Analysis of Maternal Mortality at the Maradi Maternal and Child Health Center/Niger: About 379 Cases

Introduction: Pregnancy, childbirth, and their consequences continue to be the leading cause of death, illness, and disability among women of reproductive age in developing countries. In Niger, maternal deaths account for about 39% of all deaths of women aged 15-49. Our aim was to identify the factors linked to maternal mortality in order to contribute to its reduction. Method: this is a descriptive retrospective study of 379 cases of maternal deaths collected at the Maradi CSME from January 1, 2018, to December 31, 2021.Results: Our study’s maternal mortality ratio is 2645.72 per 100,000 live births. The mean age of our patients was 27.46 years, with extremes ranging from 15 to 47 years. The 20-24 age group was the most represented, with 88 cases (23.2%). Housewives were 361 (95.3%), and 334 patients (88.1%) were uneducated. There were 261 of them from rural areas, i.e. 69%. The mean parity in our study was 3.46, with extremes ranging from 0 to 15. Multiparous patients 117 cases (30.9%) represented the most significant proportion. Only 42 patients (11.08%) had performed four or more antenatal consultations. Direct obstetric causes accounted for 56.73% of the causes of maternal death. Anemia was the leading cause of maternal death (31.66%). Nearly half of the patients had died before 24 hours after admission, i.e. 49.86%. Conclusion: Maternal mortality remains a significant challenge for developing countries, given its magnitude and timid decline. The fight to reduce maternal mortality must be the priority of our countries’ health policies.

Maternal Mortality Rates among Im/Migrant Populations in the United States

Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortality among certain races and ethnicities are known but few studies examine maternal mortality among immigrants. Since immigrants represent 13.7% of the U.S. population, it is essential to examine immigrant subsets to understand maternal mortality among this vulnerable population. Methods: A literature search identified 318 articles on maternal mortality and immigrants, with 12 articles from the U.S. The keywords included maternal mortality, United States, migrants, asylum seekers, immigrants, and disparities. Maternal mortality statistics were obtained from the World Health Organization and Center for Disease Control. Results: Studies analyzed in this review found an overall lower maternal mortality rate among immigrant women compared to U.S.-born women, except for Hispanic immigrant women. Black women had the highest maternal mortality rate, regardless of immigration status. Conclusion: Although the literature points to lower maternal mortality among immigrants, the data is still somewhat mixed, making it challenging to draw comprehensive conclusions. Additional research examining maternal mortality among Im/migrants in the U.S. is needed to guide future training among healthcare professionals and policymakers.

Maternal Hospital Mortality in Cotonou: Incidence, Care-Associated Adverse Events and Causes

Introduction: Despite the many efforts made to combat preventable maternal deaths, these still remain high in Benin. It was therefore important to revisit the causes but especially the adverse events associated with care (EIS) in maternity. Objective: Determine the incidence, adverse events associated with care and causes of intra hospital maternal mortality in cotonou. Methods: This was a cross-sectional maternal mortality review study with retrospective data collection. It covered all cases of maternal death recorded between 2017 and 2021 in two (2) reference university maternities in Cotonou. Adverse events associated with care and the patient were analyzed using the maternal death audit grid validated for Benin. SPSS.26 software was used for data analysis. Results: The in-hospital maternal mortality ratio in Cotonou was 2028 maternal deaths per 100,000 live births in 2021. Only 7.2% (n = 36) of deaths were audited. The deceased mothers were 29.8 ± 7.4 years old, with no fixed monthly income in 82.7% (n = 420). Serious adverse events associated with care were: delay in decision to refer in 37% (n = 188), non-medical referral in 85.8% (n = 436) of cases, inadequate pre-referral treatment in 25.7% of cases. In receiving maternities, delay in diagnosis and inappropriate treatment at the receiving maternity were noted respectively in 22.9% and 28.6% of cases of maternal death. The direct causes of maternal death were dominated by serious obstetric hemorrhage in 43.9% (n = 223). As for the indirect causes, they were dominated by anemia excluding obstetric hemorrhages in 21.5% (n = 109). Conclusion: The in-hospital maternal mortality ratio was very high in Cotonou. The main cause was severe obstetric hemorrhage. There were several serious healthcare-associated adverse events whose correct management would significantly reduce the incidence of maternal deaths.

Evolution and Risk Factors of Maternal Mortality in Cameroon: A Case Control Study

Background: Maternal mortality is still high in sub-Saharan Africa, especially in Cameroon where more efforts to reduce maternal mortality and provide universal access to reproductive health should be made. This study aims to see the evolution of maternal mortality and identify associated risk factors in Laquintinie hospital in Cameroon. Methods: A manual review of records for 166 maternal deaths (cases) and 322 controls was undertaken using a standard audit form. The sample included pregnant women aged 16 - 46 years admitted at the maternity of Laquintinie Hospital in Douala, Cameroon from January 2017 to December 2022. Software SSPS 3 and Logistic regression analysis were used to analyze data. Results: One hundred and sixty-six (166) maternal deaths were identified during the study period for 14,114 live births, representing a maternal mortality ratio of 1176/100,000 live births. Factors significantly associated with maternal mortality included: young age (15 - 24 years) (aOR 0.11, 95% CI 0.00 - 0.76, p = 0.037), Alcohol intake (aOR 22.79, 95% CI 1.04 - 501.3, p = 0.047), Abortion or ectopic pregnancy (aOR 61.53, 95% CI 1.29 - 2927.3, p = 0.037), having no antenatal visits (aOR 388.3 95% CI 5.6 - 2675.9, p = 0.006), being admitted with hemorrhage (aOR 343.7, 95% CI 16.2 - 7276.0, p ,713.0, 95% CI 128.2 - 5,989,223.3, p CI 0.00 - 0.18, p = 0.016). Conclusion: Despite slight decrease in maternal mortality, early diagnosis of pregnancy and good Antenatal care associated with maternal health education are important factors for reducing maternal mortality. Young women were the most affected. Singles, alcoholics, women with a no or only primary education level, and referred women represented the majority of deceased cases.

Investigation on maternal mortality in Southeast Asia,Europe and Africa using three delays model

Background:Maternal mortality is a prevalent issue in healthcare provision worldwide.It is particularly common in developing and underdeveloped countries,where maternal deaths during childbirth or pregnancy occur frequently.Various internal and external factors contribute to the high maternal mortality rate in specific regions.One model,known as the three delays model approach,examines three distinct causes that contribute to this problem.The first delay is the lack of awareness in seeking timely healthcare,the second delay involves obstacles in reaching healthcare facilities on time,and the third delay relates to poor or inadequate healthcare provision in tertiary care facilities.These delays are responsible for the elevated maternal mortality rates,with the prevalence of each delay varying across regions.Objective:The objective of this literature review is to examine and critically evaluate existing literature on perceptions and investigations regarding maternal mortality in Southeast Asia,Europe and Africa,utilizing the three delays model approach as a categorization framework.Method:This literature review followed BEME guide No.3.A total of 18 articles were included in the sample after conducting a thorough search of various databases and search engines.A Prisma flowchart was created,and the articles were critically appraised.Results:A total of 18 articles focusing on different regions were analyzed.The findings revealed that in countries of Southeast Asia,the primary cause of maternal mortality is the first delay,which refers to the lack of awareness in seeking medical care.On the other hand,in Africa and other European countries,the second and third delays are more prominently associated with maternal mortality.Conclusion:Inadequate care is one of the major causes of maternal mortality in majority of regions acrossthe globe.Multiple factors can hinder access to appropriate healthcare.The three delays model plays a significant role in the higher maternal mortality rate.By raising awareness among women and their families about the importance of seeking healthcare,the risk of fatality can be reduced.Similarly,in developing regions,it is crucial to ensure that healthcare facilities are easily accessible and provide high-quality emergency obstetric care to meet the needs of pregnant women in critical situations.

Determinants of Maternal Mortality at the Community University Hospital of Bangui: Central African Republic

Introduction: Pregnancy is a physiological condition that can sometimes end in death. The death of a woman is a constant concern for the obstetrician and is considered a major public health problem in our developing countries. Objective: To identify the determinants that contribute to maternal morbidity and mortality in the Gynaecology and Obstetrics Department of the University Community Hospital. Methodology: We conducted a retrospective study from 1 January 2015 to 31 December 2019 (5 years) in the obstetrics and gynaecology department of the Centre Hospitalier Universitaire Communautaire (CHUC). It focused on the determinants of maternal mortality. Our study population consisted of all women who died during the period and met the World Health Organization (WHO) definition of maternal mortality (MOMA). We used non-probability sampling with the exhaustive choice technique. Results: The study revealed that the number of deaths recorded was 98, while 17,172 live births were registered during the same period. The maternal mortality ratio was 570 per 100,000 live births. The most common age group was 20 to 24, with an average age of 26. The frequency of death among primiparous women was 37.74%, pauciparous women 28.30% and multiparous women 26.42%. Direct causes were dominated by abortion complications (22.41%), followed by infections (9.30%) and haemorrhage (8.19%). Indirect causes were dominated by anaemia with a proportion of 45.16%. The majority of maternal deaths occurred in the post-partum period (34.71%). Most maternal deaths occurred after vaginal delivery, 19 cases (63.33%), while 11 deaths (36.66%) occurred after caesarean section. The occurrence of direct causes was associated with age less than or equal to 25 years, abortion complications and primiparity, with a statistically significant difference. Conclusion: At the end of this study, complications of unsafe abortion and poverty are all factors contributing to the rise in the maternal mortality rate. Emphasis should be placed on promoting family planning, as this would make a major contribution to reducing maternal mortality.

Primary hyperparathyroidism-induced acute pancreatitis in pregnancy:A systematic review with a diagnostic-treatment algorithm

BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.METHODS A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google Scholar.The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was followed.The search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved studies.Demographic,imaging,surgical,obstetric,and outcome data were obtained.RESULTS Fifty-four cases were collected from the 51 studies.The median maternal age was 29 years.PHPT-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were reported.In 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of hyperplasia.In the remaining 5 cases,the diagnosis was not reported.Neck ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the preferred treatment during pregnancy in 33 cases(median week of gestation 25,Q1-Q3=20-30)and postpartum in 12 cases.The timing was not reported in the remaining 9 cases,or surgery was not performed.AP was managed surgically in 11 cases and conservatively in 43(79.6%)cases.Maternal and fetal mortality was 9.3%(5 cases).Surgery was more common in deceased mothers(60.0%vs 16.3%;P=0.052),and PTH values tended to be higher in this group(910 pg/mL vs 302 pg/mL;P=0.059).Maternal mortality was higher with higher serum lipase levels and earlier delivery week.Higher calcium(4.1 mmol/L vs 3.3 mmol/L;P=0.009)and PTH(1914 pg/mL vs 302 pg/mL;P=0.003)values increased fetal/child mortality,as well as abortions(40.0%vs 0.0%;P=0.007)and complex deliveries(60.0%vs 8.2%;P=0.01).CONCLUSION If serum calcium is not tested during admission,definitive diagnosis of PHPT-induced AP in pregnancy is delayed,while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.

Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Determinants of Home Deliveries by Pregnant Mothers in Lumbo Chabbobboma Zone of Gwembe District in Zambia

Background: Home deliveries is still high globally at 42% WHO 2022, due to high home deliveries, maternal death is also high at 43% globally. In sub-Sahara region home deliveries still high. Giving birth at health facilities in most of sub-Saharan African countries Zambia inclusive is still a challenge whereby more than 51% of first-time mothers give birth at home and this gives a risk of high maternal and perinatal deaths. Therefore Reducing number of home deliveries is important to improve maternal and perinatal health issues. In this study, the aim was to investigate the determinants of home deliveries by pregnant mothers in the Luumbo zone of Gwembe district, Zambia. Purpose: Access to skilled care and facilities with capacity to provide emergency and newborn care is critical to reduce maternal death. In Zambia 42% of women still deliveries from home, suggesting a persistent challenge for women to seek, reach, and receive quality maternity care. This study aimed investigate the determinants of home deliveries by pregnant mothers in Luumbo zone of Gwembe district, Zambia. Methods: The study was conducted among postnatal mothers who came for postnatal care at 6 weeks in Luumbo Chabbobboma clinic in Gwembe district southern province of Zambia. This was a descriptive cross-sectional study where a Simple random sampling technique was used to select 105 women of childbearing age who attended postnatal and had a recent delivery. Data were collected using a researcher-administered structured questionnaire to identify determinants of home deliveries in Luumbo Chabbobboma zone. Data analysis was done using SPSS computer software version 27.0. Both descriptive and inferential (chi-square test) analyses were performed and statistical significance was taken at α ≤ 0.05. Results: The results show that 46 (43.8%) respondents were in the age bracket 20 - 29 years. Of the 105 respondents included in the study, 24 (22.9%) of them delivered from home. The results show that high maternal age (p = 0.03), occupation (p = 0.024), distance to the facility (p = 0.014), means of transportation (p = 0.023), multiparity (p = 0.01), timing and number of ANC visits (p Conclusion: From this population. The major reason why women still deliver at home was long distance to the nearest facility. To reduce maternal and perinatal mortality access to health facilities by pregnant women needs to be improved. There should also be active engagement of the traditional and religious institutions in the area.

Emergency Obstetric Hysterectomy in a Low Resources Country: An Eight-Year Retrospective Cohort Study from a Secondary Care Hospital in Niger

Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the incidence, socio-demographic profile of patients, indications, management and maternal-fetal outcomes of EOH in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent emergency obstetric hysterectomies between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, indications, and outcomes of EOH were collated and subjected to analysis using the statistical software package SPSS 21.0. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 239 cases of emergency obstetric hysterectomy were recorded out of 269,710 deliveries, representing a frequency of 0.89%. The mean age of the patients was 32.41 years (range: 17 - 50 years). The patients were identified as married (239 cases, 100%), unemployed (228 cases, 95.4%), and not attending school (215 cases, 90%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 58.6% of the total number of cases (140 patients). The average parity among this group was 6.15 children. The majority of patients (229 patients, 95.82%) had undergone in utero transfer, with 169 patients (70.71%), originating from peripheral maternity units in the Maradi region. Upon admission, 116 patients (48.53%) exhibited active genital haemorrhage, while 58 patients (24.26%) were in shock. The primary indications for hysterectomy were uterine rupture (153 patients, 64%), uterine atony (77 patients, 32.2%), and placental accreta (six patients, 2.5%). Hysterectomy was performed by an obstetric gynaecologist (230 patients, 96.2%), an obstetric gynaecology resident (six patients, 2.5%), or a general practitioner with district surgical expertise (three patients, 1.3%). In the majority of cases (180 patients, 75.3%), total hysterectomy was performed. The incidence of maternal mortality (26 patients, 10.9%), and perinatal mortality (223 newborns, 93.4%) was notably elevated in our series. Conclusion: Our findings are in close alignment with those previously documented in the literature. The practice of emergency obstetric hysterectomy is a common occurrence in our region. It is considered a last resort when conservative procedures have failed or are not an option. Improved obstetric management would result in a reduction in the number of cases of haemostatic hysterectomy. The availability of blood products is expected to improve maternal prognosis.

Study of Factors Associated with Maternal Deaths at Timbuktu Hospital in Mali

Introduction: Despite progress in universal health coverage, maternal mortality remains a concern for developing countries, including Mali. The problem is not due only to a lack of health services but to a combination of factors that need to be identified to give hope to women of childbearing age. Objective: Determine the factors associated with maternal mortality in the Timbuktu region of Mali. Methodology: Retrospective, descriptive, cross-sectional and analytical study from January 1, 2018 to December 31, 2022 using a questionnaire and an interview guide to determine the factors associated with maternal mortality in the Timbuktu region of Mali. Results: A total of 112 maternal deaths were recorded between 2018 and 2022. The average age of the women who died was 26 years (standard deviation 7.6 years). The 14 – 23-year-old age group is the most affected (43.8%). 66.1% of women came from rural areas. Illiteracy (77.7%), lack of ANC (54.5%), distance of households from health facilities (76%) and insecurity (52.7%) have been identified as factors contributing to maternal mortality. Conclusion: This study reported a high prevalence of maternal mortality rates that may be associated with women’s socioeconomic conditions. Actions must be developed to integrate CPN into an advanced strategy for women living in rural areas in Mali.

Determinants of the Low Proportion of Pregnant Women Seen for First-Trimester Prenatal Care at KoudougouUrban Medical Center, Burkina-Faso

Introduction: Antenatal care (ANC) contributes to the reduction of maternal and neonatal morbidity and mortality. The study aimed to investigate the determinants of the low proportion of pregnant women seen for first antenatal care in the first trimester of pregnancy at the urban medical center of Koudougou, Burkina Faso. Materials and Methods: This was a cross-sectional study with data collection from June 08 to August 18, 2021. It involved a sample of 302 participants including 280 pregnant women and 22 maternity providers. Semi-structured individual interviews, non-participant observation, and a literature review were used. Results: Pregnant women age 20 and over, knowledge of the date of their last menstrual period, and knowledge of the antenatal care calendar were associated with coming into contact (1) with Antenatal care in the first trimester of pregnancy. In addition, there was a lack of availability of antenatal care services, inadequate reception of clients, and shortages of health products. Conclusion: There is a need to revisit strategies for communicating with women about ANC, reorganizing ANC services, and improving ANC services.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

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.

The Trends in Maternal Mortality between 1996 and 2009 in Guizhou, China: Ethnic Differences and Associated Factors

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.

Maternal Mortality at the Teaching Hospital of Mother and Child Lagoon (CHU-MEL) in Benin: A Preventable Drama?

Introduction: The maternal mortality ratio in developing countries is 239/ 100,000 live births (LV) in 2015, compared to 12/100,000 live births (LV) in developed countries. This study aims to analyze the avoidability of maternal deaths at the CHU-MEL from 2015 to 2019. Patients and Method: This was a descriptive analytical study with retrospective data collection from January 1st 2015 to August 31st 2019, i.e. 56 months. The data were collected from medical records, maternal death registers, anaesthesia registers. They were entered and analyzed using Epi info version 7 software. The associations between avoidability of death and aetiologies were tested using Chi2 or Fisher’s test as appropriate. The threshold for statistical significance was 5%. Results: The maternal mortality ratio over 5 years was 905 maternal deaths per 100,000 LV. The age of the deceased women ranged from 15 to 44 years, with an average of 29.09 ± 7.04 years. They were illiterate or primary educated (47.02%), married (64.50%) primigravida or paucigravidae (47.02%) and primiparous or pauciparous (59.52%). Of the 151 maternal deaths, (90.73%) were deemed preventable. Delay was the main reason for maternal death, and 82.11% had at least one type of delay. There was no significant difference between the avoidability of death and the main aetiologies of haemorrhage (p = 0.865), infections (p = 0.208) and hypertensive complications (p = 0.438). Conclusion: The maternal mortality ratio during the study period was 905 maternal deaths per 100,000 LV. Deaths were preventable in 90.73% of cases. The avoidability factors found were varied.

Qualification of nursing potential in maternal mortality in Mexico

Objectives:To develop a method that measures nursing potential through the factor analysis of relevant nursing data and social context by taking maternal mortality as the study problem.Methods:A Cross-sectional and analytical study,a multivariate analysis was performed.The Nursing Coverage Index,the Human Development Index,population density and the proportion of nurses with a bachelor's degree or upper degree,are studied by federative entity,only data from government sources are used.The Index of Nursing Qualification in Mexico(INQM)was constructed through principal component analysis.Results:The highest correlation was between the INQM and the Nursing Coverage Prioritization Index(NCPI),which was 0.849(P<0.01)and showed a strong positive linear relationship.The Population Density Prioritization Index(PDPI)shows a strong positive correlation with the INQM(0.716,P<0.01).Three factors were extracted by principal component analysis and the INQM was generated with the three main components in a model.There is very low correlation between INQM and maternal mortality rate(MMR)and no statistical significance was found.Conclusions:This study shows that nursing qualification must include economic,geographic and social variables.The INQM is an indicator that summarises the potential of each federative entity.Given these results,a contribution is provided for the application of these indices,which can help determine nursing potential in a specific geographical region.

Developing a model for reducing maternal mortality in South Africa

Objective:High maternal mortality ratios(MMRs)remain a concern in many parts of the world,especially in developing countries like South Africa.Different models have been developed,tried,and tested worldwide,in the hope that they will reduce maternal mor tality,but without much success.Methods:A qualitative approach was used to conveniently select a sample of 10 women attending an antenatal clinic in a rural area,in one of the districts of Kwa Zulu-Natal(KZN)Province.Data were collected by means of interviews with the women.Data were analyzed employing Burnard’s content analysis approach.Results:Four themes emerged:(1)age at first pregnancy;(2)birth intervals,risks in pregnancy and hospitalization;(3)the use of contraception;and(4)HIV status.All themes that emerged revealed inattention to reproductive health(RH)needs,resulting in poor RH outcomes as an area of concern.Conclusions:Greater emphasis needs to be placed on meeting the sexual and reproductive health(SRH)needs of South African women,if maternal mor tality rates are to be reduced.An alternative model for reducing maternal mor tality in South Africa is proposed.

Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool

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.

Maternal Mortality in Two Reference Hospitals in the City of Yaounde (Cameroon): Epidemiological, Clinical and Prognostic Aspects

Objectives: The objective of this work was to determine the epidemiological, clinical and prognostic aspects of maternal mortality (MM) in the city of Yaounde. Methods: We conducted a descriptive cross-sectional study with retrospective data collection of maternal deaths according to the World Health Organization (WHO) definition, from January 1, 2017 to December 31, 2019, in two tertiary centers of Yaounde: The Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH). Results: During the study period, 208 maternal deaths were identified, with 4/5 (78.4%) from referred cases. The MM ratio was 1532.8 per 100,000 live births (LB) vs. 609.5 per 100,000 live births at YCH and YGOPH respectively. The Main causes where haemorrhage (49%) followed by hypertensive diseases and their complications (21.2%), maternal mortality was associated with 50% of cases of foetal or neonatal deaths (57.4% in YCH vs 28.3% in YGOPH, P < 0.001). Health service systems were related to MM. Conclusion: Our study shows a large increase in maternal mortality ratios in YCH and YGOPH maternities since 2017. The main causes of MM found were haemorrhage followed by hypertensive diseases. These causes can be prevented. Our health systems should be improved if we want to significantly reduce the maternal mortality ratio.

The Contribution of Technological Approaches in Reducing Maternal Mortality: An Integrative Review

Aim: To analyze the role of available health technologies and techniques in reducing the number of women dying during pregnancy and childbirth. Background: Health condition of women during pregnancy and childbirth is very sensitive. During this period, proper and timely care plays an important role in reducing maternal mortality. Design: Whitte more and Knal’s framework for integrative reviews was followed in the review. PUBMED/MEDLINE, CINHAL and COCHRANE were searched for published studies between 2008 and 2015. Studies included were systematic reviews, randomized control trials, prospective cohort study, literature review and descriptive studies. Methods: 28 articles were selected to be included in the review. An integrative review approach was followed to analyze data and draw conclusions. Screening of titles and abstracts along with data extraction was completed by two authors independently. Study quality is not reported because of the methodological difficulties. Data synthesis consists of writing descriptive summaries and thematic analysis of the key findings in the included articles. Results: The included studies were based on health technologies and techniques including different devices and tools, medication and drugs, massage techniques, immersion in water, intervention radiology, simulations and training for the health professional. Conclusion: There are numerous health technologies and techniques which are relatively simple to develop, effective to use and safe to apply with no adverse effects. These include simulations and training programs, educational and awareness programs, decision support tools and information systems. Besides these, there are technologies and techniques which show promising results with no or very little adverse effects. These include Active management of the third stage of labour, use of magnesium sulphate, uterine balloon tamponade, wearable cardiac defibrillator and non-pneumatic anti-shock garment. The government, hospitals and care providers should make policies to develop and implement such type of technologies and techniques.