Predicting In-Hospital Maternal Mortality in Senegal and Mali (original) (raw)
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A Prediction Score for Maternal Mortality in Senegal and Mali
Obstetrics & Gynecology, 2013
To develop and validate a maternal mortality score to identify patients at risk of in-hospital death in developing countries. METHODS: We performed a prospective observational study in 46 referral hospitals in Senegal and Mali, starting October 1, 2007. Derivation of a maternal mortality score was performed, using generalized estimating equation, on patients included during the first 6 months of the study (301 deaths out of 43,624 deliveries) and validated on patients included during the next 6 months (345 deaths out of 46,328 deliveries). RESULTS: Nine criteria were independently associated with maternal death: severe anemia in pregnancy, malaria diagnosed during pregnancy, parity greater than 4, fewer than three antenatal visits, referral from another health facility, antepartum or postpartum hemorrhage, preeclampsia or eclampsia, uterine rupture, and genital infection or sepsis. The maternal mortality score, ranging from 0 to 100, occupies an area under the receiver operating characteristics curve of 0.89 (95% confidence interval [CI] 0.87-0.91). The low-risk group for maternal mortality, based on a score less than 10, has a negative predictive value of 99.9% (95% CI 99.8-99.9) and a negative likelihood ratio of 0.18, ruling out maternal mortality with a probability of 0.13% (95% CI 0.09-0.17). Sensitivity of the score to identify patients at risk of in-hospital death was 85.0% (95% CI 80.5-88.8). Validation of the score yielded a sensitivity of 87.8% (95% CI 83.9-91.1), a negative predictive value of 99.9% (95% CI 99.8-99.9), and a probability of maternal death of 0.12% (95% CI 0.08-0.17) in the low-risk group. CONCLUSION: The maternal mortality score could help health care professionals to identify patients at risk of maternal mortality who need careful management.
Obstetrics and Gynecology International
Background. Uganda is one of the countries in the Sub-Saharan Africa with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births. We aimed at exploring the main factors affecting maternal death and designing a predictive model for estimation of the risk of dying at admission at a major referral hospital in northern Uganda. Methods. This was a retrospective matched case-control study, carried out at Lacor Hospital in northern Uganda, including 130 cases and 336 controls, from January 2015 to December 2019. Multivariate logistic regression was used to estimate the net effect of the associated factors. A cumulative risk score for each woman based on the unstandardised canonical coefficients was obtained by the discriminant equation. Results. The average maternal mortality ratio was 328 per 100,000 live births. Direct obstetric causes contributed to 73.8% of maternal deaths; the most common were haemorrhage (42.7%), sepsis (24.0%), hypertensive disorders (1...
Maternal Mortality in a Maternity Ward at a Regional Hospital Center in Southern Senegal
International Research Journal of Obstetrics and Gynecology, 2019
•to describe the socio-demographic characteristics of the deceased patients; •to clarify the causes of maternal mortality and to identify the associated risk factors. Materials and method: This was a prospective, descriptive and analytical study conducted between January 1st, 2012 and December 31st, 2016 at the Kolda Regional Hospital Center. We collected data from maternity records, resuscitation records, anesthesia records and the operating protocol register. Results: During this study period, we recorded 120 maternal deaths out of 4116 living births, a maternal mortality ratio of 2915.4 per 100,000 living births. The average age of our patients was 27 years old. The average parity was 4 deliveries and multiparas accounted for half of the patients. In our series, 84% of patients were evacuated; high blood pressure (35.8%) and obstructed labor (18.8%) were the most common reasons for evacuation. More than half of the deaths (52.5%) occurred in the postpartum and 32.5% in the 3rd quarter. More than half of the deaths occurred within the first 24 hours after of admission (52%). Just over a third of patients (39%) had delivered by caesarean section and we had 58.8% of perinatal deaths. The conclusions of the audit were a delay in consultation (57%) followed by a delay in evacuation (28%) and a delay in the management of patients (25%). Conclusion: The multiple factors influencing the high maternal mortality rate in this region of Senegal can be attributed to the community, the medical team, and / or the health system. Strategic interventions to reduce this mortality rate should be based on community education on safe motherhood, on the improvement of the level of education, on communication systems and better transportation, on access to quality reproductive health services and availability of emergency obstetric care.
Analysis of Factors Associated with Maternal Mortality in Kenyan Hospitals
Journal of Biosocial Science, 2001
This paper examines the association of the sociodemographic characteristics of women and the unobserved hospital factors with maternal mortality in Kenya using multilevel logistic regression. The data analysed comprise hospital records for 58,151 obstetric admissions in sixteen public hospitals, consisting of 182 maternal deaths. The results show that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation is observed to be stronger for women with least favourable sociodemographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged 35 years and above, who had low levels of education, and did not attend antenatal care is about 280...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: According to the World Health Organization (WHO), it has become imperative to monitor caesarean rates in hospitals since these rates continue to increase; WHO recommends this monitoring by the Robson's system. The study objective was to describe caesarean rates in a level 3 maternity of developing country using this system, to identify the groups likely increase overall rate of caesarean. Methods: A retrospective and comparative study made in Cocody University Hospital Center (Abidjan-Cote d'Ivoire) over a period of twelve years. A total of 21,067 women who delivered during this period by caesarean were included. Results: The overall rate of caesarean during the study period was 38.7% with a significant increase from Period I to Period II (34.8 vs. 41.7%; p ˂0.000). The subgroup 2 (nulliparas, single cephalic term pregnancy, caesarean before labor) made the greatest contribution to the overall CS rate with an increase of +5% (10.1 vs. 15.1%; p˂0,000). Women with previous CS (groups 5, 7, 8, 9, 10) increased the caesarean rate of +3.4% (7 vs. 10.4%; p˂0.000). The group 6 increased it of +2.9% (4.7 vs 7.6%; p˂0.000). Caesarean indications were dominated by fetal acute distress (24.5 vs. 22.6%; p˂0,000), then followed by fetal-pelvic disproportion (21.8 vs. 10.7%), severe preeclampsia/eclampsia (13.5 vs. 17.5%; p˂0.000), scarred uterus and breech presentation. Conclusions: Robson classification has identified the groups led to a significant increase in caesarean rates in our service and therefore has good focus our preventive actions.
BMC Pregnancy and Childbirth, 2012
Background: Two years after implementing the free-CS policy, we assessed the non-financial factors associated with caesarean section (CS) in women managed by referral hospitals in Senegal and Mali. Methods: We conducted a cross-sectional survey nested in a cluster trial (QUARITE trial) in 41 referral hospitals in Senegal and Mali (10/01/2007-10/01/2008). Data were collected regarding women's characteristics and on available institutional resources. Individual and institutional factors independently associated with emergency (before labour), intrapartum and elective CS were determined using a hierarchical logistic mixed model.
PLOS ONE
BackgroundAddressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity.ObjectivesThe objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool.MethodsThis was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1stJanuary 2014 to 31stDecember,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations).ResultsThe institutional maternal morta...
Trials, 2009
5 Centre de santé de la Commune V [Health centre, Commune V], Bamako, Mali, 6 Cabinet d'étude spécialisé dans la santé et l'action sociale (HYGEA) [Office for Specialized Studies in Health and Social Action], Dakar, Senegal, 7 Centre d'appui à la recherche et à la formation (CAREF) [Centre for the Support of Research and Training], Bamako, Mali, 8 Centre de santé [Health centre] Guédiawaye District, Senegal,
BJOG : an international journal of obstetrics and gynaecology, 2017
To describe the causes of maternal death in a population-based cohort in six low and middle-income countries using a standardized, hierarchical, algorithmic cause of death (COD) methodology. A population-based, prospective observational study. Seven sites in six low-middle income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (2), Kenya, Pakistan and Zambia. All deaths amongst pregnant women resident in the study sites from 2014 to December 2016. For women who died, we used a standardized questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analyzed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease - Maternal Mortality system (trauma, abortion-related, eclampsia, hemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to health care provider assigned maternal COD. Assig...