Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism

Omrana Pasha, Sarah Saleem, Sumera Ali, Shivaprasad S Goudar, Ana Garces, Fabian Esamai, Archana Patel, Elwyn Chomba, Fernando Althabe, Janet L Moore, Margo Harrison, Mabel B Berrueta, K Hambidge, Nancy F Krebs, Patricia L Hibberd, Waldemar A Carlo, Bhala Kodkany, Richard J Derman, Edward A Liechty, Marion Koso-Thomas, Elizabeth M McClure, Robert L Goldenberg, Omrana Pasha, Sarah Saleem, Sumera Ali, Shivaprasad S Goudar, Ana Garces, Fabian Esamai, Archana Patel, Elwyn Chomba, Fernando Althabe, Janet L Moore, Margo Harrison, Mabel B Berrueta, K Hambidge, Nancy F Krebs, Patricia L Hibberd, Waldemar A Carlo, Bhala Kodkany, Richard J Derman, Edward A Liechty, Marion Koso-Thomas, Elizabeth M McClure, Robert L Goldenberg

Abstract

Background: Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network's Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries.

Methods: Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan.

Results: The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies.

Conclusions: The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.

Trial registration: The study is registered at clinicaltrials.gov [NCT01073475].

Figures

Figure 1
Figure 1
Stillbirth and Neonatal mortality rates by birth weight (2010-2013) in the NICHD Global Network’s Maternal Newborn Health Registry site in Thatta, Pakistan compared with sites in India, Africa and Latin America

References

    1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzelez-Medina D. et al.Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:980–1004. doi: 10.1016/S0140-6736(14)60696-6.
    1. Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L. et al.National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2011;377(9774):1319–1330. doi: 10.1016/S0140-6736(10)62310-0.
    1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;385(9963):117–171.
    1. United Nations. The Millennium Development Goals Report 2014. Rep. New York: United Nations; 2014.
    1. Barros AJ, Ronsmans C, Axelson H, Loaiza E, Bertoldi AD, França GV. et al.Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. Lancet. 2012;379(9822):1225–1233. doi: 10.1016/S0140-6736(12)60113-5.
    1. Hyder AA, Wali SA, McGuckin J. The burden of disease from neonatal mortality: a review of South Asia and Sub-Saharan Africa. BJOG: an Int Journal Obstetrics Gynaec. 2003;110(10):894–901. doi: 10.1111/j.1471-0528.2003.02446.x.
    1. Logie DE, Rowson M, Ndagije F. Innovations in Rwanda's health system: looking to the future. Lancet. 2008;372(9634):256–261. doi: 10.1016/S0140-6736(08)60962-9.
    1. Document A66/13. Geneva: World Health Organization; 2013. World Health Organization. Monitoring the achievement of the health-related Millennium Development Goals.
    1. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA: NIPS and ICF International; National Institute of Population Studies [NIPS] and ICF International. 2013.
    1. Wright, Simon, Ending Newborn Deaths: Ensuring Every Baby Survives. Rep. London, UK: Save the Children; 2014. . [accessed 17 Dec 2014]
    1. Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A, Ahmad F. et al.Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. Lancet. 2013;381(9884):2207–2218. doi: 10.1016/S0140-6736(12)61999-0.
    1. Calvert C, Ronsmans C. The contribution of HIV to pregnancy-related mortality: a systematic review and meta-analysis. AIDS. 2013;27(10):1631–1639. doi: 10.1097/QAD.0b013e32835fd940.
    1. National AIDS Control Program antenatal sero-surveillance for HIV/AIDS in Pakistan. 2012. [accessed 17 Dec 2014]
    1. APHI; CSO; IIHMR; ICF Macro; EMRO. Afghanistan Mortality Survey 2010. Calverton, Maryland, USA: Afghan Public Health Institute, Ministry of Public Health, Central Statistics Organization, ICF Macro, Indian Institute of Health Management Research, World Health Organization/EMRO; . Pub ID FR248; 2011.
    1. Nisar YB, Dibley MJ. Determinants of neonatal mortality in Pakistan: secondary analysis of Pakistan Demographic and Health Survey 2006-07. BMC Public Health. 2014;14:663. doi: 10.1186/1471-2458-14-663.
    1. Goudar S, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F. et al.Maternal Newborn Health Registry of the Global Network for Women’s and Children’s Health Research. Journal of Maternal Fetal and Neonatal Medicine. Int J Gynaecol Obstet. 2012;118(3):190–193. doi: 10.1016/j.ijgo.2012.04.022.
    1. Bose CL, Bauserman M, Global Network’s Maternal Newborn Health Registry. Reproductive Health. In Press.
    1. UNDP. Pakistan National Human Development Report. Poverty, Growth and Governance. Oxford University Press. Karachi; 2003.
    1. Alif Ailaan Pakistan District Education Rankings 2014. SDPI, Islamabad; 2015. Sustainable Development Policy Institute.
    1. Thatta Baseline Household Survey. USADI, Islamabad; 2009. Population Council. Family Advancement for Life and Health (FALAH)
    1. WHO; UNICEF; UNFPA; World Bank. Trends in maternal mortality: 1990 to 2008. WHO, Geneva; 2010.
    1. Mazhar SB, Batool A, Emanuel A, Khan AT, Bhutta S. Severe maternal outcomes and their predictors among Pakistani women in the WHO Multicountry Survey on Maternal and Newborn Health. Int J Gynaecol Obstet. 2014;129(1):30–33.
    1. Mgaya AH, Massawe SN, Kidanto HL, Mgaya HN. Grand multiparity: is it still a risk in pregnancy? BMC Pregnancy Childbirth. 2013;13:241. doi: 10.1186/1471-2393-13-241.
    1. Kayode GA, Ansah E, Agyepong IA, Amoakoh-Coleman M, Grobbee DE, Klipstein-Grobusch K. Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis. BMC Pregnancy Childbirth. 2014;14:165. doi: 10.1186/1471-2393-14-165.
    1. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK. et al.Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347–370. doi: 10.1016/S0140-6736(14)60792-3.
    1. Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. Int J Gynec Obstet. 2005;88(2):181–193. doi: 10.1016/j.ijgo.2004.11.026.
    1. McClure EM, Goldenberg RL, Bann CM. Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. Int J Gynaecol Obstet. 2007;96(2):139–146. doi: 10.1016/j.ijgo.2006.10.010.
    1. Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ. 2005;83(6):409–417.
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–1299. doi: 10.1016/S0140-6736(06)69381-1.
    1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–1110. doi: 10.1016/0277-9536(94)90226-7.
    1. Baig-Ansari N1, Badruddin SH, Karmaliani R, Harris H, Jehan I, Pasha O. et al.Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull. 2008;29(2):132–139.
    1. Kirsch TD, Wadhwani C, Sauer L, Doocy S, Catlett C. Impact of the 2010 Pakistan floods on rural and urban populations at six months. PLoS Curr. 2012;4:e4fdfb212d2432.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다