alexa Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India.
Healthcare

Healthcare

Journal of Community Medicine & Health Education

Author(s): Ganatra BR, Coyaji KJ, Rao VN

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Abstract A total of 121 maternal deaths, identified through multiple-source surveillance in 400 villages in Maharashtra, were prospectively enrolled during 1993-95 in a population-based case-control study, which compared deaths with the survivors of similar pregnancy complications. The cases took significantly longer to seek care and to make the first health contact after the decision to seek care was taken. They also travelled significantly greater distances through a greater number of health facilities before appropriate treatment was started. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of the following: residing in and not away from the village; presence of a resident nurse in the village; having an educated husband and a trained attendant at delivery; and being at the woman's parents' home at the time of illness. Other significant findings showed that deaths due to domestic violence were the second-largest cause of deaths in pregnancy, that more than two-thirds of maternal deaths were underreported in official records, and that liveborn infants of maternal deaths had a markedly higher risk of dying in the first year of life. This study points to the need for information-education-communication (IEC) efforts to increase family (especially male) preparedness for emergencies, decentralized obstetric management with effective triage, and a restructuring of the referral system. PIP: Maternal deaths account for 13\% of all deaths among reproductive-aged women in India. 121 maternal deaths, identified through multiple-source surveillance in 400 villages in Maharashtra, were prospectively enrolled during 1993-95 in a population-based case-control study comparing deaths with the survivors of similar pregnancy complications. Mothers who died took significantly longer to seek care and to make the first health contact after deciding to seek care. They also travelled significantly farther through more health facilities before appropriate treatment was started. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of living in rather than away from villages, having a resident nurse in the village, having an educated husband and a trained attendant at delivery, and being at the woman's parents' home at the time of illness. Domestic violence was the second largest cause of deaths in pregnancy, more than two-thirds of maternal deaths were underreported in official records, and liveborn infants of maternal deaths had a significantly higher risk of dying during the first year of life. Information-education-communication efforts to increase family preparedness for emergencies, decentralized obstetric management with effective triage, and a restructuring of the referral system are needed.
This article was published in Bull World Health Organ and referenced in Journal of Community Medicine & Health Education

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