Direct and indirect causes of maternal mortality pdf

Violence as a direct cause of and indirect contributor to. Indirect sisterhood method maternal mortality measurement. The leading cause of maternal death remains cardiac disease. Factors that increase maternal death can be direct or indirect. Unwell pregnant women should be red flagged by doctors experts call for new measures to prevent maternal deaths. Maternal mortality in the uk and the need for obstetric. It is unknown how the context in which women live contributes to their risk of obstetric or violent death during pregnancy and the postpartum period. A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Maternal health infectious diseases overview briefer. Of the direct causes of maternal death, the leading causes were obstetric hemorrhage followed by hypertensive disorders and pregnancy related infections 5. New estimates show that the leading causes of maternal deaths are haemorrhage and hypertension, which together account for more than half of maternal deaths figure 4. Maternal mortality to improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. The report states that most maternal deaths in the uk now occur in women with preexisting or new onset medical and psychiatric conditions indirect causes. The highest maternal mortality rates are in africa, with a lifetime risk of 1 in 16.

Rwanda can complement maternal death audits with other strategies, in particular confidential enquiries. Hypertensive states of pregnancy were the leading cause of mortality 26. In september 2000, 189 world leaders signed a declaration on eight millennium development goals mdgs to improve the lives of women, men, and children in their respective countries united nations general assembly 2000. Number of maternal deaths due to indirect causes in emoc facilities total number of maternal deaths in the same facilities during the same period x 100. Kassebaum and colleagues2 similarly show the growing direct and indirect effects of noncommunicable diseases on maternal mortality. Icd10 to deaths during pregnancy, childbirth and the. Direct maternal deaths are those that result directly from complications of pregnancy or its management, such as obstetric haemorrhage. Maternal mortality maternal, neonatal, and child health. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from england and wales and contemporary data from ghana, rwanda and south africa. Pdf investigation of the relationship between direct. Substantially increased funding providing widespread access to midwives high female literacy rate.

More needs to be done to prevent maternal deaths from causes not directly linked to pregnancy and childbirth, say leading experts from the royal college of physicians and surgeons of glasgow and the royal college of obstetricians and. Goal 5a calls for the reduction of maternal mortality by 75 percent between 1990 and 2015. An indirect cause of death in pregnant women is from a condition that is not directly related to the pregnancy but develops or gets worse during pregnancy. Most maternal deaths result from one or more direct causes that is, they result directly from complications of pregnancy. Percent of maternal deaths due to indirect causes at emoc. Other direct causes include ectopic pregnancy, embolism, and anesthesiarelated complications. Direct obstetric case fatality rate measure evaluation.

The estimates, which referred to the year 1990, covered 174 countries. Perinatal mortality study zmpms of 2007 identified the leading direct causes of maternal mortality in zimbabwe as postpartum hemorrhage, pregnancy induced hypertension and puerperal sepsis. The abortion category includes induced abortion, miscarriage, and ectopic pregnancy. Indirect causes, which include deaths due to conditions such as malaria, hivaids. Evidencebased interventions for major causes of maternal mortality. Its principles should be applicable for categorizing deaths. Key causes of maternal death in australia in 20082012.

Causes of maternal deaths causes of maternal deaths are divided into direct and indirect causes. Ideally, the direct obstetric case fatality rate should be calculated for all facilities rather than just for emoc facilities, such as for district hospitals. Indirect causes include anemia, malaria, and heart disease. The who application of icd10 to deaths during pregnancy, childbirth and. Indirect causes of maternal death the lancet global health. The leading direct causes of maternal deaths in kenya are shown in figure 3. Which of the following factors is not associated with halving maternal mortality in sri lanka. According to the united nations population fund, thailand has one of the lowest mmrs of the southeast asia region to which thailand belongs 4. The direct causes of maternal deaths were largely bleeding postpartum haemorrhage pph, intrapartum haemorrhage iph, and antepartum haemorrhage aph, pregnancy induced hypertension pih, sepsis, and abortions. The sample includes all infant deaths and a simple random sample of survivors total n20. Indirect infectious causes and direct obstetrical causes direct obstetrical causes aids tb malaria pneumonia. The common causes of direct maternal mortality were similar in all countries and included amniotic fluid embolism, eclampsia, obstetric haemorrhage and thromboembolism. Say and colleagues1 noted that 275% of all maternal deaths result from these indirect causes, with the highest proportion of such deaths in south asia and subsaharan africa. The aim of this research was to examine the relationship between the direct major causes of maternal mortality and some indirect factors age, parity and gravida through a canonical correlation analysisin which a relational model was used.

Most notably, cdc has been involved in a wide range of activities that address the major causes of perinatal, maternal, and under 5 morbidity and mortality. By mary kalerwamuyonga university of nairobi library 0258221 1 a thesis submitted in partial fulfillment of the requirements for the degree of master of arts population studies at the population studies and research institute, university of nairobi. For analysis purposes, we grouped maternal causes of death into seven main categories of direct and indirect causes. Maternal deaths in australia 20122014, classification of. Of these countries, 77 had no direct or indirect estimates of maternal mortality, and their estimates were derived entirely from a statistical model. Causes of maternal deaths and their percentage are shown in table no. Causes of maternal mortality direct 42% lusaka, zambia, 199697 indirect 58% direct 34% kisumu, kenya 200308. Direct and indirect effects on infant mortality in a high. Last year, ten women gave birth to ten live babies. Indirect causes of maternal mortality sciencedirect. Estimation of maternal mortality using an indirect method. Indirect deaths, however, outnumber directs deaths in many highincome countries and are on the rise in many low and middleincome countries, irrespective of reductions in maternal mortality taking place in many settings. Compared to direct obstetric deaths, indirect deaths have historically received less attention from health policy makers.

Maternal mortality is defined by the world health organization 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. Background the original indirect sisterhood method was developed in the late 1980s as an efficient means of measuring maternal mortality through populationbased surveys, generating a variety of indicators. The leading causes of direct maternal death were obstetric haemorrhage 11, thromboembolism 10 and hypertensive disorders 9 and, when combined, these accounted for more than 61% of all direct maternal deaths. Mortality from obstetricrelated causes is on the rise, and pregnancyassociated homicide remains a leading cause of death. Cardiac disease is the most common cause of indirect death.

The leading cause of indirect maternal death was cardiovascular disease 15. Most worryingly, the number of maternal deaths due to indirect causes has. Direct causes such as embolism, hemorrhage, hypertension, unsafe abortion, and other direct causes contributed to 73% of global maternal deaths whereas 27% of maternal deaths were associated with indirect causes such as hiv infection, dm, anemia, etc. The indirect causes of death were mainly anaemia and malaria in pregnancy. Conclusions the facilitybased maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. For further details on this indicator and on classification of direct and indirect causes of maternal deaths, see who et al. In a 2009 article on maternal morbidity, the authors said, that generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or management of the two, and an indirect maternal death, that is a pregnancyrelated death in a patient with a. Indirect maternal deaths outnumber direct deaths due to obstetric causes in many highincome countries, and there has been a significant increase in the proportion of maternal deaths due to indirect medical causes in low to middleincome countries. Introduction maternal mortality, also known as maternal death, continues to be the major cause of death among women of reproductive age in many countries and remains a serious public health issue especially in developing countries who, 2007. An introduction to maternal mortality pubmed central pmc. Direct causes were observed in 39 cases 60%, indirect maternal death in 24 cases 36. In 2011, the maternal mortality ratio in thailand was 26 per 100,000 live births 2.

These include direct and indirect causes of maternal mortality, preterm birth complications, pmtct, congenital syphilis, diarrheal diseases, vaccine preventable diseases, malaria, pneumonia. Late maternal death late maternal is death of a woman from direct or indirect obstetric causes, more than 42 days but less than one year, after termination of pregnancy. Pdf indirect causes of maternal death researchgate. Leading indirect causes include hiv and aids which account for about 26% of all maternal deaths. The maternal mortality committees from both countries suggest that the difference in maternal deaths due to indirect causes is because of differences in classification, rather than representing a genuine difference in risk profile or obstetric performance. Cardiac disease was the most common indirect cause of death. The indirect maternal mortality rate has not changed significantly since 2003.