 to 2.40)). Socioeconomic inequalities existed in mortality for singletons and multiple births. Conclusions This period has seen increasing rates of twin pregnancies and decreasing rates of higher order births which have coincided with changes in recommendations regarding assisted reproductive techniques. Socioeconomic differences in multiple births may reflect differential access to these treatments. Improved monitoring of multiple pregnancies is likely to have led to the reductions in stillbirths over this time. PMID:24699461

  7. Influence of olfactory bulbectomy on maternal behavior and dopaminergic function in nucleus accumbens in mice.

    PubMed

    Sato, Atsushi; Nakagawasai, Osamu; Tan-No, Koichi; Onogi, Hiroshi; Niijima, Fukie; Tadano, Takeshi

    2010-12-20

    Olfactory bulbectomy (OBX) induces behavioral, physiological, and neurochemical alterations resembling clinical depression and is widely used as an animal model of depression. It has been reported that depression is a critical cause of child abuse and neglect and that maternal behavior involves dopaminergic neurons of the mesolimbic pathway. In a previous study we found that OBX mice show maternal behavior deficits which are improved by administration of apomorphine, a non-selective dopamine agonist. Therefore, in this study, we investigated the effect of l-3,4-dihydroxyphenylalanine (l-DOPA) on maternal behavior deficits to examine the influence of pre-synaptic dopaminergic function in OBX mice. Furthermore, we measured tyrosine hydroxylase (TH) levels using microphotometry and quantified dopamine D1- and D2-like receptors using autoradiography in the nucleus accumbens (NAc). As a result, 25mg/kg l-DOPA with 12.5mg/kg benserazide improved disrupted maternal behavior in OBX mice and there are no changes in TH levels or number of D1- and D2-like receptors between sham and OBX mothers. The behavioral data support the hypothesis that changed dopaminergic function may contribute to maternal behavior deficits in OBX mice. However, our findings concerning dopaminergic function suggest that the deficits in OBX mice are not simply due to changes in TH levels or dopamine receptor number in the NAc. PMID:20638419

  8. Influence of mom and dad: quantitative genetic models for maternal effects and genomic imprinting.

    PubMed

    Santure, Anna W; Spencer, Hamish G

    2006-08-01

    The expression of an imprinted gene is dependent on the sex of the parent it was inherited from, and as a result reciprocal heterozygotes may display different phenotypes. In contrast, maternal genetic terms arise when the phenotype of an offspring is influenced by the phenotype of its mother beyond the direct inheritance of alleles. Both maternal effects and imprinting may contribute to resemblance between offspring of the same mother. We demonstrate that two standard quantitative genetic models for deriving breeding values, population variances and covariances between relatives, are not equivalent when maternal genetic effects and imprinting are acting. Maternal and imprinting effects introduce both sex-dependent and generation-dependent effects that result in differences in the way additive and dominance effects are defined for the two approaches. We use a simple example to demonstrate that both imprinting and maternal genetic effects add extra terms to covariances between relatives and that model misspecification may over- or underestimate true covariances or lead to extremely variable parameter estimation. Thus, an understanding of various forms of parental effects is essential in correctly estimating quantitative genetic variance components. PMID:16751674

  9. Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: results from nine states in India.

    PubMed

    Randive, Bharat; San Sebastian, Miguel; De Costa, Ayesha; Lindholm, Lars

    2014-12-01

    Proportion of women giving birth in health institutions has increased sharply in India since the introduction of cash incentive program, Janani Suraksha Yojana (JSY) in 2005. JSY was intended to benefit disadvantaged population who had poor access to institutional care for childbirth and who bore the brunt of maternal deaths. Increase in institutional deliveries following the implementation of JSY needs to be analysed from an equity perspective. We analysed data from nine Indian states to examine the change in socioeconomic inequality in institutional deliveries five years after the implementation of JSY using the concentration curve and concentration index (CI). The CI was then decomposed in order to understand pathways through which observed inequalities occurred. Disparities in access to emergency obstetric care (EmOC) and in maternal mortality reduction among different socioeconomic groups were also assessed. Slope and relative index of inequality were used to estimate absolute and relative inequalities in maternal mortality ratio (MMR). Results shows that although inequality in access to institutional delivery care persists, it has reduced since the introduction of JSY. Nearly 70% of the present inequality was explained by differences in male literacy, EmOC availability in public facilities and poverty. EmOC in public facilities was grossly unavailable. Compared to richest division in nine states, poorest division has 135 more maternal deaths per 100,000 live births in 2010. While MMR has decreased in all areas since JSY, it has declined four times faster in richest areas compared to the poorest, resulting in increased inequalities. These findings suggest that in order for the cash incentive to succeed in reducing the inequalities in maternal health outcomes, it needs to be supported by the provision of quality health care services including EmOC. Improved targeting of disadvantaged populations for the cash incentive program could be considered.

  10. Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: results from nine states in India.

    PubMed

    Randive, Bharat; San Sebastian, Miguel; De Costa, Ayesha; Lindholm, Lars

    2014-12-01

    Proportion of women giving birth in health institutions has increased sharply in India since the introduction of cash incentive program, Janani Suraksha Yojana (JSY) in 2005. JSY was intended to benefit disadvantaged population who had poor access to institutional care for childbirth and who bore the brunt of maternal deaths. Increase in institutional deliveries following the implementation of JSY needs to be analysed from an equity perspective. We analysed data from nine Indian states to examine the change in socioeconomic inequality in institutional deliveries five years after the implementation of JSY using the concentration curve and concentration index (CI). The CI was then decomposed in order to understand pathways through which observed inequalities occurred. Disparities in access to emergency obstetric care (EmOC) and in maternal mortality reduction among different socioeconomic groups were also assessed. Slope and relative index of inequality were used to estimate absolute and relative inequalities in maternal mortality ratio (MMR). Results shows that although inequality in access to institutional delivery care persists, it has reduced since the introduction of JSY. Nearly 70% of the present inequality was explained by differences in male literacy, EmOC availability in public facilities and poverty. EmOC in public facilities was grossly unavailable. Compared to richest division in nine states, poorest division has 135 more maternal deaths per 100,000 live births in 2010. While MMR has decreased in all areas since JSY, it has declined four times faster in richest areas compared to the poorest, resulting in increased inequalities. These findings suggest that in order for the cash incentive to succeed in reducing the inequalities in maternal health outcomes, it needs to be supported by the provision of quality health care services including EmOC. Improved targeting of disadvantaged populations for the cash incentive program could be considered. PMID:25462599

  11. A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality

    PubMed Central

    2010-01-01

    Background The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action. Methods/Design This study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy. The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the women's group intervention, and

  12. Multilevel Factors Influencing Maternal Stress during the First Three Years.

    ERIC Educational Resources Information Center

    Mulsow, Miriam; Caldera, Yvonne M.; Pursley, Marta; Reifman, Alan; Huston, Aletha C.

    2002-01-01

    Study applies family stress theory to the influence of personal, child, and familial factors on a mother's parenting stress during the first 3 years of her infant's life. Mother's personality was most predictive of parenting stress. Counterintuitively, mothers who were more satisfied with work or school choices were more likely to be chronically…

  13. The influence of women's empowerment on maternal health care utilization: evidence from Albania.

    PubMed

    Sado, Lantona; Spaho, Alma; Hotchkiss, David R

    2014-08-01

    Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health. PMID:24929918

  14. The influence of women's empowerment on maternal health care utilization: evidence from Albania.

    PubMed

    Sado, Lantona; Spaho, Alma; Hotchkiss, David R

    2014-08-01

    Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health.

  15. Low paternity skew and the influence of maternal kin in an egalitarian, patrilocal primate

    PubMed Central

    Strier, Karen B.; Chaves, Paulo B.; Mendes, Sérgio L.; Fagundes, Valéria; Di Fiore, Anthony

    2011-01-01

    Levels of reproductive skew vary in wild primates living in multimale groups depending on the degree to which high-ranking males monopolize access to females. Still, the factors affecting paternity in egalitarian societies remain unexplored. We combine unique behavioral, life history, and genetic data to evaluate the distribution of paternity in the northern muriqui (Brachyteles hypoxanthus), a species known for its affiliative, nonhierarchical relationships. We genotyped 67 individuals (22 infants born over a 3-y period, their 21 mothers, and all 24 possible sires) at 17 microsatellite marker loci and assigned paternity to all infants. None of the 13 fathers were close maternal relatives of females with which they sired infants, and the most successful male sired a much lower percentage of infants (18%) than reported for the most successful males in other species. Our findings of inbreeding avoidance and low male reproductive skew are consistent with the muriqui's observed social and sexual behavior, but the long delay (≥2.08 y) between the onset of male sexual behavior and the age at which males first sire young is unexpected. The allocation of paternity implicates individual male life histories and access to maternal kin as key factors influencing variation in paternal—and grandmaternal—fitness. The apparent importance of lifelong maternal investment in coresident sons resonates with other recent examinations of maternal influences on offspring reproduction. This importance also extends the implications of the “grandmother hypothesis” in human evolution to include the possible influence of mothers and other maternal kin on male reproductive success in patrilocal societies. PMID:22065786

  16. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

    PubMed Central

    Kassebaum, Nicholas J; Bertozzi-Villa, Amelia; Coggeshall, Megan S; Shackelford, Katya A; Steiner, Caitlyn; Heuton, Kyle R; Gonzalez-Medina, Diego; Barber, Ryan; Huynh, Chantal; Dicker, Daniel; Templin, Tara; Wolock, Timothy M; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsène Kouablan; Adsuar, José C; Agardh, Emilie E; Akena, Dickens; Alasfoor, Deena; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Al Kahbouri, Mazin J; Alla, François; Allen, Peter J; AlMazroa, Mohammad A; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzmán, Nelson; Amankwaa, Adansi A; Amare, Azmeraw T; Amini, Hassan; Ammar, Walid; Antonio, Carl A T; Anwari, Palwasha; Ärnlöv, Johan; Arsenijevic, Valentina S Arsic; Artaman, Ali; Asad, Majed Masoud; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Badawi, Alaa; Balakrishnan, Kalpana; Basu, Arindam; Basu, Sanjay; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L; Bernabe, Eduardo; Beyene, Tariku J; Bhutta, Zulfiqar; Abdulhak, Aref Bin; Blore, Jed D; Basara, Berrak Bora; Bose, Dipan; Breitborde, Nicholas; Cárdenas, Rosario; Castañeda-Orjuela, Carlos A; Castro, Ruben Estanislao; Catalá-López, Ferrán; Cavlin, Alanur; Chang, Jung-Chen; Che, Xuan; Christophi, Costas A; Chugh, Sumeet S; Cirillo, Massimo; Colquhoun, Samantha M; Cooper, Leslie Trumbull; Cooper, Cyrus; da Costa Leite, Iuri; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Degenhardt, Louisa; De Leo, Diego; del Pozo-Cruz, Borja; Deribe, Kebede; Dessalegn, Muluken; deVeber, Gabrielle A; Dharmaratne, Samath D; Dilmen, Uğur; Ding, Eric L; Dorrington, Rob E; Driscoll, Tim R; Ermakov, Sergei Petrovich; Esteghamati, Alireza; Faraon, Emerito Jose A; Farzadfar, Farshad; Felicio, Manuela Mendonca; Fereshtehnejad, Seyed-Mohammad; de Lima, Graça Maria Ferreira; Forouzanfar, Mohammad H; França, Elisabeth B; Gaffikin, Lynne; Gambashidze, Ketevan; Gankpé, Fortuné Gbètoho; Garcia, Ana C; Geleijnse, Johanna M; Gibney, Katherine B; Giroud, Maurice; Glaser, Elizabeth L; Goginashvili, Ketevan; Gona, Philimon; González-Castell, Dinorah; Goto, Atsushi; Gouda, Hebe N; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Hankey, Graeme J; Harb, Hilda L; Havmoeller, Rasmus; Hay, Simon I; Heredia Pi, Ileana B; Hoek, Hans W; Hosgood, H Dean; Hoy, Damian G; Husseini, Abdullatif; Idrisov, Bulat T; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H; Jahangir, Eiman; Jee, Sun Ha; Jensen, Paul N; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B; Juel, Knud; Kabagambe, Edmond Kato; Kan, Haidong; Karam, Nadim E; Karch, André; Karema, Corine Kakizi; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kazi, Dhruv S; Kemp, Andrew H; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz Ahmed; Khang, Young-Ho; Knibbs, Luke; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kulkarni, Chanda; Kulkarni, Veena S; Kumar, G Anil; Kumar, Kaushalendra; Kumar, Ravi B; Kwan, Gene; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lansingh, Van C; Larsson, Anders; Lee, Jong-Tae; Leigh, James; Leinsalu, Mall; Leung, Ricky; Li, Xiaohong; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S; Lin, Hsien-Ho; Lipshultz, Steven E; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K; London, Stephanie J; Lotufo, Paulo A; Ma, Jixiang; Ma, Stefan; Machado, Vasco Manuel Pedro; Mainoo, Nana Kwaku; Majdan, Marek; Mapoma, Christopher Chabila; Marcenes, Wagner; Marzan, Melvin Barrientos; Mason-Jones, Amanda J; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Memish, Ziad A; Mendoza, Walter; Miller, Ted R; Mills, Edward J; Mokdad, Ali H; Mola, Glen Liddell; Monasta, Lorenzo; de la Cruz Monis, Jonathan; Hernandez, Julio Cesar Montañez; Moore, Ami R; Moradi-Lakeh, Maziar; Mori, Rintaro; Mueller, Ulrich O; Mukaigawara, Mitsuru; Naheed, Aliya; Naidoo, Kovin S; Nand, Devina; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Nelson, Robert G; Neupane, Sudan Prasad; Newton, Charles R; Ng, Marie; Nieuwenhuijsen, Mark J; Nisar, Muhammad Imran; Nolte, Sandra; Norheim, Ole F; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O; Omer, Saad B; Opio, John Nelson; Orisakwe, Orish Ebere; Pandian, Jeyaraj D; Papachristou, Christina; Park, Jae-Hyun; Caicedo, Angel J Paternina; Patten, Scott B; Paul, Vinod K; Pavlin, Boris Igor; Pearce, Neil; Pereira, David M; Pesudovs, Konrad; Petzold, Max; Poenaru, Dan; Polanczyk, Guilherme V; Polinder, Suzanne; Pope, Dan; Pourmalek, Farshad; Qato, Dima; Quistberg, D Alex; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad ur; Raju, Murugesan; Rana, Saleem M; Refaat, Amany; Ronfani, Luca; Roy, Nobhojit; Sánchez Pimienta, Tania Georgina; Sahraian, Mohammad Ali; Salomon, Joshua A; Sampson, Uchechukwu; Santos, Itamar S; Sawhney, Monika; Sayinzoga, Felix; Schneider, Ione J C; Schumacher, Austin; Schwebel, David C; Seedat, Soraya; Sepanlou, Sadaf G; Servan-Mori, Edson E; Shakh-Nazarova, Marina; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shiue, Ivy; Sigfusdottir, Inga Dora; Silberberg, Donald H; Silva, Andrea P; Singh, Jasvinder A; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stroumpoulis, Konstantinos; Sturua, Lela; Sykes, Bryan L; Tabb, Karen M; Talongwa, Roberto Tchio; Tan, Feng; Teixeira, Carolina Maria; Tenkorang, Eric Yeboah; Terkawi, Abdullah Sulieman; Thorne-Lyman, Andrew L; Tirschwell, David L; Towbin, Jeffrey A; Tran, Bach X; Tsilimbaris, Miltiadis; Uchendu, Uche S; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uzun, Selen Begüm; Vallely, Andrew J; van Gool, Coen H; Vasankari, Tommi J; Vavilala, Monica S; Venketasubramanian, N; Villalpando, Salvador; Violante, Francesco S; Vlassov, Vasiliy Victorovich; Vos, Theo; Waller, Stephen; Wang, Haidong; Wang, Linhong; Wang, XiaoRong; Wang, Yanping; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Westerman, Ronny; Wilkinson, James D; Woldeyohannes, Solomon Meseret; Wong, John Q; Wordofa, Muluemebet Abera; Xu, Gelin; Yang, Yang C; Yano, Yuichiro; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Yu, Chuanhua; Jin, Kim Yun; El SayedZaki, Maysaa; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zhu, Jun; Zou, Xiao Nong; Lopez, Alan D; Naghavi, Mohsen; Murray, Christopher J L; Lozano, Rafael

    2014-01-01

    Summary Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990–2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017–327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483–407 574) in 1990. The global annual rate of change in the MMR was −0·3% (−1·1 to 0·6) from 1990 to 2003, and −2·7% (−3·9 to −1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290–2866) maternal deaths were related to HIV in 2013, 0·4% (0·2–0·6) of the global total. MMR was highest in the

  17. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam

    PubMed Central

    Minh, Hoang Van; Giang, Kim Bao; Hoat, Luu Ngoc; Chung, Le Hong; Huong, Tran Thi Giang; Phuong, Nguyen Thi Kim; Valentine, Nicole B.

    2016-01-01

    Introduction Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed ‘barriers’. Methods Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15–49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. Results In Vietnam, about 54% of women aged 15–49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14–0.55; OR=0

  18. Maternal influences on egg and larval characteristics of plaice ( Pleuronectes platessa L.)

    NASA Astrophysics Data System (ADS)

    Kennedy, J.; Geffen, A. J.; Nash, R. D. M.

    2007-07-01

    Maternal influences on various egg and larval characteristics were examined using plaice from the Irish Sea and Norwegian coastal waters. Thirty-nine batches of eggs were incubated during the spawning season of 2004 and 2005. Thirty-seven larvae from one batch were also monitored individually to examine the influence of egg size on larval size at hatching, yolk sac volume and growth at the individual level. The relationship between egg dry weight (EDW) and egg diameter (ED) differed between the fish from different origins. Egg size increased with maternal size and decreased with progression through spawning. Eggs from the Norwegian coast hatched on average two days earlier than eggs from the Irish Sea. This resulted in the larvae from the Norwegian coast hatching at a smaller size and with larger yolk sac volumes. Larger eggs gave rise to larvae with larger yolk sac volumes at hatching (independent of incubation period) both at the batch and individual level. Larval growth rate was influenced by larval hatching size and yolk sac volume with smaller larvae and larvae with larger yolk sacs having a greater growth rate between hatching and two weeks after hatching. The effects of egg size on larval plaice were present until the end of the yolk sac stage due to differences in the time taken to absorb the yolk sac. Neither hatching rate, age at first feeding nor larval survival was related to maternal size or egg dry weight.

  19. Maternal nutrition during pregnancy influences offspring wool production and wool follicle development.

    PubMed

    Magolski, J D; Luther, J S; Neville, T L; Redmer, D A; Reynolds, L P; Caton, J S; Vonnahme, K A

    2011-11-01

    The effects of maternal nutrition on offspring wool production (quality and quantity) were evaluated. Primiparous Rambouillet ewes (n = 84) were randomly allocated to 1 of 6 treatments in a 2 × 3 factorial design. Selenium treatment [adequate Se (ASe, 9.5 μg/kg of BW) vs. high Se (HSe, 81.8 μg/kg of BW)] was initiated at breeding, and maternal nutritional intake [control (CON, 100% of requirements) vs. restricted (60% of CON) vs. overfed (140% of CON)] was initiated at d 50 of gestation. Lamb birth weight was recorded at delivery, and all lambs were placed on the same diet immediately after birth to determine the effects of prenatal nutrition on postnatal wool production and follicle development. At 180 ± 2.2 d of age, lambs were necropsied and pelt weights were recorded. Wool samples were collected from the side and britch areas, whereas skin samples were collected from the side of each lamb only. Although Se status did not influence side staple length in males, female lambs born from ewes on the ASe treatment had a shorter staple length (P < 0.05) when compared with females from ewes on the HSe treatment. Maternal nutritional intake and Se status did not influence (P ≥ 0.23) wool characteristics on the britch. However, at the britch, wool from female lambs had a reduced comfort factor (P = 0.01) and a greater (P = 0.02) fiber diameter compared with wool from male lambs. Maternal Se supplementation, maternal nutritional plane, sex of the offspring, or their interactions had no effect (P > 0.13) on primary (29.10 ± 1.40/100 µm(2)) and secondary (529.84 ± 21.57/100 µm(2)) wool follicle numbers. Lambs from ASe ewes had a greater (P = 0.03) secondary:primary wool follicle ratio compared with lambs from HSe ewes (20.93 vs. 18.01 ± 1.00). Despite similar postnatal diets, wool quality was affected by maternal Se status and the maternal nutritional plane.

  20. Melatonin influences sex-specific prenatal mortality in meadow voles.

    PubMed

    Gorman, M R; Ferkin, M H; Dark, J

    1994-11-01

    Meadow voles exhibit seasonal changes in litter size, ovulation rates, and prenatal mortality. To investigate the proximate bases of seasonal changes in reproductive effort, adult female voles, maintained in long photoperiods (14 h of light/day), were injected daily with 10 micrograms melatonin 2 h before light offset to extend the duration of the nighttime melatonin pulse. At parturition the number, sex, and weight of offspring were assessed. The number of ovarian corpora lutea (CL), an index of potential litter size, was used to calculate rates of prenatal survival (i.e., pups per CL). Prenatal survival rates were reduced in female but not male pups of dams that had been injected before blastocyst implantation (Days 1-6 of pregnancy) with melatonin as compared with saline. Melatonin injections initiated after blastocyst implantation (Days 7-21 of pregnancy) did not affect prenatal survival, nor were birth weights of pups affected by either pre- or postimplantation melatonin treatment. We conclude that sex-specific prenatal survival is a labile feature of vole reproduction that may be under proximate control of photoperiod and melatonin before blastocyst implantation. PMID:7849189

  1. Beyond classical inheritance: the influence of maternal genotype upon child's brain morphology and behavior.

    PubMed

    van der Knaap, Noortje J F; El Marroun, Hanan; Klumpers, Floris; Mous, Sabine E; Jaddoe, Vincent W V; Hofman, Albert; Homberg, Judith R; White, Tonya; Tiemeier, Henning; Fernández, Guillén

    2014-07-16

    Genetic variance has been associated with variations in brain morphology, cognition, behavior, and disease risk. One well studied example of how common genetic variance is associated with brain morphology is the serotonin transporter gene polymorphism within the promoter region (5-HTTLPR). Because serotonin is a key neurotrophic factor during brain development, genetically determined variations in serotonin activity during maturation, in particular during early prenatal development, may underlie the observed association. However, the intrauterine microenvironment is not only determined by the child's, but also the mother's genotype. Therefore, we hypothesized that maternal 5-HTTLPR genotype influences the child's brain development beyond direct inheritance. To test this hypothesis, we investigated 76 children who were all heterozygous for the 5-HTTLPR (sl) and who had mothers who were either homozygous for the long (ll) or the short allele (ss). Using MRI, we assessed brain morphology as a function of maternal genotype. Gray matter density of the somatosensory cortex was found to be greater in children of ss mothers compared with children of ll mothers. Behavioral assessment showed that fine motor task performance was altered in children of ll mothers and the degree of this behavioral effect correlated with somatosensory cortex density across individuals. Our findings provide initial evidence that maternal genotype can affect the child's phenotype beyond effects of classical inheritance. Our observation appears to be explained by intrauterine environmental differences or by differences in maternal behavior.

  2. Brain abscess and subdural empyema. Factors influencing mortality and results of various surgical techniques.

    PubMed Central

    Van Alphen, H A; Dreissen, J J

    1976-01-01

    The authors review the results of various surgical techniques in relation to mortality and morbidity in 100 consecutive cases of brain abscess and subdural empyema. The mortality rate is the same with total excision and fractional drainage of brain abscesses, although in acute and subacute cases slight differences between both techniques are seen. In terms of morbidity, fractional drainage appears to be more favourable than total excision. The authors believe that factors other than surgical procedure influence mortality in cases of brain abscess and subdural empyema. These factors are defined in detail. Images PMID:932767

  3. The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

    PubMed Central

    2013-01-01

    Background Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC). Methods Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (<18 years, 18-<35 years, ≥35 years) categories were matched with each other to create exposure categories, with those who are parity 1-2 and age 18-<35 years as the reference. Outcomes included small-for-gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed. Results Nulliparous, age <18 year women, compared with women who were parity 1-2 and age 18-<35 years had the highest odds of SGA (pooled adjusted OR: 1.80), preterm (pooled aOR: 1.52), neonatal mortality (pooled aOR: 2.07), and infant mortality (pooled aOR: 1.49). Increased odds were also noted for SGA and neonatal mortality for nulliparous/age 18-<35 years, preterm, neonatal, and infant mortality for parity ≥3/age 18-<35 years, and preterm and neonatal mortality for parity ≥3/≥35 years. Conclusions Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman’s reproductive period. Funding Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child

  4. Environmental Contingency in Life History Strategies: The Influence of Mortality and Socioeconomic Status on Reproductive Timing

    PubMed Central

    Griskevicius, Vladas; Delton, Andrew W.; Robertson, Theresa E.; Tybur, Joshua M.

    2013-01-01

    Why do some people have children early, whereas others delay reproduction? By considering the trade-offs between using one’s resources for reproduction versus other tasks, the evolutionary framework of life history theory predicts that reproductive timing should be influenced by mortality and resource scarcity. A series of experiments examined how mortality cues influenced the desire to have children sooner rather than later. The effects of mortality depended critically on whether people grew up in a relatively resource-scarce or resource-plentiful environment. For individuals growing up relatively poor, mortality cues produced a desire to reproduce sooner—to want children now, even at the cost of furthering one’s education or career. Conversely, for individuals growing up relatively wealthy, mortality cues produced a desire to delay reproduction—to further one’s education or career before starting a family. Overall, mortality cues appear to shift individuals into different life history strategies as a function of childhood socioeconomic status, suggesting important implications for how environmental factors can influence fertility and family size. PMID:20873933

  5. Vole infant development is influenced perinatally by maternal photoperiodic history.

    PubMed

    Lee, T M; Zucker, I

    1988-11-01

    Vole pups were maintained from the time of conception in the same short-day (SD) photoperiod (10 h light/day, LD 10:14); groups differed only with respect to SD photoperiodic histories of dams before gestation, which simulated those experienced by dams breeding in autumn (SD-2, 2 wk of short days), midwinter (SD-21), or late winter (SD-26). Compared with SD-2 pups, offspring born to SD-26 dams matured more rapidly with respect to body size and reproductive status. Several other somatic and behavioral measures indicated that winter preparedness was greatest in pups whose dams had experienced 2 wk and least in those that had experienced 26 wk of SD treatment before conception. A cross-fostering design, in which pups gestated in long (LD 14:10) or short photoperiods were reared postnatally in the same or opposite day length, indicated that several photoresponsive traits are influenced predominantly by prenatal photoperiod, others by postnatal day length, and others by both photoregimens. Information is communicated to fetuses about the length of time dams have been exposed to short day lengths before mating as well as about the day length prevailing during gestation. The changes induced by the mother in her pups pre- and postnatally likely facilitate adaptation of newly weaned voles to seasonally varying environmental conditions.

  6. Vole infant development is influenced perinatally by maternal photoperiodic history.

    PubMed

    Lee, T M; Zucker, I

    1988-11-01

    Vole pups were maintained from the time of conception in the same short-day (SD) photoperiod (10 h light/day, LD 10:14); groups differed only with respect to SD photoperiodic histories of dams before gestation, which simulated those experienced by dams breeding in autumn (SD-2, 2 wk of short days), midwinter (SD-21), or late winter (SD-26). Compared with SD-2 pups, offspring born to SD-26 dams matured more rapidly with respect to body size and reproductive status. Several other somatic and behavioral measures indicated that winter preparedness was greatest in pups whose dams had experienced 2 wk and least in those that had experienced 26 wk of SD treatment before conception. A cross-fostering design, in which pups gestated in long (LD 14:10) or short photoperiods were reared postnatally in the same or opposite day length, indicated that several photoresponsive traits are influenced predominantly by prenatal photoperiod, others by postnatal day length, and others by both photoregimens. Information is communicated to fetuses about the length of time dams have been exposed to short day lengths before mating as well as about the day length prevailing during gestation. The changes induced by the mother in her pups pre- and postnatally likely facilitate adaptation of newly weaned voles to seasonally varying environmental conditions. PMID:3056043

  7. The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

    PubMed

    Jain, Anrudh K; Sathar, Zeba; Salim, Momina; Shah, Zakir Hussain

    2013-09-01

    This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

  8. Can maternal-fetal hemodynamics influence prenatal development in dogs?

    PubMed

    Freitas, Luana Azevedo de; Mota, Gustavo Lobato; Silva, Herlon Victor Rodrigues; Carvalho, Cibele Figueira; Silva, Lúcia Daniel Machado da

    2016-09-01

    The goals of this study were to report embryonic and fetal ultrasound changes and compare blood flow of uteroplacental and umbilical arteries of normal and abnormal conceptus. Accordingly, from the day of mating or artificial insemination, all fetuses in 60 pregnancies were evaluated weekly. According to the ultrasound findings, the gestational age was determined and the conceptuses were divided into normal or abnormal (embryonic and fetal abnormalities). The two-dimensional ultrasound assessment consists of measuring and evaluating the echogenicity of conceptus and extra-fetal structures. Doppler velocimetry measured the resistivity index (RI) and pulsatility index (PI) of uteroplacental and umbilical arteries. Two-dimensional and Doppler measurements were expressed as mean and standard deviation. Differences between normal and abnormal groups were subject to Mann-Whitney test (P<0.05). Of 264 fetuses, 15.90% showed embryonic abnormalities (resorption) and 5.68% presented fetal abnormalities (congenital abnormalities, fetal underdevelopment and fetal death). We observed a reduced diameter and abnormalities in the contour of gestational vesicle, lack of viability, increased placental thickness, increased fluid echogenicity and increases in RI and PI of uteroplacental arteries of conceptuses with embryonic resorption between the 2nd and 4th weeks. Fetuses with abnormalities showed changes in the flow of uteroplacental and umbilical arteries prior to visualization of two-dimensional alterations and different vascular behavior according to the classification of the change. Results show that ultrasound is efficient for the detection of embryonic and fetal abnormalities. When combined with Doppler ultrasound, it allows early detection of gestational changes, as well as hemodynamic changes, in conceptuses with abnormalities, which may influence their development. PMID:27509872

  9. The economic burden of maternal mortality on households: evidence from three sub-counties in rural western Kenya

    PubMed Central

    2015-01-01

    Background This study explores the consequences of a maternal death to households in rural Western Kenya focusing particularly on the immediate financial and economic impacts. Methods Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy and health care access and utilization; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions. Results The health service utilization costs associated with maternal deaths were significantly higher, due to more frequent service utilization as well as due to the higher cost of each visit suggesting more involved treatments and interventions were sought with these women. The already high costs incurred by cases during pregnancy were further increased during delivery and postpartum mainly a result of higher facility-based fees and expenses. Households who experienced a maternal death spent about one-third of their annual per capita consumption expenditure on healthcare access and use as opposed to at most 12% among households who had a health pregnancy and delivery. Funeral costs were often higher than the healthcare costs and altogether forced households to dis-save, liquidate assets and borrow money. What is more, the surviving members of the households had significant redistribution of labor and responsibilities to make up for the lost contributions of the deceased women. Conclusion Kenya is in the process of instituting free maternity services in all public facilities. Effectively implemented, this policy can lift a major economic burden experienced by a very large number of household who seek maternal health services which can be catastrophic in complicated cases that result in maternal death. There needs to be further emphasis on insurance schemes that can

  10. Influence of maternal nutritional status on vascular function in the offspring.

    PubMed

    Poston, Lucilla

    2011-05-01

    Suboptimal maternal nutritional status has been implicated in the development of cardiovascular risk in the child. Initially inferred from studies of low-birthweight children, investigations in cohorts of women subjected to famine provide direct evidence for an independent influence of the mother's diet on the cardiovascular health of her child. Animal studies from rodents and sheep have shown associations between maternal undernutrition and raised blood pressure, as well as abnormalities in resistance artery function, particularly in endothelium-dependent responses. Early life exposure to the influences of maternal over nutritional states, e.g. obesity and excessive gestational weight gain, has also been associated with markers of cardiovascular risk in man, and animal models have shown raised blood pressure and endothelial dysfunction in offspring of diet-induced obese dams. Increased sympathetic tone is commonly associated with hypertension in animal models of both under nutritional and over nutritional states. This and several other similarities may indicate commonality of mechanism and could reflect supranormal nutritional status in postnatal life in both conditions.

  11. Neonatal thyroid-stimulating hormone level is influenced by neonatal, maternal, and pregnancy factors.

    PubMed

    Trumpff, Caroline; Vandevijvere, Stefanie; Moreno-Reyes, Rodrigo; Vanderpas, Jean; Tafforeau, Jean; Van Oyen, Herman; De Schepper, Jean

    2015-11-01

    The percentage of newborns with a neonatal whole blood thyroid-stimulating hormone (TSH) greater than 5 mIU/L has been used as an indicator of iodine deficiency at the population level. However, TSH levels in newborns may be influenced by many factors other than iodine status. The objective of this study was to identify neonatal, maternal, and pregnancy-related determinants of neonatal TSH levels in a retrospective cohort study. The study sample included 313 Belgian mothers and their 4- to 5-year-old children. The children had a neonatal TSH concentration between 0 and 15 mIU/L at neonatal screening, and blood samples were collected 3 to 5 days after birth. Children with suspected congenital hypothyroidism (neonatal TSH level >15 mIU/L), prematurely born (i.e., <37 weeks), or with a low birth weight (i.e., <2500 g) were excluded. Information about maternal and birth-related determinants was collected from the neonatal screening center via a self-administered questionnaire filled in by the mother together with the child's health booklet. Higher TSH levels were found in spring and winter compared to summer and autumn (P = .011). Higher TSH levels were associated with lifetime smoking behavior (up to child birth) in the mother (P = .005), lower weight gain during pregnancy (P = .014), and longer pregnancies (P = .003). This study showed that several neonatal, maternal, and pregnancy-related determinants are influencing neonatal TSH level. PMID:26428622

  12. Maternal and offspring pools of osteocalcin influence brain development and functions

    PubMed Central

    Oury, Franck; Khrimian, Lori; Denny, Christine. A.; Gardin, Antoine; Chamouni, Alexandre; Goeden, Nick; Huang, Yung-yu; Lee, Hojoon; Srinivas, Prashanth; Gao, Xiao-Bing; Suyama, Shigetomo; Langer, Thomas; Mann, John. J.; Horvath, Tamas. L.; Bonnin, Alexandre; Karsenty, Gerard

    2013-01-01

    The powerful regulation of bone mass exerted by the brain suggests the existence of bone-derived signals modulating this regulation or other functions of the brain. We show here that the osteoblast-derived hormone osteocalcin crosses the blood-brain barrier, binds to neurons of the brainstem, midbrain and hippocampus, enhances the synthesis of monoamine neurotransmitters, inhibits GABA synthesis, prevents anxiety and depression and favors learning and memory independently of its metabolic functions. In addition to these post-natal functions, maternal osteocalcin crosses the placenta during pregnancy and prevents neuronal apoptosis before embryos synthesize this hormone. As a result the severity of the neuro-anatomical defects and learning and memory deficits of Osteocalcin−/− mice is determined by the maternal genotype, and delivering osteocalcin to pregnant Osteocalcin−/− mothers rescues these abnormalities in their Osteocalcin−/− progeny. This study reveals that the skeleton via osteocalcin influences cognition and contributes to the maternal influence on fetal brain development. PMID:24074871

  13. Differential leaflet mortality may influence biogeochemical cycling following tropical cyclones.

    PubMed

    Marler, Thomas E; Ferreras, Ulysses

    2014-01-01

    Intensity of tropical cyclones is expected to increase in the coming century, and an improved understanding of their influence on biogeochemical cycles would benefit ecologists and conservationists. We studied the November 2013 Typhoon Haiyan damage to observe that numerous examples of partial leaf necrosis on intact leaves of trees in the Cycadaceae and Arecaceae families resulted, leaving behind a copious amount of arboreal dead leaf material attached to live leaves. The decay process of this form of arboreal litter has not been previously studied. When compared with decay of ground litter or detached litter suspended in the canopy, we predict the decay process of this form of arboreal litter will include increased photooxidation, leaching, and comminution by detritivorous insects and mites; but decreased catabolism of organic molecules by saprophytic organisms.

  14. The influence of maternal labels on dietary preferences of spiny mouse weanlings.

    PubMed

    Porter, R H; McFadyen-Ketchum, S; King, G A

    1990-07-01

    To assess the influence of conspecific chemical cues on the development of dietary preferences, spiny mouse (Acomys cahirinus) weanling were tested for their responses to food items that were partially eaten (thus, presumably labeled) by various categories of conspecifics. Consumption of a highly preferred novel food (fresh carrot) labeled by the pups' parents, or mother alone, was greater than that of a clean sample of the same food. The presence of labels emanating from the father or an alien mother had no effect on food consumption. Salient maternal labels that elicit preferential feeding by young appear to be individually unique, therefore allowing pups to recognize such cues emanating from their own mother. The attractive substance that mothers transfer to food items while eating (the maternal label per se) has not been identified, but saliva is a likely candidate. PMID:2236255

  15. Bidirectional influences between maternal parenting and children's peer problems: a longitudinal monozygotic twin difference study.

    PubMed

    Yamagata, Shinji; Takahashi, Yusuke; Ozaki, Koken; Fujisawa, Keiko K; Nonaka, Koichi; Ando, Juko

    2013-03-01

    This twin study examined the bidirectional relationship between maternal parenting behaviors and children's peer problems that were not confounded by genetic and family environmental factors. Mothers of 259 monozygotic twin pairs reported parenting behaviors and peer problems when twins were 42 and 48 months. Path analyses on monozygotic twin difference scores revealed that authoritative parenting (the presence of consistent discipline and lack of harsh parenting) and peer problems simultaneously influenced each other. Authoritative parenting reduced peer problems, and peer problems increased authoritative parenting. Neither consistent discipline nor harsh parenting alone was associated with peer problems. These results suggest that maternal authoritative parenting works protectively in regard to children's peer problems, and peer problems can evoke such effective parenting.

  16. The influence of maternal energy status during midgestation on beef offspring carcass characteristics and meat quality.

    PubMed

    Mohrhauser, D A; Taylor, A R; Underwood, K R; Pritchard, R H; Wertz-Lutz, A E; Blair, A D

    2015-02-01

    Research has suggested that maternal undernutrition may cause the development of a thrifty phenotype in the offspring, potentially resulting in greater adiposity and reduced muscle mass. These alterations in adipose and muscle development could have lasting impacts on offspring growth, carcass characteristics, and meat quality. However, limited research exists evaluating the impact of maternal energy status on these economically important traits of the offspring. Therefore, the objective of this study was to determine the influence of maternal energy status during midgestation on offspring carcass characteristics and meat quality. To alter maternal energy status, cows either grazed dormant, winter range (positive energy status [PES]) or were fed in a drylot at 80% of the energy requirements for BW maintenance (negative energy status [NES]) during a mean period of 102 ± 10.9 to 193 ± 10.9 d of gestation. Changes in BCS, BW, LM area (LMA), and 12th rib backfat were measured throughout midgestation. At the end of midgestation, cows in the NES group had a reduction (P ≤ 0.05) in BCS, BW, LMA, and 12th rib backfat when compared with PES dams. Cows and calves were managed similarly after midgestation through weaning and calves were managed and fed a common diet through the receiving, backgrounding, and finishing phases in the feedlot. Calves were harvested after 208 d in the feedlot, carcass characteristics were recorded, and strip loins were recovered for analysis of objective color and Warner-Bratzler shear force (WBSF). Maternal energy status had no influence on offspring HCW, dressing percent, LMA, percent KPH, marbling score, percent intramuscular fat, objective color, or WBSF (P > 0.10). Progeny of NES cows tended to have improvements in 12th rib backfat and USDA yield grade (P < 0.10). Greater ratio of marbling score to 12th rib fat thickness and ratio of percent intramuscular fat to 12th rib fat thickness (P < 0.05) were discovered in progeny from cows

  17. Maternal and infant characteristics influencing the anogenital distance and penile length in newborns.

    PubMed

    Singal, Arbinder Kumar; Jain, Viral G

    2016-08-01

    Recent studies have suggested that maternal characteristics can affect reproductive health of offspring, possibly through pre-natal hormonal influence. Anogenital distance (AGD) is an anthropometric measure which is a sensitive reproductive endpoint of masculinisation. It provides a read-out of pre-natal androgen exposure and has been associated with several reproductive health outcomes in humans. We studied AGD and stretched penile length (SPL) in a large, racially homogenous sample of consecutive newborns to understand their association with maternal and infant characteristics. A prospective cross-sectional study involving measurement of AGD and SPL at birth was performed by a single trained observer. A total of 1077 newborns (553 males and 524 females) were included in final anthropometric analysis. The mean AGD of males was 2.56 ± 0.31 cm, and the mean AGD of females was 1.54 ± 0.17 cm. The mean SPL of males was 3.31 ± 0.38 cm. On multiple regression analysis, for both males and females, birthweight (β = 0.229, P < 0.001 and β = 0.135, P < 0.001, respectively) was modest but significant predictor for AGD. For SPL, only gestational age (β = 0.054, P < 0.001) was found to be statistically significant predictor. There was no significant association observed for gravidity, parity and maternal age with both AGD and SPL. Thus, no maternal characteristics (age, gravidity, parity) influence AGD or SPL in human infants.

  18. High early life mortality in free-ranging dogs is largely influenced by humans

    PubMed Central

    Paul, Manabi; Sen Majumder, Sreejani; Sau, Shubhra; Nandi, Anjan K.; Bhadra, Anindita

    2016-01-01

    Free-ranging dogs are a ubiquitous part of human habitations in many developing countries, leading a life of scavengers dependent on human wastes for survival. The effective management of free-ranging dogs calls for understanding of their population dynamics. Life expectancy at birth and early life mortality are important factors that shape life-histories of mammals. We carried out a five year-long census based study in seven locations of West Bengal, India, to understand the pattern of population growth and factors affecting early life mortality in free-ranging dogs. We observed high rates of mortality, with only ~19% of the 364 pups from 95 observed litters surviving till the reproductive age; 63% of total mortality being human influenced. While living near people increases resource availability for dogs, it also has deep adverse impacts on their population growth, making the dog-human relationship on streets highly complex. PMID:26804633

  19. The influence of maternal behaviors during childhood on self-efficacy in individuals with sickle cell disease.

    PubMed

    Jenerette, Coretta M; Valrie, Cecelia R

    2010-11-01

    Little is known about the influence of maternal behaviors during childhood on the self-efficacy of individuals with sickle cell disease (SCD).This study retrospectively investigated the relationship between maternal overprotection and caring during childhood and self-efficacy in adulthood. Using a cross-sectional survey design, 32 adults with SCD completed questionnaires about demographics, maternal parenting behaviors, and self-efficacy. On average, adults with SCD reported moderate levels of SCD self-efficacy, high levels of overprotection, and high levels of caring. Self-efficacy was significantly related to educational level ( r = .39, p = .04), number of SCD crises per year (r = -.41, p = .04), and caring (r = .48, p = .01). Using simultaneous regression modeling, maternal caring was significantly predictive of self-efficacy (β = .44, p = .03). Results suggest that maternal caring during childhood may promote the development of self-efficacy in adults with SCD.

  20. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    PubMed Central

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  1. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    PubMed

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  2. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    PubMed

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  3. Maternal and contextual influences and the effect of temperament development during infancy on parenting in toddlerhood.

    PubMed

    Bridgett, David J; Gartstein, Maria A; Putnam, Samuel P; McKay, Talia; Iddins, Erin; Robertson, Christopher; Ramsay, Kristin; Rittmueller, Anna

    2009-01-01

    In the current study, latent growth modeling (LGM) was used to: (1) identify the developmental trajectories of infant negative emotions (NE) and regulatory capacity (RC) from 4 to 12 months of age, (2) examine maternal and family factors that may affect NE and RC trajectories, (3) examine transactional associations between developing NE and RC, and (4) examine the effect of infant temperament trajectories on negative parenting when toddlers reached 18 months of age. Mothers from 156 families completed a measure of infant temperament when infants were 4, 6, 8, 10, and 12 months of age and completed maternal relationship stress, depression, and family demographics measures when infants were 4 months of age. Information regarding negative parenting was collected when toddlers reached 18 months of age. LGM results suggest that maternal relationship stress and depression influence infant NE development, that high NE early in infancy may compromise the development of infant regulation, and that steeper decreases of infant RC contribute the greatest amount of variance to negative parenting in toddlerhood. The implications for models of early emotion regulation and incorporating changes in temperament over time into developmentally sensitive models (e.g., emerging parenting practices and developmental psychopathology) are discussed.

  4. Maternal condition does not influence birth sex ratios in anubis baboons (Papio anubis).

    PubMed

    Silk, Joan B; Strum, Shirley C

    2010-09-22

    Trivers and Willard predicted that when parental condition has differential effects on the fitness of male and female offspring, parents who are in good condition will bias investment toward the sex that benefits most from additional investment. Efforts to test predictions derived from Trivers and Willard's model have had mixed results, perhaps because most studies have relied on proxy measures of parental condition, such as dominance rank. Here, we examine the effects of female baboons condition on birth sex ratios and post-natal investment, based on visual assessments of maternal body condition. We find that local environmental conditions have significant effects on female condition, but maternal condition at conception has no consistent relationship with birth sex ratios. Mothers who are in poorer condition at the time of conception resume cycling significantly later than females who are in better condition, but the sex of their infants has no effect on the time to resumption of cycling. Thus, our findings provide strong evidence that maternal condition influences females' ability to reproduce, but females do not facultatively adjust the sex ratio of their offspring in relation to their dominance rank or current condition.

  5. Maternal Condition Does Not Influence Birth Sex Ratios in Anubis Baboons (Papio anubis)

    PubMed Central

    Silk, Joan B.; Strum, Shirley C.

    2010-01-01

    Trivers and Willard predicted that when parental condition has differential effects on the fitness of male and female offspring, parents who are in good condition will bias investment toward the sex that benefits most from additional investment. Efforts to test predictions derived from Trivers and Willard's model have had mixed results, perhaps because most studies have relied on proxy measures of parental condition, such as dominance rank. Here, we examine the effects of female baboons condition on birth sex ratios and post-natal investment, based on visual assessments of maternal body condition. We find that local environmental conditions have significant effects on female condition, but maternal condition at conception has no consistent relationship with birth sex ratios. Mothers who are in poorer condition at the time of conception resume cycling significantly later than females who are in better condition, but the sex of their infants has no effect on the time to resumption of cycling. Thus, our findings provide strong evidence that maternal condition influences females' ability to reproduce, but females do not facultatively adjust the sex ratio of their offspring in relation to their dominance rank or current condition. PMID:20877648

  6. Non-Pneumatic Anti-Shock Garment (NASG), a First-Aid Device to Decrease Maternal Mortality from Obstetric Hemorrhage: A Cluster Randomized Trial

    PubMed Central

    Miller, Suellen; Bergel, Eduardo F.; El Ayadi, Alison M.; Gibbons, Luz; Butrick, Elizabeth A.; Magwali, Thulani; Mkumba, Gricelia; Kaseba, Christine; Huong, N. T. My; Geissler, Jillian D.; Merialdi, Mario

    2013-01-01

    Background Obstetric hemorrhage is the leading cause of maternal mortality. Using a cluster randomized design, we investigated whether application of the Non-pneumatic Anti-Shock Garment (NASG) before transport to referral hospitals (RHs) from primary health care centers (PHCs) decreased adverse outcomes among women with hypovolemic shock. We hypothesized the NASG group would have a 50% reduction in adverse outcomes. Methods and Findings We randomly assigned 38 PHCs in Zambia and Zimbabwe to standard obstetric hemorrhage/shock protocols or the same protocols plus NASG prior to transport. All women received the NASG at the RH. The primary outcomes were maternal mortality; severe, end-organ failure maternal morbidity; and a composite mortality/morbidity outcome, which we labeled extreme adverse outcome (EAO). We also examined whether the NASG contributed to negative side effects and secondary outcomes. The sample size for statistical power was not reached; of a planned 2400 women, 880 were enrolled, 405 in the intervention group. The intervention was associated with a non-significant 46% reduced odds of mortality (OR 0.54, 95% CI 0.14–2.05, p = 0.37) and 54% reduction in composite EAO (OR 0.46, 95% CI 0.13–1.62, p = 0.22). Women with NASGs recovered from shock significantly faster (HR 1.25, 95% CI 1.02–1.52, p = 0.03). No differences were observed in secondary outcomes or negative effects. The main limitation was small sample size. Conclusions Despite a lack of statistical significance, the 54% reduced odds of EAO and the significantly faster shock recovery suggest there might be treatment benefits from earlier application of the NASG for women experiencing delays obtaining definitive treatment for hypovolemic shock. As there are no other tools for shock management outside of referral facilities, and no safety issues found, consideration of NASGs as a temporizing measure during delays may be warranted. A pragmatic study with rigorous evaluation is

  7. Household Size and Water Availability as Demographic Predictors of Maternal and Child Mortality in Delta State: Implications for Health Education

    ERIC Educational Resources Information Center

    Ogbe, Joseph O.

    2010-01-01

    The purpose of this study was to stimulate action to address and identify maternal, child and community needs towards the improvement in health of pregnant women, children and communities. Four null hypotheses were generated from the research questions while multiple regression analysis was used to analyse the data. The study found that household…

  8. Maternal and Antenatal Risk Factors for Stillbirths and Neonatal Mortality in Rural Bangladesh: A Case-Control Study

    PubMed Central

    Owais, Aatekah; Faruque, Abu Syed Golam; Das, Sumon K.; Ahmed, Shahnawaz; Rahman, Shahed; Stein, Aryeh D.

    2013-01-01

    Objective To identify maternal and antenatal factors associated with stillbirths and neonatal deaths in rural Bangladesh. Study Design A prospective cohort study is being conducted to evaluate a maternal and child nutrition program in rural Bangladesh. Cases were all stillbirths and neonatal deaths that occurred in the cohort between March 7, 2011 and December 30, 2011. Verbal autopsies were used to determine cause of death. For each case, four controls were randomly selected from cohort members alive at age 3-months. Multivariable logistic regression was used to identify factors associated with these deaths. Results Overall, 112 adverse pregnancy outcomes (44 stillbirths, 19/1,000 births; 68 neonatal deaths, 29/1,000 live births) were reported. Of the stillbirths 25 (56.8%) were fresh. The main causes of neonatal death were birth asphyxia (35%), sepsis (28%) and preterm birth (19%). History of bleeding during pregnancy was the strongest risk factor for stillbirths (adjusted odds ratio 22.4 [95% confidence interval 2.5, 197.5]) and neonatal deaths (adjusted odds ratio 19.6 [95% confidence interval 2.1, 178.8]). Adequate maternal nutrition was associated with decreased risk of neonatal death (adjusted odds ratio 0.4 [95% confidence interval 0.2, 0.8]). Conclusions Identifying high-risk pregnancies during gestation and ensuring adequate antenatal and obstetric care needs to be a priority for any community-based maternal and child health program in similar settings. PMID:24244638

  9. Price and maternal obesity influence purchasing of low- and high-energy-dense foods2

    PubMed Central

    Epstein, Leonard H; Dearing, Kelly K; Paluch, Rocco A; Roemmich, James N; Cho, David

    2007-01-01

    Background Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. Objective We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother’s food purchases in a laboratory food-purchasing analogue. Design Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). Results Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). Conclusion These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods. PMID:17921365

  10. Maternal investment of female mallards is influenced by male carotenoid-based coloration

    PubMed Central

    Giraudeau, M.; Duval, C.; Czirják, G. Á.; Bretagnolle, V.; Eraud, C.; McGraw, K. J.; Heeb, P.

    2011-01-01

    The differential allocation hypothesis predicts that females modify their investment in a breeding attempt according to its reproductive value. One prediction of this hypothesis is that females will increase reproductive investment when mated to high-quality males. In birds, it was shown that females can modulate pre-hatch reproductive investment by manipulating egg and clutch sizes and/or the concentrations of egg internal compounds according to paternal attractiveness. However, the differential allocation of immune factors has seldom been considered, particularly with an experimental approach. The carotenoid-based ornaments can function as reliable signals of quality, indicating better immunity or ability to resist parasites. Thus, numerous studies show that females use the expression of carotenoid-based colour when choosing mates; but the influence of this paternal coloration on maternal investment decisions has seldom been considered and has only been experimentally studied with artificial manipulation of male coloration. Here, we used dietary carotenoid provisioning to manipulate male mallard (Anas platyrhynchos) bill coloration, a sexually selected trait, and followed female investment. We show that an increase of male bill coloration positively influenced egg mass and albumen lysozyme concentration. By contrast, yolk carotenoid concentration was not affected by paternal ornamentation. Maternal decisions highlighted in this study may influence chick survival and compel males to maintain carotenoid-based coloration from the mate-choice period until egg-laying has been finished. PMID:20843851

  11. Maternal investment of female mallards is influenced by male carotenoid-based coloration.

    PubMed

    Giraudeau, M; Duval, C; Czirják, G A; Bretagnolle, V; Eraud, C; McGraw, K J; Heeb, P

    2011-03-01

    The differential allocation hypothesis predicts that females modify their investment in a breeding attempt according to its reproductive value. One prediction of this hypothesis is that females will increase reproductive investment when mated to high-quality males. In birds, it was shown that females can modulate pre-hatch reproductive investment by manipulating egg and clutch sizes and/or the concentrations of egg internal compounds according to paternal attractiveness. However, the differential allocation of immune factors has seldom been considered, particularly with an experimental approach. The carotenoid-based ornaments can function as reliable signals of quality, indicating better immunity or ability to resist parasites. Thus, numerous studies show that females use the expression of carotenoid-based colour when choosing mates; but the influence of this paternal coloration on maternal investment decisions has seldom been considered and has only been experimentally studied with artificial manipulation of male coloration. Here, we used dietary carotenoid provisioning to manipulate male mallard (Anas platyrhynchos) bill coloration, a sexually selected trait, and followed female investment. We show that an increase of male bill coloration positively influenced egg mass and albumen lysozyme concentration. By contrast, yolk carotenoid concentration was not affected by paternal ornamentation. Maternal decisions highlighted in this study may influence chick survival and compel males to maintain carotenoid-based coloration from the mate-choice period until egg-laying has been finished. PMID:20843851

  12. Influences on the quality of young children's diets: the importance of maternal food choices.

    PubMed

    Fisk, Catherine M; Crozier, Sarah R; Inskip, Hazel M; Godfrey, Keith M; Cooper, Cyrus; Robinson, Siân M

    2011-01-01

    It is recognised that eating habits established in early childhood may track into adult life. Developing effective interventions to promote healthier patterns of eating throughout the life course requires a greater understanding of the diets of young children and the factors that influence early dietary patterns. In a longitudinal UK cohort study, we assessed the diets of 1640 children at age 3 years using an interviewer-administered FFQ and examined the influence of maternal and family factors on the quality of the children's diets. To describe dietary quality, we used a principal components analysis-defined pattern of foods that is consistent with healthy eating recommendations. This was termed a 'prudent' diet pattern and was characterised by high intakes of fruit, vegetables and wholemeal bread, but by low intakes of white bread, confectionery, chips and roast potatoes. The key influence on the quality of the children's diets was the quality of their mother's diets; alone it accounted for almost a third of the variance in child's dietary quality. Mothers who had better-quality diets, which complied with dietary recommendations, were more likely to have children with comparable diets. This relationship remained strong even after adjustment for all other factors considered, including maternal educational attainment, BMI and smoking, and the child's birth order and the time spent watching television. Our data provide strong evidence of shared family patterns of diet and suggest that interventions to improve the quality of young women's diets could be effective in improving the quality of their children's diets. PMID:20807465

  13. Mode of delivery and other maternal factors influence the acquisition of Streptococcus mutans in infants.

    PubMed

    Li, Y; Caufield, P W; Dasanayake, A P; Wiener, H W; Vermund, S H

    2005-09-01

    S. mutans plays a key role in dental caries. The extent to which perinatal events influence the acquisition of S. mutans is unclear. We hypothesized that several maternal factors, including the mode of delivery, influence the initial acquisition of S. mutans in infants. A prospective cohort study was conducted in 156 mother-infant pairs. The study found that maternal gestational age (p = 0.04), S. mutans level (p = 0.02), caries score (p = 0.02), sexually transmitted disease (STD) infection experience (p = 0.01), and family income (p = 0.03) had significant effects on the acquisition of S. mutans. Among infants who became infected, those delivered by Caesarean section acquired S. mutans 11.7 mos earlier than did vaginally delivered infants (p = 0.038). C-section infants harbored a single genotype of S. mutans that was identical to that of their mothers (100% fidelity). Analysis of the data demonstrated the possible perinatal influences on infants' acquisition of a member of the cariogenic microbiota, and its potential effect on caries outcome.

  14. Influence of maternal health literacy on child participation in social welfare programs: the Philadelphia experience.

    PubMed

    Pati, Susmita; Mohamad, Zeinab; Cnaan, Avital; Kavanagh, Jane; Shea, Judy A

    2010-09-01

    We examined the influence of maternal health literacy on child participation in social welfare programs. In this cohort, 20% of the mothers had inadequate or marginal health literacy. Initially, more than 50% of the families participated in Temporary Assistance for Needy Families (TANF), the Food Stamp Program, and Special Supplemental Nutrition Program for Women, Infants, and Children, whereas fewer than 15% received child care subsidies or public housing. In multivariate regression, TANF participation was more than twice as common among children whose mothers had adequate health literacy compared with children whose mothers had inadequate health literacy.

  15. Maternal melatonin treatment influences rates of neonatal development of meadow vole pups.

    PubMed

    Lee, T M; Spears, N; Tuthill, C R; Zucker, I

    1989-03-01

    Meadow vole dams, housed in a 14L:10D photoperiod were injected daily 3 h before onset of darkness with 10 micrograms melatonin. Treatment during gestation or lactation produced offspring that exhibited altered somatic, testicular, and pelage growth. Gestational melatonin treatment decreased preweaning weight gain, delayed testicular development, and increased pelage growth in offspring, whereas melatonin treatment during lactation increased pelage depth at weaning and increased post-weaning somatic growth. These results suggest that pre- and postnatal maternal melatonin secretory patterns influence postnatal development of photosensitive traits in offspring. PMID:2667649

  16. Indigenous Ethnicity and Low Maternal Education Are Associated with Delayed Diagnosis and Mortality in Infants with Congenital Heart Defects in Panama

    PubMed Central

    Zúñiga, Julio; Higuera, Gladys; Carrión Donderis, María; Gómez, Beatriz; Motta, Jorge

    2016-01-01

    Background This is the first study in Panama and Central America that has included indigenous populations in an assessment of the association between socioeconomic variables with delayed diagnosis and mortality due to congenital heart defects (CHD). Methods A retrospective observational study was conducted. A sample calculation was performed and 954 infants born from 2010 to 2014 were randomly selected from clinical records of all Panamanian public health institutions with paediatric cardiologists. Critical CHD was defined according to the defects listed as targets of newborn pulse oximetry screening. Diagnoses were considered delayed when made after the third day of life for the critical CHD and after the twentieth day of life for the non-critical. A logistic regression model was performed to examine the association between socioeconomic variables and delayed diagnosis. A Cox proportional hazards model was used to assess the relationship between socioeconomic features and mortality. Results An increased risk of delayed diagnosis was observed in infants with indigenous ethnicity (AOR, 1.56; 95% CI, 1.03–2.37), low maternal education (AOR, 1.57; 95% CI, 1.09–2.25) and homebirth (AOR, 4.32; 95% CI, 1.63–11.48). Indigenous infants had a higher risk of dying due to CHD (HR, 1.43; 95% CI, 1.03–1.99), as did those with low maternal education (HR, 1.95; 95% CI, 1.45–2.62). Conclusion Inequalities in access to health care, conditioned by unfavourable socioeconomic features, may play a key role in delayed diagnosis and mortality of CHD patients. Further studies are required to study the relationship between indigenous ethnicity and these adverse health outcomes. PMID:27648568

  17. Influence of prenatal maternal stress on umbilical cord blood cytokine levels

    PubMed Central

    Andersson, Niklas W.; Li, Qian; Mills, Carrie W.; Ly, Jenny; Chen, Jia

    2016-01-01

    Purpose Prenatal maternal stress (PNMS) is known to influence fetal programming and development. Thus far, the effects of PNMS on the developing immune system have mainly been documented in animal studies. This study aimed to examine the association between PNMS and immune cytokine profiles in the umbilical cord blood of newborn human infants. Methods PNMS, including perceived stress, numbers of stressful life events experiences (both partner and health related), and state and trait anxiety, was assessed with five questionnaires and interviews from 43 pregnant women during the second trimester. Seven key cytokines important for immune function, i.e., IL-12, IL-1β, IL-4, IL-5, IL-6, IL-8, and TNF-α, were analyzed in cord blood by bead-based ELISA method (Luminex 200). Logistic regression was used to estimate the associations of PNMS scores and cytokine levels. Results Increased levels of IL-1β, IL-4, IL-5, IL-6, and IL-8 were significantly associated with at least one of the maternal stress assessments, while the levels of IL-12 and TNF-α were not significantly associated with any of the PNMS measurements examined. Conclusion These preliminary findings suggest that PNMS may influence cytokine levels in newborn infants, in particular Th2-related cytokines. This report supports previous findings in animal studies and could suggest that newborns born to mothers with elevated PNMS have a predisposition to immune-related disorders. PMID:26846778

  18. The fitness of dispersing spotted hyaena sons is influenced by maternal social status.

    PubMed

    Höner, Oliver P; Wachter, Bettina; Hofer, Heribert; Wilhelm, Kerstin; Thierer, Dagmar; Trillmich, Fritz; Burke, Terry; East, Marion L

    2010-01-01

    Life history theory predicts that mothers should provide their offspring with a privileged upbringing if this enhances their offspring's and their own fitness. In many mammals, high-ranking mothers provide their offspring with a privileged upbringing. Whether dispersing sons gain fitness benefits during adulthood from such privileges (a 'silver spoon' effect) has rarely been examined. In this paper, we show that in the complex, female-dominated society of spotted hyaenas, high-born sons grew at higher rates, were more likely to disperse to clans offering the best fitness prospects, started reproducing earlier and had a higher reproductive value than did lower-born sons. This illustrates the evolutionary importance of maternal effects even in societies in which male size or fighting ability does not influence fitness. By demonstrating for the first time in a non-human mammal that maternal status influences immigration patterns, the study also advances our understanding of two key ecological and evolutionary processes, dispersal and habitat selection. PMID:20975715

  19. Pre-reproductive maternal enrichment influences offspring developmental trajectories: motor behavior and neurotrophin expression

    PubMed Central

    Caporali, Paola; Cutuli, Debora; Gelfo, Francesca; Laricchiuta, Daniela; Foti, Francesca; De Bartolo, Paola; Mancini, Laura; Angelucci, Francesco; Petrosini, Laura

    2014-01-01

    Environmental enrichment is usually applied immediately after weaning or in adulthood, with strong effects on CNS anatomy and behavior. To examine the hypothesis that a pre-reproductive environmental enrichment of females could affect the motor development of their offspring, female rats were reared in an enriched environment from weaning to sexual maturity, while other female rats used as controls were reared under standard conditions. Following mating with standard-reared males, all females were housed individually. To evaluate the eventual transgenerational influence of positive pre-reproductive maternal experiences, postural and motor development of male pups was analyzed from birth to weaning. Moreover, expression of Brain Derived Neurotrophic Factor and Nerve Growth Factor in different brain regions was evaluated at birth and weaning. Pre-reproductive environmental enrichment of females affected the offspring motor development, as indicated by the earlier acquisition of complex motor abilities displayed by the pups of enriched females. The earlier acquisition of motor abilities was associated with enhanced neurotrophin levels in striatum and cerebellum. In conclusion, maternal positive experiences were transgenerationally transmitted, and influenced offspring phenotype at both behavioral and biochemical levels. PMID:24910599

  20. Pre-reproductive maternal enrichment influences offspring developmental trajectories: motor behavior and neurotrophin expression.

    PubMed

    Caporali, Paola; Cutuli, Debora; Gelfo, Francesca; Laricchiuta, Daniela; Foti, Francesca; De Bartolo, Paola; Mancini, Laura; Angelucci, Francesco; Petrosini, Laura

    2014-01-01

    Environmental enrichment is usually applied immediately after weaning or in adulthood, with strong effects on CNS anatomy and behavior. To examine the hypothesis that a pre-reproductive environmental enrichment of females could affect the motor development of their offspring, female rats were reared in an enriched environment from weaning to sexual maturity, while other female rats used as controls were reared under standard conditions. Following mating with standard-reared males, all females were housed individually. To evaluate the eventual transgenerational influence of positive pre-reproductive maternal experiences, postural and motor development of male pups was analyzed from birth to weaning. Moreover, expression of Brain Derived Neurotrophic Factor and Nerve Growth Factor in different brain regions was evaluated at birth and weaning. Pre-reproductive environmental enrichment of females affected the offspring motor development, as indicated by the earlier acquisition of complex motor abilities displayed by the pups of enriched females. The earlier acquisition of motor abilities was associated with enhanced neurotrophin levels in striatum and cerebellum. In conclusion, maternal positive experiences were transgenerationally transmitted, and influenced offspring phenotype at both behavioral and biochemical levels.

  1. Fetal exposure to maternal stress and risk for schizophrenia spectrum disorders among offspring: Differential influences of fetal sex.

    PubMed

    Fineberg, Anna M; Ellman, Lauren M; Schaefer, Catherine A; Maxwell, Seth D; Shen, Ling; H Chaudhury, Nashid; Cook, Aundrea L; Bresnahan, Michaeline A; Susser, Ezra S; Brown, Alan S

    2016-02-28

    Exposure to adverse life events during pregnancy has been linked to increased risk of schizophrenia spectrum disorders (SSD) in offspring. Nevertheless, much of the previous work inferred maternal stress from severe life events rather than directly assessing maternal reports of stress. The present study aimed to examine maternal reports of stress during pregnancy and risk for offspring SSD. Participants were 95 SSD cases and 206 controls who were offspring from a large birth cohort study that followed pregnant women from 1959 to 1966. During pregnancy interviews, women were asked if anything worrisome had occurred recently. Interviews were qualitatively coded for stress-related themes, including reports of daily life stress, by two independent raters. None of the maternal psychosocial stress themes were significantly associated with increased odds of offspring SSD in analyses of the full sample. However, results indicated a significant daily life stress by infant sex interaction. Maternal daily life stress during pregnancy was associated with significantly increased odds of SSD among male offspring. Findings suggest sex-specific fetal sensitivity to maternal reported daily life stress during pregnancy on risk for SSD, with males appearing to be more vulnerable to the influences of maternal stress during pregnancy. PMID:26753951

  2. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

    PubMed Central

    Taş, İlhan; Ülger, Burak Veli; Önder, Akın; Kapan, Murat; Bozdağ, Zübeyir

    2015-01-01

    Objective: Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. Material and Methods: Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. Results: The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Conclusion: Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation. PMID:25931940

  3. The Influence of Hospital Market Competition on Patient Mortality and Total Performance Score.

    PubMed

    Haley, Donald Robert; Zhao, Mei; Spaulding, Aaron; Hamadi, Hanadi; Xu, Jing; Yeomans, Katelyn

    2016-01-01

    The Affordable Care Act of 2010 launch of Medicare Value-Based Purchasing has become the platform for payment reform. It is a mechanism by which buyers of health care services hold providers accountable for high-quality and cost-effective care. The objective of the study was to examine the relationship between quality of hospital care and hospital competition using the quality-quantity behavioral model of hospital behavior. The quality-quantity behavioral model of hospital behavior was used as the conceptual framework for this study. Data from the American Hospital Association database, the Hospital Compare database, and the Area Health Resources Files database were used. Multivariate regression analysis was used to examine the effect of hospital competition on patient mortality. Hospital market competition was significantly and negatively related to the 3 mortality rates. Consistent with the literature, hospitals located in more competitive markets had lower mortality rates for patients with acute myocardial infarction, heart failure, and pneumonia. The results suggest that hospitals may be more readily to compete on quality of care and patient outcomes. The findings are important because policies that seek to control and negatively influence a competitive hospital environment, such as Certificate of Need legislation, may negatively affect patient mortality rates. Therefore, policymakers should encourage the development of policies that facilitate a more competitive and transparent health care marketplace to potentially and significantly improve patient mortality.

  4. Factors Influencing The Six-Month Mortality Rate In Patients With A Hip Fracture

    PubMed Central

    Ristic, Branko; Rancic, Nemanja; Bukumiric, Zoran; Zeljko, Stepanovic; Ignjatovic-Ristic, Dragana

    2016-01-01

    Abstract Background There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients. Methods The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study. Results Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease. Conclusion Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened. PMID:27284379

  5. The Influence of Hospital Market Competition on Patient Mortality and Total Performance Score.

    PubMed

    Haley, Donald Robert; Zhao, Mei; Spaulding, Aaron; Hamadi, Hanadi; Xu, Jing; Yeomans, Katelyn

    2016-01-01

    The Affordable Care Act of 2010 launch of Medicare Value-Based Purchasing has become the platform for payment reform. It is a mechanism by which buyers of health care services hold providers accountable for high-quality and cost-effective care. The objective of the study was to examine the relationship between quality of hospital care and hospital competition using the quality-quantity behavioral model of hospital behavior. The quality-quantity behavioral model of hospital behavior was used as the conceptual framework for this study. Data from the American Hospital Association database, the Hospital Compare database, and the Area Health Resources Files database were used. Multivariate regression analysis was used to examine the effect of hospital competition on patient mortality. Hospital market competition was significantly and negatively related to the 3 mortality rates. Consistent with the literature, hospitals located in more competitive markets had lower mortality rates for patients with acute myocardial infarction, heart failure, and pneumonia. The results suggest that hospitals may be more readily to compete on quality of care and patient outcomes. The findings are important because policies that seek to control and negatively influence a competitive hospital environment, such as Certificate of Need legislation, may negatively affect patient mortality rates. Therefore, policymakers should encourage the development of policies that facilitate a more competitive and transparent health care marketplace to potentially and significantly improve patient mortality. PMID:27455368

  6. The influence of maternal health literacy and child's age on participation in social welfare programs.

    PubMed

    Pati, Susmita; Siewert, Elizabeth; Wong, Angie T; Bhatt, Suraj K; Calixte, Rose E; Cnaan, Avital

    2014-07-01

    The objective of this study is to determine the influence of maternal health literacy and child's age on participation in social welfare programs benefiting children. In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the test of functional health literacy in adults (short version). Participation in social welfare programs [Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), child care subsidy, and public housing] was self-reported at child's birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. The mothers were primarily African-Americans (83%), single (87%), with multiple children (62%). Nearly 24% of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR = 0.54, 95% CI 0.34-0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age.

  7. The influence of maternal health literacy and child's age on participation in social welfare programs.

    PubMed

    Pati, Susmita; Siewert, Elizabeth; Wong, Angie T; Bhatt, Suraj K; Calixte, Rose E; Cnaan, Avital

    2014-07-01

    The objective of this study is to determine the influence of maternal health literacy and child's age on participation in social welfare programs benefiting children. In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the test of functional health literacy in adults (short version). Participation in social welfare programs [Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), child care subsidy, and public housing] was self-reported at child's birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. The mothers were primarily African-Americans (83%), single (87%), with multiple children (62%). Nearly 24% of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR = 0.54, 95% CI 0.34-0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age. PMID:23990157

  8. Temperature Influences Selective Mortality during the Early Life Stages of a Coral Reef Fish

    PubMed Central

    Rankin, Tauna L.; Sponaugle, Su

    2011-01-01

    For organisms with complex life cycles, processes occurring at the interface between life stages can disproportionately impact survival and population dynamics. Temperature is an important factor influencing growth in poikilotherms, and growth-related processes are frequently correlated with survival. We examined the influence of water temperature on growth-related early life history traits (ELHTs) and differential mortality during the transition from larval to early juvenile stage in sixteen monthly cohorts of bicolor damselfish Stegastes partitus, sampled on reefs of the upper Florida Keys, USA over 6 years. Otolith analysis of settlers and juveniles coupled with environmental data revealed that mean near-reef water temperature explained a significant proportion of variation in pelagic larval duration (PLD), early larval growth, size-at-settlement, and growth during early juvenile life. Among all cohorts, surviving juveniles were consistently larger at settlement, but grew more slowly during the first 6 d post-settlement. For the other ELHTs, selective mortality varied seasonally: during winter and spring months, survivors exhibited faster larval growth and shorter PLDs, whereas during warmer summer months, selection on PLD reversed and selection on larval growth became non-linear. Our results demonstrate that temperature not only shapes growth-related traits, but can also influence the direction and intensity of selective mortality. PMID:21559305

  9. Enterococcal bacteraemia: factors influencing mortality, length of stay and costs of hospitalization.

    PubMed

    Cheah, A L Y; Spelman, T; Liew, D; Peel, T; Howden, B P; Spelman, D; Grayson, M L; Nation, R L; Kong, D C M

    2013-04-01

    Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95% CI, 3.99-18.38), a higher burden of co-morbidities (OR, 4.55; 95% CI, 1.83-11.33) and longer time to appropriate antibiotics (OR, 1.02; 95% CI, 1.01-1.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89 days; 95% CI, 0.56-11.52) and hospitalization costs (AU$ 28 872; 95% CI, 734-70 667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95% CI, 0.03-0.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.

  10. Influence of maternally-derived antibodies on live attenuated influenza vaccine efficacy in pigs.

    PubMed

    Pyo, Hyun Mi; Hlasny, Magda; Zhou, Yan

    2015-07-17

    Vaccination during pregnancy is practiced in swine farms as one measure to control swine influenza virus (SIV) infection in piglets at an early age. Vaccine-induced maternal antibodies transfer to piglets through colostrum and stabilize the herd: however, maternally derived antibodies (MDA) interfere with immune response following influenza vaccination in piglets at the later stage of life. In addition, MDA is related to enhanced respiratory disease in SIV infection. Previously, we have developed a bivalent live attenuated influenza vaccine (LAIV) which harbors both H1 and H3 HAs. We demonstrated vaccination of this LAIV provided protection to homologous and heterologous SIV infection in pigs. In this study we aimed to investigate the influence of MDA on LAIV efficacy. To this end, SIV sero-negative sows were vaccinated with a commercial vaccine. After parturition, nursery piglets were vaccinated with LAIV intranasally or intramuscularly, and were then challenged with SIV. We report that MDA hampered serum antibody response induced by intramuscular vaccination but not by intranasal vaccination of the LAIV. Viral challenge in the presence of MDA caused exacerbated respiratory disease in unvaccinated piglets. In contrast, all LAIV vaccinated piglets were protected from homologous viral infection regardless of the route of vaccination and the presence of MDA. Our results demonstrated that LAIV conferred protection in the presence of MDA without inciting exacerbated respiratory disease.

  11. Influence of parental deprivation on the behavioral development in Octodon degus: modulation by maternal vocalizations.

    PubMed

    Braun, Katharina; Kremz, Petra; Wetzel, Wolfram; Wagner, Thomas; Poeggel, Gerd

    2003-04-01

    Repeated separation from the family during very early stages of life is a stressful emotional experience which induces a variety of neuronal and synaptic changes in limbic cortical areas that may be related to behavioral alterations. First, we investigated whether repeated parental separation and handling, without separation from the family, leads to altered spontaneous exploratory behavior in a novel environment (open field test) in 8-day-old Octodon degus. Second, we tested whether the parentally deprived and handled animals display different stimulus-evoked exploratory behaviors in a modified open field version, in which a positive emotional stimulus, the maternal call, was presented. In the open field test a significant influence of previous emotional experience was found for the parameters of running, rearing, and vocalization. Parentally deprived degus displayed increased horizontal (running) and vertical (rearing) motoric activities, but decreased vocalization, compared to normal and handled controls. The presentation of maternal vocalizations significantly modified running, vocalization, and grooming activities, which in the case of running activity was dependent on previous emotional experience. Both deprivation-induced locomotor hyperactivity together with the reduced behavioral response towards a familiar acoustic emotional signal are similar to behavioral disturbances observed in human attachment disorders.

  12. Maternal influences on seed mass effect and initial seedling growth in four Quercus species

    NASA Astrophysics Data System (ADS)

    González-Rodríguez, Victoria; Villar, Rafael; Navarro-Cerrillo, Rafael M.

    2011-01-01

    Seed mass represents the reserves available for growth in the first stages of plant establishment. Variation in seed mass is an important trait which may have consequences for growth and survival of seedlings. Three mechanisms have been proposed to explain how seed mass influences seedling development: the reserve use effect, the metabolic effect and the seedling-size effect. Few studies have evaluated at the same time the three hypotheses within species and none have evaluated the effect of the mother trees. We studied four Quercus species by selecting five mother trees per species. Seeds were sown in a glasshouse and the use of seed reserves, seedling growth and morphology were measured. Considering all mothers of the same species together, we did not find the reserve effect for any species, the metabolic effect was observed in all species except for Quercus suber, and the seedling-size effect was matched for all the species. Within species, maternal origin modified the studied relationships and thus the studied mechanisms as we did not observe seed mass effects on all mothers from each species. Moreover, the metabolic effect was not found in any mother of Quercus ilex and Quercus faginea. We concluded that a maternal effect can change seed mass relationships with traits related to seedling establishment. The conservation of this high intra-specific variability must be considered to guarantee species performance in heterogeneous environments and in particular in the current context of climate change.

  13. Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival.

    PubMed

    Smith, Stephanie L; Shiffman, Jeremy

    2016-10-01

    This study investigates a puzzle concerning global health priorities-why do comparable issues receive differential levels of attention and resources? It considers maternal and neonatal mortality, two high-burden issues that pertain to groups at risk at birth and whose lives could be saved with effective intrapartum care. Why did maternal survival gain status as a global health priority earlier and to a greater degree than newborn survival? Higher mortality and morbidity burdens among newborns and the cost-effectiveness of interventions would seem to predict that issue's earlier and higher prioritization. Yet maternal survival emerged as a priority two decades earlier and had attracted considerably more attention and resources by the close of the Millennium Development Goals era. This study uses replicative process-tracing case studies to examine the emergence and growth of political priority for these two issues, probing reasons for unexpected variance. The study finds that maternal survival's grounding as a social justice issue spurred growth of a strong and diverse advocacy network and aligned the issue with powerful international norms (e.g. expectations to advance women's rights and the Millennium Development Goals), drawing attention and resources to the issue over three decades. Newborn survival's disadvantage stems from its long status as an issue falling under the umbrellas of maternal and child survival but not fully adopted by these networks, and with limited appeal as a public health issue advanced by a small and technically focused network; network expansion and alignment with child survival norms have improved the issue's status in the past few years.

  14. Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival.

    PubMed

    Smith, Stephanie L; Shiffman, Jeremy

    2016-10-01

    This study investigates a puzzle concerning global health priorities-why do comparable issues receive differential levels of attention and resources? It considers maternal and neonatal mortality, two high-burden issues that pertain to groups at risk at birth and whose lives could be saved with effective intrapartum care. Why did maternal survival gain status as a global health priority earlier and to a greater degree than newborn survival? Higher mortality and morbidity burdens among newborns and the cost-effectiveness of interventions would seem to predict that issue's earlier and higher prioritization. Yet maternal survival emerged as a priority two decades earlier and had attracted considerably more attention and resources by the close of the Millennium Development Goals era. This study uses replicative process-tracing case studies to examine the emergence and growth of political priority for these two issues, probing reasons for unexpected variance. The study finds that maternal survival's grounding as a social justice issue spurred growth of a strong and diverse advocacy network and aligned the issue with powerful international norms (e.g. expectations to advance women's rights and the Millennium Development Goals), drawing attention and resources to the issue over three decades. Newborn survival's disadvantage stems from its long status as an issue falling under the umbrellas of maternal and child survival but not fully adopted by these networks, and with limited appeal as a public health issue advanced by a small and technically focused network; network expansion and alignment with child survival norms have improved the issue's status in the past few years. PMID:27543685

  15. Influence of pesticide use in fruit orchards during blooming on honeybee mortality in 4 experimental apiaries.

    PubMed

    Calatayud-Vernich, Pau; Calatayud, Fernando; Simó, Enrique; Suarez-Varela, Maria Morales; Picó, Yolanda

    2016-01-15

    Samples of dead honey bees (Apis mellifera L.) were collected periodically from 4 different locations during citrus and stone fruit trees blooming season to evaluate the potential impact of agrochemicals on honey bee death rate. For the determination of mortality, dead honey bee traps were placed in front of the experimental hives entrance located in areas of intensive agriculture in Valencian Community (Spain). A total of 34 bee samples, obtained along the monitoring period, were analyzed by means of QuEChERS extraction method and screened for 58 pesticides or their degradation products by LC-MS/MS. An average of four pesticides per honey bee sample was detected. Coumaphos, an organophosphate acaricide used against varroosis in the experimental hives, was detected in 94% of the samples. However, this acaricide was unlikely to be responsible for honey bee mortality because its constantly low concentration during all the monitoring period, even before and after acute mortality episodes. The organophosphates chlorpyrifos and dimethoate, as well as the neonicotinoid imidacloprid, were the most frequently detected agrochemicals. Almost 80% of the samples had chlorpyrifos, 68% dimethoate, and 32% imidacloprid. Maximum concentrations for these three compounds were 751, 403, 223 ng/g respectively. Influence of these pesticides on acute honey bee mortality was demonstrated by comparing coincidence between death rate and concentrations of chlorpyrifos, dimethoate and imidacloprid. PMID:26398448

  16. Influence of pesticide use in fruit orchards during blooming on honeybee mortality in 4 experimental apiaries.

    PubMed

    Calatayud-Vernich, Pau; Calatayud, Fernando; Simó, Enrique; Suarez-Varela, Maria Morales; Picó, Yolanda

    2016-01-15

    Samples of dead honey bees (Apis mellifera L.) were collected periodically from 4 different locations during citrus and stone fruit trees blooming season to evaluate the potential impact of agrochemicals on honey bee death rate. For the determination of mortality, dead honey bee traps were placed in front of the experimental hives entrance located in areas of intensive agriculture in Valencian Community (Spain). A total of 34 bee samples, obtained along the monitoring period, were analyzed by means of QuEChERS extraction method and screened for 58 pesticides or their degradation products by LC-MS/MS. An average of four pesticides per honey bee sample was detected. Coumaphos, an organophosphate acaricide used against varroosis in the experimental hives, was detected in 94% of the samples. However, this acaricide was unlikely to be responsible for honey bee mortality because its constantly low concentration during all the monitoring period, even before and after acute mortality episodes. The organophosphates chlorpyrifos and dimethoate, as well as the neonicotinoid imidacloprid, were the most frequently detected agrochemicals. Almost 80% of the samples had chlorpyrifos, 68% dimethoate, and 32% imidacloprid. Maximum concentrations for these three compounds were 751, 403, 223 ng/g respectively. Influence of these pesticides on acute honey bee mortality was demonstrated by comparing coincidence between death rate and concentrations of chlorpyrifos, dimethoate and imidacloprid.

  17. Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring

    PubMed Central

    Desarnaud, Frank; Bader, Heather N.; Makotkine, Iouri; Flory, Janine D.; Bierer, Linda M.; Meaney, Michael J.

    2014-01-01

    Objective Differential effects of maternal and paternal PTSD have been observed in adult offspring of Holocaust survivors in both glucocorticoid receptor sensitivity and vulnerability to psychiatric disorder. The current study examined the relative influences of maternal and paternal PTSD on DNA methylation of the exon 1F promoter of the glucocorticoid receptor gene (NR3C1) in peripheral blood mononuclear cells (PBMCs), and its relationship to glucocorticoid receptor sensitivity, in Holocaust offspring. Method Adult offspring with at least one Holocaust survivor parent (n=80), and demographically similar participants without parental Holocaust exposure or PTSD (n=15) completed clinical interviews, self-report measures, and biological procedures. Blood samples were collected for analysis of glucocorticoid receptor gene exon 1F (GR-1F) promoter methylation and cortisol levels in response to low-dose dexamethasone, and two-way analysis of covariance was performed using maternal and paternal PTSD as main effects. Hierarchical-clustering analysis was used to permit visualization of maternal vs. paternal PTSD effects on clinical variables. Results A significant interaction demonstrated that in the absence of maternal PTSD, offspring with paternal PTSD showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation. Lower GR-1F promoter methylation was significantly associated with greater post-dexamethasone cortisol suppression. The clustering analysis confirmed that maternal and paternal PTSD effects were differentially associated with clinical indicators. Conclusions This is the first study to demonstrate alterations of GR-1F promoter methylation in relation to parental PTSD and neuroendocrine outcomes. The moderation of paternal PTSD effects by maternal PTSD suggests different mechanisms for the intergenerational transmission of trauma-related vulnerabilities. PMID:24832930

  18. Global variance in female population height: the influence of education, income, human development, life expectancy, mortality and gender inequality in 96 nations.

    PubMed

    Mark, Quentin J

    2014-01-01

    Human height is a heritable trait that is known to be influenced by environmental factors and general standard of living. Individual and population stature is correlated with health, education and economic achievement. Strong sexual selection pressures for stature have been observed in multiple diverse populations, however; there is significant global variance in gender equality and prohibitions on female mate selection. This paper explores the contribution of general standard of living and gender inequality to the variance in global female population heights. Female population heights of 96 nations were culled from previously published sources and public access databases. Factor analysis with United Nations international data on education rates, life expectancy, incomes, maternal and childhood mortality rates, ratios of gender participation in education and politics, the Human Development Index (HDI) and the Gender Inequality Index (GII) was run. Results indicate that population heights vary more closely with gender inequality than with population health, income or education.

  19. Direct and Indirect Effects of Maternal and Peer Influences on Sexual Intention among Urban African American and Hispanic Females.

    PubMed

    Barman-Adhikari, Anamika; Cederbaum, Julie; Sathoff, Chelsea; Toro, Rosa

    2014-12-01

    Peer and family influences are interconnected in complex ways. These influences shape adolescent decision-making regarding engagement in sexual behaviors. Evidence indicates the more proximal (and direct) a process is to an individual, the more likely it is to affect his/her development and behavior. Therefore, family factors (e.g., parenting practices) and peer influence (e.g., peer norms) tend to be more strongly associated with adolescent behavior than distal factors (e.g., media or the economy). Guided by an ecological framework, this study explored how maternal influence variables interact with perceptions of peer influence to affect daughters' intentions to have sex. A nonprobability sample of 176 mother-daughter dyads was recruited in clinics and service organizations in the northeastern United States. Results from path analysis revealed that maternal influence variables had a significant indirect relationship with daughters' intentions to have sex through daughters' perceptions of peer influence. Maternal processes can act as protective factors for adolescent girls who perceive their peers are engaged in sexual behaviors. Therefore, risk reduction interventions with adolescents should include opportunities for parents to learn about sex-related issues and develop skills that will allow them to buffer negative peer influence.

  20. The influence of culture on maternal soothing behaviours and infant pain expression in the immunization context

    PubMed Central

    Vinall, Jillian; Pillai Riddell, Rebecca; Greenberg, Saul

    2011-01-01

    OBJECTIVE: To investigate how maternal culture (ie, individualist versus collectivist) influences soothing techniques and infant distress. METHODS: Archival data were analyzed using a subsample of 80 mother-infant dyads selected from a larger database of infant pain expression. RESULTS: Mothers belonging to the individualist group used more affection behaviours when attempting to regulate their infants’ distress. No differences were observed in mothers’ touching, holding, rocking, vocalizing, caregiving or distracting their infants. Mothers’ culture did not appear to be related to the level of distress expressed by their infants. CONCLUSIONS: These results suggest that the similarities in soothing and infant pain expression between individualist and collectivist cultures are more prominent than their differences. PMID:22059192

  1. Maternal understanding of diarrhoea-related dehydration and its influence on ORS use in Indonesia.

    PubMed

    MacDonald, S E; Moralejo, M N D G; Matthews, M K

    2007-01-01

    Dehydration resulting from diarrhoea remains a significant cause of death for young children in developing countries such as Indonesia. Although Oral Rehydration Solution (ORS) is effective in preventing and treating dehydration, its use in home treatment is not widespread. This study sought to assess whether mothers' understanding of diarrhoea-related dehydration influenced their use of ORS in home treatment. One hundred mothers of children under the age of five years in rural Indonesia were surveyed using a structured questionnaire, administered in an interview format in their homes. Only 38 (38%) of the mothers surveyed could identify two or more correct signs of dehydration. Significant relationship was found between maternal knowledge of correct signs of dehydration and the use of ORS in home treatment (OR 3.36, 95% CI 1.24, 10.63). Resulting recommendations include improved health education programming for mothers of young children, as well as future programme evaluation and intervention studies.

  2. Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality.

    PubMed

    Van Lerberghe, Wim; Matthews, Zoe; Achadi, Endang; Ancona, Chiara; Campbell, James; Channon, Amos; de Bernis, Luc; De Brouwere, Vincent; Fauveau, Vincent; Fogstad, Helga; Koblinsky, Marge; Liljestrand, Jerker; Mechbal, Abdelhay; Murray, Susan F; Rathavay, Tung; Rehr, Helen; Richard, Fabienne; ten Hoope-Bender, Petra; Turkmani, Sabera

    2014-09-27

    This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.

  3. Viral competition and maternal immunity influence the clinical disease caused by very virulent infectious bursal disease virus.

    PubMed

    Jackwood, Daral J

    2011-09-01

    The very virulent form of infectious bursal disease virus (vvIBDV) causes an immunosuppressive disease that is further characterized by the rapid onset of morbidity and high mortality in susceptible chickens. In 2009, vvIBDV was first reported in California, U. S. A., and since that time only a few cases of acute infectious bursal disease attributed to vvIBDV have been recognized in California. In other countries where vvIBDV has become established, it rapidly spreads to most poultry-producing regions. Two factors that may be involved in limiting the spread or reducing the severity of the clinical disease caused by vvIBDV in the U. S. A. are maternal immunity and competition with endemic variant strains of the virus. In this study, the ability of vvIBDV to infect and cause disease in maternally immune layer chickens was examined at weekly intervals over a 5-wk period during which their neutralizing maternal antibodies waned. Birds inoculated with vvIBDV at 2, 3, and 4 wk of age seemed healthy throughout the duration of the experiment, but macroscopic and microscopic lesions were observed in their bursa tissues. A real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay also confirmed the presence of vvIBDV RNA in their bursa tissues, indicating this virus was infecting the birds even at 2 wk of age when neutralizing maternal antibodies to infectious bursal disease virus were still relatively high (> 2000 geometric mean antibody titer). No mortality was observed in any birds when inoculated at 2, 3, or 4 wk of age; however, inoculation at 5 and 6 wk of age resulted in 10% and 20% mortality, respectively. Three experiments on the competition between vvIBDV and the two variant viruses T1 and FF6 were conducted. In all three experiments, specific-pathogen-free (SPF) birds that were inoculated with only the vvIBDV became acutely moribund, and except for Experiment 1 (62% mortality) all succumbed to the infection within 4 days of being exposed. When the

  4. The impacts of maternal mortality and cause of death on children’s risk of dying in rural South Africa: evidence from a population based surveillance study (1992-2013)

    PubMed Central

    2015-01-01

    Background Maternal mortality, the HIV/AIDS pandemic, and child survival are closely linked. This study contributes evidence on the impact of maternal death on children’s risk of dying in an HIV-endemic population in rural South Africa. Methods We used data for children younger than 10 years from the Agincourt health and socio-demographic surveillance system (1992 – 2013). We used discrete time event history analysis to estimate children’s risk of dying when they experienced a maternal death compared to children whose mother survived (N=3,740,992 child months). We also examined variation in risk due to cause of maternal death. We defined mother’s survival status as early maternal death (during pregnancy, childbirth, or within 42 days of most recent childbirth or identified cause of death), late maternal death (within 43-365 days of most recent childbirth), any other death, and mothers who survived. Results Children who experienced an early maternal death were at 15 times the risk of dying (RRR 15.2; 95% CI 8.3–27.9) compared to children whose mother survived. Children under 1 month whose mother died an early (p=0.002) maternal death were at increased risk of dying compared to older children. Children whose mothers died of an HIV/AIDS or TB-related early maternal death were at 29 times the risk of dying compared to children with surviving mothers (RRR 29.2; 95% CI 11.7–73.1). The risk of these children dying was significantly higher than those children whose mother died of a HIV/AIDS or TB-related non-maternal death (p=0.017). Conclusions This study contributes further evidence on the impact of a mother’s death on child survival in a poor, rural setting with high HIV prevalence. The intersecting epidemics of maternal mortality and HIV/AIDS – especially in sub-Saharan Africa – have profound implications for maternal and child health and well-being. Such evidence can help guide public and primary health care practice and interventions. PMID:26000547

  5. Maternal Modeling and the Acquisition of Fear and Avoidance in Toddlers: Influence of Stimulus Preparedness and Child Temperament

    ERIC Educational Resources Information Center

    Dubi, Kathrin; Rapee, Ronald M.; Emerton, Jane L.; Schniering, Carolyn A.

    2008-01-01

    The aim of the present study was to investigate the influence of maternal modeling on the acquisition of fear and avoidance towards fear-relevant and fear-irrelevant, novel stimuli in a sample of 71 toddlers. Children were shown a rubber snake or spider (fear-relevant objects) and a rubber mushroom or flower (fear-irrelevant objects), which were…

  6. Genesee County REACH Windshield Tours: enhancing health professionals understanding of community conditions that influence infant mortality.

    PubMed

    Kruger, Daniel J; French-Turner, Tonya; Brownlee, Shannon

    2013-06-01

    The Genesee County Racial and Ethnic Approaches to Community Health (REACH) program is a community-based program designed to reduce African American infant mortality rates in Flint, Michigan. Genesee County REACH activities address three core themes: fostering community mobilization, reducing racism, and enhancing the maternal-infant health care system. The REACH Community Action Plan was generated using a community-based participatory approach, and is based on a socio-ecological model with interventions focused at the individual, organizational, health system, and community levels. Genesee County REACH's Community Windshield Tours were developed to raise awareness of social and environmental barriers to health promotion among health care system staff in Flint, Michigan. These tours provide a close-up examination of the community's environmental conditions and the experiences of mothers, children, and families at risk for poor birth outcomes. In this article, we report our findings from pre-/post-tour surveys, as well as long-term follow-up surveys, to assess the impact of this REACH activity on participants' knowledge and beliefs about Genesee County residents, and to determine any resultant individual, policy, system, or environmental changes. We used t tests to compare participants' responses before and after the tours. We found that several individual- and systems-level changes have resulted from these tours, reflecting greater cultural sensitivity and increased understanding of patients' circumstances. African American infant mortality rates in Genesee County declined to a historic low in 2005, and they remain lower than in previous years. Although REACH coalition partners recognize that this reduction cannot be attributed to a single intervention or activity, REACH activities such as the Community Windshield Tours addressing multiple levels of the socio-ecological model may have had a synergistic effect.