Maternal Mortality Correlates by Nation

Background: This study reports the results of a secondary analysis of data provided by the World Health Organization to determine the correlates of maternal mortality among all reporting nations worldwide. Historically, maternal mortality ratios have declined in nations that provided a system for access to skilled care for the majority of its women. Currently, maternal mortality ratios are associated with access to skilled care as well as economic indicators, literacy, education, access to contraceptives, transportation and HIV prevalence. Methods: Descriptive statistics, bi-variate correlations and multiple linear regression analyses are reported using maternal mortality ratios as the dependent variable. In addition, an examination of countries that are exceptions to the regression is also reported. Results: Strong positive Pearson two-tailed correlations were found between MMR and infant mortality rate (0.866), total fertility rate (0.854), poverty rate (0.756), and adolescent fertility rate (0.710). Strong negative correlations were found between MMR and percentage of births attended by a skilled attendant (-0.786), percentage of women using contraceptives (-0.786), and adult literacy rate (-0.710). Eighty-one percent of the variation in MMR can be explained by differences in IMR, percent of births attended by a skilled provider, percent of women using contraceptive, total fertility rate, adolescent fertility rate, adult literacy rate and poverty. Discussion: Examination of the correlates of maternal mortality gives direction to the effort to achieve the WHO’s Millennium Development Goal of reducing maternal mortality by two-thirds from 1995-2015.

Maternal Mortality Interventions: A Systematic Review

Background: In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. Methods: This systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers.

Psychological Distress in California: Identifying Those at Greatest Risk

In order to address the unmet need for prevention and treatment of psychological distress and mental disorders, program planners and treatment providers need to identify individuals at high risk. The results of the California Health Interview Survey from 2009 (n = 47,614) indicate that there are high relative risks by demographics and smoking status for reports of psychological distress and intermediate measures: feeling nervous, hopeless, worthless, depressed, restless, and that everything is an effort. Specific demographic factors and smoking status can predict a greater need for prevention and treatment of psychological distress and lack of insurance coverage for treatment. Profiles associated with high risk can help in referral for diagnosis or to plan prevention programs.