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Maternal mortality in developing countries: challenges in scaling-up priority interventions

Prata N, Passano P, Sreenivas A, Gerdts CE

Womens Health (Lond), 2010 Mar;6(2):311-27.
PMID: 20187734 DOI: 10.2217/whe.10.8

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.

Matched MeSH terms: Maternal Health Services/organization & administration*
Fulltext Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol

Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, et al.

BMC Med Res Methodol, 2007;7:43.
PMID: 17892586

Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?

Matched MeSH terms: Maternal Health Services/standards*
Effective family planning programs

Rosenfield AG

Med Today, 1973;7(3-4):80-94.
PMID: 12309877

PIP: Organizational and content features of various national family planning programs are reviewed. The Thai program is cited as an example of a family planning program organized on a massive unipurpose compaign basis. The Korean and Taiwan programs have utilized special field workers while upgrading the general health care network. 3 major problems with family planning programs are: 1) the lack of experience with such programs; 2) lack of commitment at the highest political levels; and 3) medical conservatism. Utilization of all available contraceptive methods instead of reliance on 1 method would improve most programs. Nursing and auxiliary personnel could be trained to take over the work of physicians in family planning programs. This is already being done with IUD insertion and pill prescription in several programs. The postpartum tubal ligation approach has proven effective and should be extended. There is a place in all national programs for both the private and the commercial sectors. Incentives for clinics, personnel, and acceptors might spread family planning more rapidly.

Matched MeSH terms: Maternal Health Services*
Some aspects of maternal care in rural peninsular Malaysia

Salleh NM, Tan BA, Arshat H

Malays J Reprod Health, 1986 Jun;4(1):20-8.
PMID: 12268569

PIP: The effectiveness and impact of the Population and Family Health Project in the rural areas of Malaysia is evaluated. A total of 790 women who delivered during the past 3 years from the time of the survey, were identified from 2,013 women aged 15-49 years, during the 2nd Family and Health Survey (1979) in Peninsular Malaysia. The rural health districts which were selected by random sampling include: Perlis, Kubang Pasu, Sebeang Perai Selatan, Kuala Selangor, Hulu Langat, Melaka Utara, Kota Bharu/Tumpat, and Pasir Mas. The pattern of maternal care during pregnancy, delivery and puerperium are examined with respect to selected variables. These women are further classified into 2 groups by type of birth attendant at delivery and these 2 groups are also examined in relation to selected socioeconomic variables. The major proportion of women had their 1st antenatal visit during the 2nd and 3rd trimester of pregnancy. The highest % (28.3%) of 1st antenatal visits occurred during the 5th month of pregnancy. Use of a trained medical practitioner is preferred (82.5%), while only 17.5% of women preferred the services of traditonal birth attendants. Women in this latter group had less education and were in lower income groups, than the former group of women. Majority of women in all ethnic and age groups had no postnatal check after their last childbirth.

Matched MeSH terms: Maternal Health Services*
Maternity services and the role of the traditional birth attendant, bidan kampung, in rural Malaysia

Ali A, Howden-Chapman P

J Public Health Manag Pract, 2007 May-Jun;13(3):278-86.
PMID: 17435495 DOI: 10.1097/01.PHH.0000267686.08282.3c

This study was undertaken to explore the roles played by bidan kampungs and understand their contribution to rural Malay women during pregnancy and childbirth hundred sixteen pregnant women, 13 Western midwives, and 12 bidan kampungs were recruited using convenience and snowball sampling. Data were collected from focus groups, in-depth interviews, field notes, and observations. The findings indicated that although the women were happy to have Western maternity care, they valued the social and spiritual support received from bidan kampungs during pregnancy and postnatal care. Western care was considered useful for "modern" illnesses. The traditional maternity care that women received included pantang or ritual prohibitions that helped them through pregnancy and helped them achieve better postnatal recovery. The study indicates that there is a need to combine Western and traditional care for the benefit of the pregnant women and their infants' health.

Matched MeSH terms: Maternal Health Services/manpower*
Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran

Faisal I, Matinnia N, Hejar AR, Khodakarami Z

Midwifery, 2014 Feb;30(2):227-33.
PMID: 24055288 DOI: 10.1016/j.midw.2013.08.011

to gain a deeper understanding of why Iranian primigravidae request caesarean section without any medical indication.

Matched MeSH terms: Maternal Health Services
Fulltext Effectiveness of free maternal healthcare programme under the successful delivery programme in jigawa state, Nigeria

Muhammad Abdulkadir, Ruslan Rainis, Alshammari Eissa Zaidan, Murtala Uba Muhammad, Yamuna A Kani

Malaysian Journal of Social Sciences and Humanities, 2019;4(7):140-151.
MyJurnal

In the state effort reduce the number of maternal death, a free child and maternal healthcare programme were introduced called Successful delivery. This main aim of this research is to evaluate if women registered with the programme had a better chance of accessing the services in the state. A crosssectional quantitative study involving household interviews of all women of the reproductive age group (15–49 years) residing in Jigawa state from February to April 2019. Logistic regression analysis at 95% confidence interval was used to determine the independent associations between the scheme and use of antenatal care, hospital delivery and postnatal care services. Successful delivery program influenced the antenatal care visit as women registered with the schemes are more likely to have maximum of six visit 39.5 times than those who did not and also more likely to have four visit 2.6 times than those without scheme. Hospital delivery is also attached to the scheme as women registered with the scheme is 5.3 times likely to deliver at hospital when compared to those with not. Successful delivery program influence antenatal care visit and hospital base delivery. Nevertheless many of the pregnant women after delivery did not attend postnatal care.

Matched MeSH terms: Maternal Health Services
Fulltext Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration

Acuin CS, Khor GL, Liabsuetrakul T, Achadi EL, Htay TT, Firestone R, et al.

Lancet, 2011 Feb 05;377(9764):516-25.
PMID: 21269675 DOI: 10.1016/S0140-6736(10)62049-1

Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals.

Matched MeSH terms: Maternal Health Services
Exploring factors contributing to mistreatment of women during childbirth in West Bank, Palestine

Dwekat IMM, Tengku Ismail TA, Ibrahim MI, Ghrayeb F

Women Birth, 2021 Jul;34(4):344-351.
PMID: 32684342 DOI: 10.1016/j.wombi.2020.07.004

BACKGROUND: Respectful care during childbirth is a universal right for each woman in every health system, and mistreatment of women during childbirth is a major breach of this right.
AIM: This study aimed to explore the views of Palestinian women and healthcare providers regarding factors contributing to the mistreatment of women during childbirth at childbirth facilities in the West Bank, Palestine.
METHODS: A qualitative study was conducted in the West Bank, Palestine, from February 2019 to April 2019. In-depth interviews were conducted with six Palestinian women and five healthcare providers. Consent was obtained individually from each participant, and the interviews ranged from 40 to 50min. Data collection was continued until thematic saturation was reached. Open-ended questions were asked during interviews. Thematic analysis was used to interpret the data collected from the interviews.
RESULTS: Four themes were identified with regards to the women and healthcare providers' views about factors contributing to the mistreatment of women during childbirth in the West Bank, Palestine: limitation in childbirth facilities, factors within the healthcare providers, the women themselves, and barriers within the community.
DISCUSSION: Mistreatment of women during childbirth may occur due to the limitations of resources and staff in childbirth facilities. Some women also justified the mistreatment, and certain characteristics of the women were believed to be the factors for mistreatment.
CONCLUSION: As the first known study of its kind in West Bank, the identified contributing factors especially the limitations of resources and staff are essential to provide good quality and respectful care at childbirth facilities.

Matched MeSH terms: Maternal Health Services
Fulltext Development, validity and reproducibility of a food frequency questionnaire in pregnancy for the Universiti Sains Malaysia birth cohort study

Loy SL, Marhazlina M, Nor AY, Hamid JJ

Malays J Nutr, 2011 Apr;17(1):1-18.
PMID: 22135861 MyJurnal

Introduction: This study aimed to develop and examine the validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) among Malay pregnant women in Kelantan, Malaysia.
Methods: A total of 177 Malay pregnant women participated in the validation study while 85 of them participated in the reproducibility study which was carried out in the antenatal clinic of Universiti Sains Malaysia Hospital. The newly developed FFQ was validated against two 24-hour dietary recalls (DR). The FFQ was repeated 20 to 28 days apart.
Results: Results showed that the FFQ moderately over estimated the nutrient and food intakes compared to the DR. Spearman correlation
coefficients for nutrients ranged from 0.24 (fat) to 0.61 (calcium) and for foods, ranged from 0.13 (organ meats, onion and garlic) to 0.57 (malt drink). For nutrients, 72 to 85% of women were classified into the correct quartiles from the FFQ and the DR while for foods, 67 to 85% of women were classified correctly. Bland-Altman plot showed relatively good agreement between these two dietary methods. The intra-class correlation (ICC) was used to estimate reproducibility. It ranged from 0.75 (vitamin C) to 0.94 (phosphorus) for nutrients while it ranged from 0.73 (confectionary) to 0.96 (coffee) for foods.
Conclusion: On average, at least 90% of pregnant women were correctly classified into the quartiles for nutrients and foods from the two sets of the FFQ. The FFQ presented acceptable reproducibility and appears to be a valid tool for categorising pregnant women according to dietary intake.
Keywords: Assessment of nutritional status, diet, food frequency questionnaire, maternal nutrition

Matched MeSH terms: Maternal Health Services
Fulltext Maternal obesity and its determinants: A neglected issue?

Nurul-Farehah S, Rohana AJ

Malays Fam Physician, 2020;15(2):34-42.
PMID: 32843943

Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

Matched MeSH terms: Maternal Health Services
Midwives' Attitude and Barriers of Evidence Based Practice in Maternity Care

Azmoude E, Aradmehr M, Dehghani F

Malays J Med Sci, 2018 May;25(3):120-128.
PMID: 30899193 DOI: 10.21315/mjms2018.25.3.12

Objectives: Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.
Methods: In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.
Results: The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.
Conclusion: Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

Matched MeSH terms: Maternal Health Services
Differential utilisation of health facilities and services for childbirth in Peninsula Malaysia--the ethnic factor

Arhsat H, Tan BA, Tey NP

Malays J Reprod Health, 1985 Dec;3(2):105-14.
PMID: 12314737
Matched MeSH terms: Maternal Health Services*
The pattern of maternal mortality at maternity hospital Kuala Lumpur

Nafisah Adeeb

Malays J Reprod Health, 1983 Jan;1(1):34-9.
PMID: 12279887
Matched MeSH terms: Maternal Health Services
Medical services to the aborigines in West Malaysia

Bolton JM

Br Med J, 1968 Jun 29;2(5608):818-23.
PMID: 5658921
Matched MeSH terms: Maternal Health Services
Fulltext Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur

Tee ES, Kandiah M, Ali J, Kandiah V, Zahari MR, Kuladevan R, et al.

Malays J Reprod Health, 1984 Jun;2(1):32-50.
PMID: 12267519

The study presents recent data on the prevalence and pattern of nutritional anemia in the Maternity Hospital, Kuala Lumpur. A total of 309 pregnant women in their third trimester, of Malay, Chinese and Indian origin from the lower socio-economic strata were randomly selected for the study. Hematological indices (including Hb, PCV, MCHC, and TRBC), serum iron, transferrin saturation and ferritin, serum folate as well as protein and albumin were determined. Based on Hb and PCV values, 30-40 percent of the women could be considered anemic; approximately 50 percent of them presented with unsatisfactory serum iron, transferrin saturation and ferritin values; 60.9 percent had low serum folate levels; and about 30 percent may be considered to be of poor protein nutriture. Anemia in the study population was seen to be related mostly to iron and to a lesser extent, folate deficiency. Hematological, iron, folate and protein status was observed to be the poorest amongst the Indian women, better in the Malay group and generally the best amongst the Chinese women. Birth records of 169 of these women revealed that all of them had live births. Nearly all the infants were delivered by normal vaginal delivery (NVD) The mean gestational age was 38.6 weeks. One of the infants had a birth weight of <2.0 kg; incidence of low birth weight, <2.5 kg, was 8.3 percent. Although there was a trend of deteriorating hematological, iron and protein status of women from the 0, 1 -3 and >=4 parity groups, these differences were not statlstlcally significant.

Matched MeSH terms: Maternal Health Services

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