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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.
The context of birth
Published in Helen Baston, Midwifery, 2020
Since the commitment made in 2000 to the eight Millennium Development Goals (MDGs) the progress towards a global reduction in Maternal Mortality Ratio (MMR) has been significant. For example, in 2000 there were 451,000 maternal deaths globally compared with 295,000 in 2017, representing a reduction of 38.4 per cent (WHO 2019:41). The MMR is presented as the number of maternal deaths per 100,000 live births and varies considerably between and within countries. Globally the MMR in 2017 was 211 (per 100,000 live births) yet 542 in sub-Saharan Africa; 157 in Southern Asia; 10 in Europe; and 7 in Australia and New Zealand (WHO 2019:41). However, taking a closer look at specific populations, some even more alarming data estimates suggest that the MMR is as high as 1,150 in South Sudan, 1,140 in Chad and 1,120 in Sierra Leone (WHO 2019:34). These rates are estimates based on the available data, which is variable in quality and quantity.
Death from natural causes
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
From 1990 to 2015, the global maternal mortality ratio declined by 44 per cent – from 385 deaths to 216 deaths per 100,000 live births, according to UN data. This gives an average annual rate of reduction of 2.3 per cent. Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3300, compared to 1 in 41 in low-income countries. UK evidence suggests a mortality rate of ∼8.5/100,000 during pregnancy or shortly after childbirth of which heart disease was the most significant figure, contributing to 2/100,000. There is an international strategy aimed at reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030. There are also country-level targets: The primary national target is that by 2030, every country should reduce its MMR by at least two-thirds from its 2010 baseline. The secondary target, which applies to countries with the highest maternal mortality burdens, is that no country should have an MMR greater than 140 deaths per 100,000 live births by 2030.
Prognostic scores for prediction of maternal near miss and maternal death after admission to an intensive care unit: A narrative review
Published in Health Care for Women International, 2022
Flávio Xavier Silva, Leila Katz, José Guilherme Cecatti
It was estimated that 295,000 maternal deaths occurred worldwide in 2017, resulting in an overall maternal mortality ratio (MMR: maternal deaths per 100,000 live births) of around 211 maternal deaths per 100,000 LB (World Health Organization (WHO), 2019a). More than 90% of these deaths occurred in low- and middle-income countries (LMIC), as a result of complications related to pregnancy and childbirth (WHO, 2019b). Many of these complications are preventable and treatable. Hemorrhages, hypertensive syndromes and infections are the causes that most kill and, when they do not, can result in severe health injuries (Adeoye et al., 2015; Chowdhury et al., 2009; Koblinsky et al., 2012). In Brazil, 1,736 maternal deaths were registered in 2019, which represents a MMR of 60 deaths per 100,000 LB, six times higher than those from high-income countries (Health Ministry of Brazil, n.d.; WHO, 2019b).
Policies and actions to reduce maternal mortality in Nepal: perspectives of key informants
Published in Sexual and Reproductive Health Matters, 2022
Rajendra Karkee, Kirti Man Tumbahanghe, Alison Morgan, Nashna Maharjan, Bharat Budhathoki, Dharma S. Manandhar
Nepal adopted many of these interventions targeted at both the supply and demand sides, including a national programme to scale-up the number of skilled birth attendants (SBAs) and birthing facilities, free maternity care, monetary incentive schemes for antenatal care (ANC) visits and delivery at a health facility, and the national scale-up of the birth preparedness and complication readiness programme.6 As a result, there have been impressive increases in institutional deliveries between 1990 and 2015. According to the National Demographic Health Surveys, the proportion of institutional deliveries increased from 8% in 1996 to 18% in 2006 and 57% in 2015. The maternal mortality ratio (MMR) was estimated as 539 per 100,000 live births in 1996, 281 in 2006, and 239 in 2015.1,7 This trend indicates that there has been slow progress between 2006 and 2015 in reducing maternal mortality in Nepal, despite the steep increase in institutional deliveries during the same period.
Impact of socio-demographic variables on antenatal services in eastern Uttar Pradesh, India
Published in Health Care for Women International, 2021
Renu Bala, Ajay Singh, Vertika Singh, Priyanka Verma, Snehil Budhwar, Om Prakash Shukla, Gyan Prakash Singh, Kiran Singh
This community-based observational study was conducted in Varanasi district, Uttar Pradesh located in the northern region of India. Uttar Pradesh is the most populous state with low socio-economic status. It has a significantly diverse geographic and cultural profile. Uttar Pradesh has the highest Maternal Mortality Ratio (MMR) (284/100,000 live births, NITI Aayog, Government of India, 2011–2013 (Aayog, 2018) and Infant Mortality Ratio (IMR) 64/1000 live births (NFHS 4) (Dhirar et al., 2018; Sheet, 2017); in India. Most of the population (77.7%) in this region resides in rural areas and belongs to the Hindu religion (Chandramouli & General, 2011). One Junior Research Fellow and Project Manager recruited for the present study surveyed 10 rural and suburban villages around Banaras Hindu University. Local Accredited Social Health Activist (ASHA, recruited under NRHM) workers were contacted for detailed information on pregnant females in the area. For studying socio-demographic characteristics of pregnant females, participants were enrolled between the period August 2016 and October 2018 from Primary healthcare Center, Kashi Vidhyapeeth Block hospital, Varanasi district, Uttar Pradesh, India.