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Issues in Design, Implementation, and Evaluation of Maternal Health Interventions in Low- and Middle-Income Countries
Published in Vincent La Placa, Julia Morgan, Social Science Perspectives on Global Public Health, 2023
Aduragbemi Banke-Thomas, Ejemai Eboreime
Despite diverse efforts invested in strengthening health systems and improving health outcomes, many global public health challenges remain unresolved, as new ones emerge. Many maternal health interventions have been implemented with several failing to achieve their intended results. As has been established, failure in achieving desired outcomes may be related to how the intervention was designed (design failure) or how it was implemented (implementation failure) (Allen and Gunderson, 2011). No other domain of global public health highlights these failures better than maternal health. Within the maternal health domain, despite a 38% reduction in global maternal deaths since 2000, 295,000 women still die annually due to pregnancy and childbirth complications. Almost all maternal deaths occur in low- and middle-income countries (LMICs) with Nigeria accounting for over two-fifths of the global burden. A key target of the ‘Sustainable Development Goals’ is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 (United Nations, 2016). This chapter will use case studies of two maternal health interventions, implemented in Nigeria, to highlight and discuss issues in design, implementation, and evaluation of maternal health interventions and policies in LMICs.
Introduction
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
Historically, statistics have been used to tell a story with numbers. Numbers often communicate ideas more succinctly than do words. For example, the World Health Organization (WHO) defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes” [1]. Therefore, when presented with the graph in Figure 1.1[2, 3], someone concerned with maternal mortality might react with alarm at the reported striking behavior of the United States and research the issue further.
Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
This is a large and growing public health problem, directly affecting global maternal mortality [106], which is nevertheless beyond the scope of this chapter. The interested reader is referred to a review of the topic [125] and to online resources at CDC (www.cdc.gov/tb/default.htm).
Towards renewed commitment to prevent maternal mortality and morbidity: learning from 30 years of maternal health priorities
Published in Sexual and Reproductive Health Matters, 2023
Andrea Solnes Miltenburg, Birgit Kvernflaten, Tarek Meguid, Johanne Sundby
Key interventions to reduce maternal mortality include complementary, mutually reinforcing strategies.61 The SMI and later the Partnership for Maternal, Newborn and Child Health (PMNCH) advocated for such comprehensive strategies for three decades. Yet the models that travelled across the globe and that were prioritised were based on narrow indicators, often poorly defined and resulting in interventions with sometimes insufficient evidence of effectiveness in resource-poor settings. Donor-driven funding approaches flourishing after the MDGs play a major role in this.62 The quality of care indicators as presented by the WHO,47 although broadened and based on a growing evidence base, remain a simplified approach towards a complex problem. When “travelling” to local contexts, indicators do not function as anticipated.4 In striving to reflect a more reliable picture of reality, the main indicator against which progress was measured over the years, changed from MMR to SBA to Facility Birth, often through the use of countrywide demographic and health surveys. Limitations of relying on such data are now widely acknowledged.63 Relying on only quantitative measurements neglects the implementation process and unexpected contextual challenges that occur. There is a need for greater emphasis on other research methods to explore how known interventions can be effective at country, district, and facility levels. Such understanding can only be obtained by performing qualitative studies. Much is still needed to increase the use of such studies for decision-making.
Incidence and predictors of women’s place of delivery among pregnant women who received antenatal care in Southern Ethiopia: a prospective cohort study
Published in Current Medical Research and Opinion, 2023
Tesfaye Temesgen, Zerihun Figa, Rediet Gido, Abbas Ahmed Mahamed, Ahimedin Sefa, Desalegn Tarekeng, Gedefa Amanu, Etaferaw Bekele, Tesfaye Gugsa, Daniel Sisay W/tsadik, Tsion Mulat Tebeje, Mesfin Abebe
The World Health Organization (WHO) predicts a world where “every pregnant woman and newborn receive quality care throughout pregnancy, childbirth and postnatal period” to reduce maternal mortality, and morbidity and improve their health4. Also, the safe motherhood initiative which was implemented for decades was highly focused on institutional delivery as one element of emergency obstetric care and hoped institutional delivery utilization could reduce 16 to 33% of maternal deaths5,6. Sub-Saharan Africa accounts for an estimated 66% of all maternal deaths7. Ethiopia is one of the sub-Saharan countries with high maternal deaths. Despite a decrease since the 2016 Ethiopian Demographic and Health Survey, Ethiopia still has one of the highest maternal mortality rates, with 412 deaths per 100,000 live births (EDHS)8. The majority of maternal deaths occur on the first day after giving birth1. In sub-Saharan Africa, however, the high maternal and child mortality has been attributed to low coverage of maternal services during pregnancy, most of which is linked to extremely low utilization of skilled delivery services9.
Maternal mortality and its determining factors among hospitalised mothers in Tehran, Iran, 2013–2020
Published in Journal of Obstetrics and Gynaecology, 2022
Faezeh Aghajani, Khadije Maajani, Amin Nakhostin-Ansari, Arezoo Maleki-Hajiagha, Reyhaneh Aghajani, Afsaneh Tehranian
Maternal mortality is a key indicator of a nation's health status and the accessibility and effectiveness of its healthcare system. The global maternal mortality ratio (MMR) has declined at a rate of 1.3% per year since 1990. The developed countries accounted for the majority of this decline (3.1% against 1.4% in developing countries) (WHO 2010, 2012a). Despite the reduction of maternal mortality rates achieved by the improvements in living and healthcare standards, pregnancy and the postpartum period should always be viewed as critical periods for women. Over a 40-year period (1975–2015), the MMR in Iran decreased from 274 to 25 per 100,000 live births (Figure 1) (Hogan et al. 2010; WHO 2010; Zolala and Haghdoost 2011), demonstrating a reduction in MMR of more than 80%. While we could reduce MMR, we would not meet our future goals using the same methods. Furthermore, we have a long way to go before accomplishing our ultimate objective of eradicating preventable maternal deaths by 2030 (WHO 2015). Assessing the current situation and identifying causes and determinants appear vital in lowering maternal mortality. This study identifies the leading causes and risk factors of maternal deaths, which occurred in hospitals supervised by the Tehran University of Medical Sciences (TUMS) between March 2013 and March 2020. Future healthcare and policy decisions can be based on these results to improve maternal health and wellbeing.