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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross-sectional study
The Lancet, Volume 381, No. 9879, Year 2013
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Description
Background: We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. Methods: In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. Results: From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23 015 (7·3%) women had potentially life-threatening disorders and 3024 (1·0%) developed an SMO. 808 (26·7%) women with an SMO had post-partum haemorrhage and 784 (25·9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0·826 [95% CI 0·802-0·851]). Interpretation: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. © 2013. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.
Authors & Co-Authors
Souza, Joao Paulo
Switzerland, Geneva
Organisation Mondiale de la Santé
Gülmezoglu, Ahmet Metin
Switzerland, Geneva
Organisation Mondiale de la Santé
Vogel, Joshua P.
Switzerland, Geneva
Organisation Mondiale de la Santé
Carroli, Guillermo
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Lumbiganon, Pisake
Thailand, Khon Kaen
Khon Kaen University
Qureshi, Zahida P.
Kenya, Nairobi
University of Nairobi
Costa, Maria José
Angola, Luanda
Who Angola
Fawole, Bukola O.
Nigeria, Ibadan
University of Ibadan
Mugerwa, Yvonne
Uganda, Kampala
Makerere University
Idi, Nafiou
Niger, Niamey
Universite Abdou Moumouni
Neves, Isilda
Angola, Luanda
Delegação Provincial de Saúde de Luanda
Wolomby-Molondo, Jean José
Democratic Republic Congo, Kinshasa
Clinique Universitaire de Kinshasa
Bang, Hoang Thi
Viet Nam, Hanoi
Who
Cheang, Kannitha
Cambodia, Phnom Penh
Who
Chuyun, Kang
China, Beijing
Peking University
Jayaratne, Kapila
Sri Lanka, Colombo
Ministry of Health Colombo
Jayathilaka, Chandani Anoma
Sri Lanka, Colombo
Who
Mazhar, Syeda Batool
Pakistan, Islamabad
Pakistan Institute of Medical Sciences
Mori, Rintaro
Japan, Tokyo
National Center for Child Health and Development
Mustafa, Mir Lais
Afghanistan, Kabul
Afghan National Public Health Institute
Pathak, Laxmi Raj
Nepal, Kathmandu
Minister for Health and Population Nepal
Perera, Deepthi
Sri Lanka, Colombo
Ministry of Health Colombo
Rathavy, Tung
Cambodia, Phnom Penh
National Maternal and Child Health Center
Recidoro, Zenaida Dy
Philippines, Manila
National Center for Disease Prevention and Control
Roy, Malabika S.
India, New Delhi
Indian Council of Medical Research
Pang, Ruyan
China, Beijing
Peking University
Shrestha, Naveen
Nepal, Pokhara
Pokhara University
Taneepanichsku, Surasak
Thailand, Bangkok
Chulalongkorn University
Tien, Nguyen Viet
Viet Nam, Hanoi
National Hospital of Obstetrics and Gynaecology
Ganchimeg, Togoobaatar
Japan, Tokyo
The University of Tokyo
Wehbe, Mira A.
Lebanon, Beirut
American University of Beirut
Yadamsuren, Buyanjargal
Mongolia, Ulaanbaatar
Ministry of Health
Yan, Wang
China, Beijing
Peking University
Yunis, Khalid A.
Lebanon, Beirut
American University of Beirut
Bataglia, Vicente
Panama, Panama City
Hospital Nacional, Panama
Cecatti, José Guilherme
Brazil, Campinas
Universidade Estadual de Campinas
Hernández-Prado, Bernardo
United States, Seattle
Institute for Health Metrics and Evaluation
Nardín, Juan Manuel
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Narváez, Alberto
Ecuador
Colegio Medico de Pichincha and Fundación Salud
Ortiz-Panozo, Eduardo
Mexico, Cuernavaca
Instituto Nacional de Salud Publica
Pérez-Cuevas, Ricardo
Mexico, Mexico City
Division of Social Protection and Health
Valladares, Eliette C.
Nicaragua, Managua
Universidad Nacional Autónoma de Nicaragua, Managua
Zavaleta, Nelly M.
Peru, Lima
Instituto de Investigacion Nutricional
Armson, B. Anthony
Canada, Halifax
Dalhousie University
Crowther, Caroline A.
Australia, Adelaide
The University of Adelaide
Hogue, Carol J.Rowland
United States, Atlanta
Emory University
Lindmark, Gunilla C.
Sweden, Uppsala
Uppsala Universitet
Mittal, Suneeta K.
India, New Delhi
All India Institute of Medical Sciences, new Delhi
Pattinson, Robert Clive
South Africa, Pretoria
University of Pretoria
Stanton, Mary Ellen
United States, Washington, D.c.
United States Agency for International Development
Campódonico, Liana
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Cuesta, Cristina
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Giordano, Daniel
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Intarut, Nirun
Thailand, Bangkok
Chulalongkorn University
Laopaiboon, Malinee
Thailand, Khon Kaen
Khon Kaen University
Bahl, Rajiv
Switzerland, Geneva
Organisation Mondiale de la Santé
Martines, José Carlos
Switzerland, Geneva
Organisation Mondiale de la Santé
Mathai, Matthews
Switzerland, Geneva
Organisation Mondiale de la Santé
Merialdi, Mario
Switzerland, Geneva
Organisation Mondiale de la Santé
Say, Lale
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Citations: 647
Authors: 60
Affiliations: 43
Identifiers
Doi:
10.1016/S0140-6736(13)60686-8
ISSN:
01406736
e-ISSN:
1474547X
Research Areas
Health System And Policy
Maternal And Child Health
Noncommunicable Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Grounded Theory
Study Approach
Quantitative
Participants Gender
Female