Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths

Anaam Arif; Asfandyar Sherani; Qudsia Uzma; Babar Alam; Ellen Thom; Attiya Abro; Naila Ehsan; Ismail Mirwani; Aisha Siddiqa; Uzma Sohail; Najma Ghaffar; Shazia Saeed; Rehana Kamal; Fozia Muhammad Bukhsh; Safia Bibi; Fozia Baloch

doi:doi:10.11648/j.jgo.20221001.11

Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths

Anaam Arif, Asfandyar Sherani, Qudsia Uzma, Babar Alam, Ellen Thom, Attiya Abro, Naila Ehsan, Ismail Mirwani, Aisha Siddiqa, Uzma Sohail, Najma Ghaffar, Shazia Saeed, Rehana Kamal, Fozia Muhammad Bukhsh, Safia Bibi, Fozia Baloch

Published in Journal of Gynecology and Obstetrics (Volume 10, Issue 1)

Received: 7 June 2021 Accepted: 19 July 2021 Published: 8 January 2022

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Abstract

Pakistan is the sixth most populous country in the world & is ranked 53^rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.

Published in	Journal of Gynecology and Obstetrics (Volume 10, Issue 1)
DOI	10.11648/j.jgo.20221001.11
Page(s)	1-5
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Maternal Death, Causes, MPDSR, Surveillance, Response, Tertiary Care, Balochistan, Pakistan

References

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[4]	(August 2020). Maternal Mortality Survey. Islamabad: National Institute of Population Studies.
[5]	Shahzadi Zain, B. J. (2019). The design and delivery of maternal health interventions in Pakistan: a scoping review. Health Care for Women International, 30.
[6]	Ronsmans, C. (2006). Maternal mortality: who, when, where, and why. Lancet, 1129.
[7]	Amy St Pierre, J. Z. (Jan 2018). Challenges and Opportunities in Identifying, Reviewing, and Preventing Maternal Deaths. Obstet Gynecol, 1, 138-142.
[8]	(2015). Strategies toward ending preventable maternal mortality (EPMM). World Health Organization.
[9]	Helen Smith, C. A. (2017). Implementing maternal death surveillance and response: a review of lessons from country case studies. BMC Pregnancy & Childbirth, 11.
[10]	Kinney, M. V. (2019). Implementation of maternal and perinatal death reviews: a scoping review protocol. BMJ Open.
[11]	Al-Fareed Zafar, N. J. (2019). Maternal Mortality: Interesting comparison between Tertiary, Secondary and Primary Centers in Pakistan. Annals of King Edward Medical University, 3.
[12]	Adriane Martin Hilber, P. D. (2020). The development of a new accountability measurement framework and tool for global health initiatives. Health Policy & Planning, 10.
[13]	Kristine R. Hearld, J. L. (2018). Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan. Maternal & Child Health Journal, 8.
[14]	Leontine Alkema, D. C.-B. (November, 2015). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet, 13.
[15]	Mary V Kinney, D. R. (2019). Implementation of maternal and perinatal death reviews: a scoping review protocol. BMJ, 7.

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APA Style

Anaam Arif, Asfandyar Sherani, Qudsia Uzma, Babar Alam, Ellen Thom, et al. (2022). Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths. Journal of Gynecology and Obstetrics, 10(1), 1-5. https://doi.org/10.11648/j.jgo.20221001.11

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ACS Style

Anaam Arif; Asfandyar Sherani; Qudsia Uzma; Babar Alam; Ellen Thom, et al. Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths. J. Gynecol. Obstet. 2022, 10(1), 1-5. doi: 10.11648/j.jgo.20221001.11

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AMA Style

Anaam Arif, Asfandyar Sherani, Qudsia Uzma, Babar Alam, Ellen Thom, et al. Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths. J Gynecol Obstet. 2022;10(1):1-5. doi: 10.11648/j.jgo.20221001.11

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@article{10.11648/j.jgo.20221001.11,
  author = {Anaam Arif and Asfandyar Sherani and Qudsia Uzma and Babar Alam and Ellen Thom and Attiya Abro and Naila Ehsan and Ismail Mirwani and Aisha Siddiqa and Uzma Sohail and Najma Ghaffar and Shazia Saeed and Rehana Kamal and Fozia Muhammad Bukhsh and Safia Bibi and Fozia Baloch},
  title = {Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.jgo.20221001.11},
  url = {https://doi.org/10.11648/j.jgo.20221001.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221001.11},
  abstract = {Pakistan is the sixth most populous country in the world & is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.},
 year = {2022}
}

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T1  - Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths
AU  - Anaam Arif
AU  - Asfandyar Sherani
AU  - Qudsia Uzma
AU  - Babar Alam
AU  - Ellen Thom
AU  - Attiya Abro
AU  - Naila Ehsan
AU  - Ismail Mirwani
AU  - Aisha Siddiqa
AU  - Uzma Sohail
AU  - Najma Ghaffar
AU  - Shazia Saeed
AU  - Rehana Kamal
AU  - Fozia Muhammad Bukhsh
AU  - Safia Bibi
AU  - Fozia Baloch
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JF  - Journal of Gynecology and Obstetrics
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AB  - Pakistan is the sixth most populous country in the world & is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.
VL  - 10
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Author Information

Anaam Arif

World Health Organization, Reproductive, Maternal, Newborn, Child and Adolescent Health, Islamabad, Pakistan
Asfandyar Sherani

World Health Organization, Reproductive, Maternal, Newborn, Child and Adolescent Health, Islamabad, Pakistan
Qudsia Uzma

World Health Organization, Reproductive, Maternal, Newborn, Child and Adolescent Health, Islamabad, Pakistan
Babar Alam

World Health Organization, Reproductive, Maternal, Newborn, Child and Adolescent Health, Islamabad, Pakistan
Ellen Thom

World Health Organization, Reproductive, Maternal, Newborn, Child and Adolescent Health, Islamabad, Pakistan
Attiya Abro

Ministry of Health Services Regulation & Coordination, Islamabad, Pakistan
Naila Ehsan

Department of Gynecology / Obstetrics, Bolan Medical Complex Hospital, Quetta, Pakistan
Ismail Mirwani

Department of Health, Provincial Directorate, Quetta, Pakistan
Aisha Siddiqa

Department of Gynecology / Obstetrics, Sandeman Provincial Hospital, Quetta, Pakistan
Uzma Sohail

Department of Gynecology / Obstetrics, Bolan Medical Complex Hospital, Quetta, Pakistan
Najma Ghaffar

Department of Gynecology / Obstetrics, Bolan Medical Complex Hospital, Quetta, Pakistan
Shazia Saeed

Department of Gynecology / Obstetrics, Sandeman Provincial Hospital, Quetta, Pakistan
Rehana Kamal

Department of Gynecology / Obstetrics, Sandeman Provincial Hospital, Quetta, Pakistan
Fozia Muhammad Bukhsh

Department of Gynecology / Obstetrics, Bolan Medical Complex Hospital, Quetta, Pakistan
Safia Bibi

Department of Gynecology / Obstetrics, Bolan Medical Complex Hospital, Quetta, Pakistan
Fozia Baloch

Teaching Hospital Turbat, Turbat Pakistan

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APA Style

Anaam Arif, Asfandyar Sherani, Qudsia Uzma, Babar Alam, Ellen Thom, et al. (2022). Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths. Journal of Gynecology and Obstetrics, 10(1), 1-5. https://doi.org/10.11648/j.jgo.20221001.11

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ACS Style

Anaam Arif; Asfandyar Sherani; Qudsia Uzma; Babar Alam; Ellen Thom, et al. Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths. J. Gynecol. Obstet. 2022, 10(1), 1-5. doi: 10.11648/j.jgo.20221001.11

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AMA Style

Anaam Arif, Asfandyar Sherani, Qudsia Uzma, Babar Alam, Ellen Thom, et al. Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths. J Gynecol Obstet. 2022;10(1):1-5. doi: 10.11648/j.jgo.20221001.11

Copy | Download

@article{10.11648/j.jgo.20221001.11,
  author = {Anaam Arif and Asfandyar Sherani and Qudsia Uzma and Babar Alam and Ellen Thom and Attiya Abro and Naila Ehsan and Ismail Mirwani and Aisha Siddiqa and Uzma Sohail and Najma Ghaffar and Shazia Saeed and Rehana Kamal and Fozia Muhammad Bukhsh and Safia Bibi and Fozia Baloch},
  title = {Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.jgo.20221001.11},
  url = {https://doi.org/10.11648/j.jgo.20221001.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221001.11},
  abstract = {Pakistan is the sixth most populous country in the world & is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths
AU  - Anaam Arif
AU  - Asfandyar Sherani
AU  - Qudsia Uzma
AU  - Babar Alam
AU  - Ellen Thom
AU  - Attiya Abro
AU  - Naila Ehsan
AU  - Ismail Mirwani
AU  - Aisha Siddiqa
AU  - Uzma Sohail
AU  - Najma Ghaffar
AU  - Shazia Saeed
AU  - Rehana Kamal
AU  - Fozia Muhammad Bukhsh
AU  - Safia Bibi
AU  - Fozia Baloch
Y1  - 2022/01/08
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221001.11
DO  - 10.11648/j.jgo.20221001.11
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221001.11
AB  - Pakistan is the sixth most populous country in the world & is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.
VL  - 10
IS  - 1
ER  -

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