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Shamsa Zafar; Rachel Jean-Baptiste; Atif Rahman; James P Neilson; Nynke R van den Broek
Publisher: Public Library of Science (PLoS)
Journal: PLoS ONE
Languages: English
Types: Article
Subjects: Q, wq_20, R, Research Article, Science, wa_395, Medicine, wq_240, wa_310
Background\ud \ud For more accurate estimation of the global burden of pregnancy associated disease, clarity is needed on definition and assessment of non-severe maternal morbidity. Our study aimed to define maternal morbidity with clear criteria for identification at primary care level and estimate the distribution of and evaluate associations between physical (infective and non-infective) and psychological morbidities in two different low-income countries.\ud \ud Methods\ud \ud Cross sectional study with assessment of morbidity in early pregnancy (34%), late pregnancy (35%) and the postnatal period (31%) among 3459 women from two rural communities in Pakistan (1727) and Malawi (1732). Trained health care providers at primary care level used semi-structured questionnaires documenting signs and symptoms, clinical examination and laboratory tests which were bundled to reflect infectious, non-infectious and psychological morbidity.\ud \ud Results\ud \ud One in 10 women in Malawi and 1 in 5 in Pakistan reported a previous pregnancy complication with 1 in 10 overall reporting a previous neonatal death or stillbirth. In the index pregnancy, 50.1% of women in Malawi and 53% in Pakistan were assessed to have at least one morbidity (infective or non-infective). Both infective (Pakistan) and non-infective morbidity (Pakistan and Malawi) was lower in the postnatal period than during pregnancy. Multiple morbidities were uncommon (<10%). There were marked differences in psychological morbidity: 26.9% of women in Pakistan 2.6% in Malawi had an Edinburgh Postnatal Depression Score (EPDS) > 9. Complications during a previous pregnancy, infective morbidity (p <0.001), intra or postpartum haemorrhage (p <0.02) were associated with psychological morbidity in both settings.\ud \ud Conclusions\ud \ud Our findings highlight the need to strengthen the availability and quality of antenatal and postnatal care packages. We propose to adapt and improve the framework and criteria used in this study, ensuring a basic set of diagnostic tests is available, to ensure more robust assessment of non-severe maternal morbidity.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Liskin LS. Maternal morbidity in developing countries: a review and comments. Int J Gynecol Obstet. 1992, 37(2):77-87.
    • 2. AbouZahr C. Global burden of maternal death and disability. Brit Med Bull. 2003, 67:1-11. PMID: 14711750
    • 3. Fortney JA, Smith JB. The base of the iceberg: prevalence and perceptions of maternal morbidity in four developing countries: the maternal morbidity network. Research Triangle Park, N.C.: Family Health International; 1997.
    • 4. Datta KK, Sharma RS, Razack PMA, Ghosh TK, Arora RR. Morbidity pattern among rural women in Alwar-Rajasthan-A cohort study. Health and Population-Perspectives & Issues. 1980; 3(4):282-92.
    • 5. Koblinsky MA, Campbell OMR, Harlow SD. Mother and more: a broader perspective on women's health. In: Koblinsky MA, Timyan J, Gay J, editors. The health of women: a global perspective. Boulder: Westview Press; 1993.
    • 6. Ashford L. Hidden suffering: disabilities from pregnancy and childbirth in less developed countries. Washington, DC: Population Reference Bureau, MEASURE Communication; 2002.
    • 7. World Health Organization. The World Health Report 2005: make every mother and child count. Geneva: World Health Organization; 2005
    • 8. Firoz T, von Dadelszen P, Magee LA, Chou D, Tuncalp O, Say L, et al. Measuring maternal health: Focus on maternal morbidity. B World Health Organ. 2013, 91(10):794-796.
    • 9. World Health Organization. DALYs and reproductive health: report of an informal consultation, 27-28 April 1998. Geneva: Division of Reproductive Health (Technical Support), World Health Organization; 1999.
    • 10. Say L, Souza JP, Pattinson RC, for the WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss-towards a standard tool for monitoring quality of maternal health care. Best Pract Res Cl Ob. 2009, 23(3):287-296.
    • 11. Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Brit J Obstet Gynaec. 1998, 105(9):985-990. PMID: 9763050
    • 12. Pattinson R, Say L, Souza JP, van den Broek N, Rooney C. WHO maternal death and near-miss classifications. B World Health Organ. 2009, 87(10):734.
    • 13. World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: World Health Organisation; 2011.
    • 14. Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004, 1(1):3. PMID: 15357863
    • 15. Wall LL. Dead Mothers and Injured Wives: The Social Context of Maternal Morbidity and Mortality Among the Hausa of Northern Nigeria. Stud Family Plann. 1998, 29(4):341-359.
    • 16. Zurayk H, Khattab H, Younis N, Kamal O, El-Helw M. Comparing Women's Reports with Medical Diagnoses of Reproductive Morbidity Conditions in Rural Egypt. Stud Family Plann. 1995; 26: 14-21.
    • 17. Gülmezoglu AM, Say L, Betrán AP, Villar J, Piaggio G. WHO systematic review of maternal mortality and morbidity: methodological issues and challenges. BMC Med Res Methodol. 2004; 4: 16. PMID: 15236664
    • 18. Chersich MF, Luchters SMF, Temmerman M, Kley N, Njeru C, Yard E, et al. Maternal morbidity in the first year after childbirth in Mombasa Kenya; a needs assessment. BMC Pregn Childb. 2009; 9: 51.
    • 19. Prual A, Huguet D, Garbin O, Rabé G. Severe obstetric morbidity of the third trimester, delivery and early puerperium in Niamey (Niger). Afr J Reprod Health. 1998; 2: 10-19. PMID: 10214424
    • 20. Ukachukwu VE, Unger H, Onoka C, Nduka C, Maina S, Ngugi N. Maternal morbidity and mortality in peri-urban Kenya-assessing progress in improving maternal healthcare. E Afr J Public Health. 2009; 6: 112-118.
    • 21. Waterstone M, Wolfe C, Hooper R, Bewley S. Postnatal morbidity after childbirth and severe obstetric morbidity. Brit J Obstet Gynaec. 2003; 110: 128-133.
    • 22. van den Broek NR, White SA, Ntonya C, Ngwale M, Cullinan TR, Molyneux ME, et al. Reproductive health in rural Malawi: a population-based survey. Brit J Obstet Gynaec. 2003; 110: 902-908.
    • 23. World Health Organization. World Health Statistics 2014. Geneva: World Health Organization; 2014. Available: http://www.who.int/gho/publications/world_health_statistics/2014/en/.
    • 24. Cox JL, Connor YM, Henderson I, McGuire RJ, Kendell RE. Prospective study of the psychiatric disorders of childbirth by self-report questionnaire. J Affect Disorders. 1983; 5: 1-7. PMID: 6220039
    • 25. Rahman A, Iqbal Z, Lovel H, Shah HA. Screening for Postnatal Depression in the Developing world: A comparison of the WHO Self-reporting questionnaire (SRQ-20) and the Edinburgh postnatal depression screen (EPDS). J Pakistan Psychiatric Soc. 2005; 2: 69.
    • 26. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. Review: A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiat Scand. 2009; 119: 350-364. doi: 10.1111/j.1600-0447.2009.01363.x PMID: 19298573
    • 27. National Statistical Office (NSO) and ICF Macro. Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland, USA: NSO and ICF Macro. 2011. Available: http:// dhsprogram.com/pubs/pdf/FR247/FR247.pdf
    • 28. Bhatia J. Levels and determinants of maternal morbidity: Results from a community based study in southern India. Int J Gynecol Obstet. 1995; 50: S153-S163.
    • 29. Bathia JC, Cleland J. Obstetric morbidity in south India: results from a community survey. Soc Sci Med 1996; 43: 1507-1516 PMID: 8923622
    • 30. Bang RA, Bang AT, Reddy MH, Deshmukh MD, Baitule SB, Filippi V. Maternal morbidity during labour and the puerperium in rural homes and the need for medical attention: A prospective observational study in Gadchiroli, India. Brit J Obstet Gynaec. 2004; 111: 231-238.
    • 31. Osman-Hassan E. Study of the prevalence and perception of maternal morbidity in Menoufeya Governorate, Egypt. Cairo: The Egyptian Fertility Care Society; 1995.
    • 32. Ugandan Maternal Child/Family Planning Division. Evaluation of maternal morbidity and mortality in 12 selected districts of Uganda: (March 1993). Entebbe: Ministry of Health, Maternal Child/Family Planning Division; 1994.
    • 33. Younis N, Khattab H, Zurayk H, el-Mouelhy M, Amin MF, Farag AM. A community study of gynecological and related morbidities in rural Egypt. Stud Family Plann. 1993; 24: 175-186.
    • 34. Villar J, Bergsjø P. WHO antenatal care randomized trial: manual for the implementation of the new model. Geneva: UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Dept. of Reproductive Health and Research, Family and Community Health, World Health Organization; 2002.
    • 35. Mathai M, von Xylander S, Zupan J. WHO technical consultation on postpartum and postnatal care. Geneva: World Health Organization (WHO); 2010.
    • 36. van den Broek NR, Ntonya C, Mhango E, White SA. Diagnosing anaemia in pregnancy in rural clinics: assessing the potential of the Haemoglobin Colour Scale. Bull World Health Organ. 1999; 77: 15-21. PMID: 10063656
    • 37. Sawyer A, Ayers S, Smith H. Pre- and postnatal psychological wellbeing in Africa: A systematic review. J Affect Disorders. 2010; 123: 17-29. doi: 10.1016/j.jad.2009.06.027 PMID: 19635636
    • 38. Husain N, Bevc I, Husain M, Chaudhry IB, Atif N, Rahman A. Prevalence and social correlates of postnatal depression in a low income country. Arch Women Ment Hlth. 2006; 9: 197-202.
    • 39. Hanlon C, Hughes M, Prince M, Medhin G, Alem A, Araya M, et al. Detecting perinatal common mental disorders in Ethiopia: Validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale. J Affect Disorders. 2008; 108: 251-262. PMID: 18055019
    • 40. Danel I, Berg C, Johnson CH, Atrash H. Magnitude of maternal morbidity during labor and delivery: United States, 1993-1997. Am J Public Health. 2003; 93: 631-634. PMID: 12660209
    • 41. Geller SE, Cox SM, Callaghan WM, Berg CJ. Morbidity and mortality in pregnancy. Women Health Iss. 2006; 16: 176-188.
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