This study is a first attempt to describe Lebanese women's responses to the medic... more This study is a first attempt to describe Lebanese women's responses to the medical management of their pregnancy and delivery. A qualitative approach in data collection and analysis was adopted to gain an in-depth view of women's perceptions. Women of any parity undergoing a normal vaginal delivery during the three months preceding the interview were interviewed in different areas in Lebanon: one urban, one semi-rural and two remote rural. Childbirth for all the women interviewed was managed within the medical system. Findings show that women accord total trust to their physicians, and very rarely question the usefulness of many routinely applied procedures, even those which the literature shows are unnecessary. When probed, women report that many aspects of the technical care are intimidating and that they experience discomfort with these procedures. Women are more vocal about patient-provider communication and value good interaction with their provider. The extent of passivity and feelings of discontent women have varies according to their social class and the amount of psychosocial support they receive throughout the process of childbirth.
This study assesses the prevalence and determinants of postpartum depression (PPD). 396 women del... more This study assesses the prevalence and determinants of postpartum depression (PPD). 396 women delivering in Beirut and a rural area (Beka'a Valley) were interviewed 24 hours and 3-5 months after delivery. During the latter visit, they were screened using the Edinburgh postnatal depression scale. The overall prevalence of PPD was 21% but was significantly lower in Beirut than the Beka'a Valley (16% vs. 26%). Lack of social support and prenatal depression were significantly associated with PPD in both areas, whereas stressful life events, lifetime depression, vaginal delivery, little education, unemployment, and chronic health problems were significantly related to PPD in one of the areas. Prenatal depression and more than one chronic health problem increased significantly the risk of PPD. Caesarean section decreased the risk of PPD, particularly in Beirut but also in the Beka'a Valley. Caregivers should use pre-and postnatal assessments to identify and address women at risk of PPD.
... Daniela Schoeps I ; Marcia Furquim de Almeida II ; Gizelton Pereira Alencar I ; Ivan França J... more ... Daniela Schoeps I ; Marcia Furquim de Almeida II ; Gizelton Pereira Alencar I ; Ivan França Jr. II ; Hillegonda Maria Dutilh Novaes III ; Arnaldo Augusto Franco de Siqueira II ; Oona Campbell IV ; Laura Cunha Rodrigues IV. ... 17. Reichenheim ME, Moraes CL, Hasselmann MH. ...
Successful cervical cancer prevention depends on reaching, screening and treating women with pre-... more Successful cervical cancer prevention depends on reaching, screening and treating women with pre-invasive disease. We aimed to evaluate the effectiveness of two media interventions-a photo-comic and a radio-drama-in increasing cervical screening uptake. A randomized controlled trial compared a photo-comic on cervical cancer screening with a placebo comic. One month after the comics were distributed a radiodrama paralleling the photo-comic was broadcast on the community radio station and a retrospective evaluation was carried out. The trial was set in Khayelitsha, a peri-urban squatter community near Cape Town, South Africa. A random sample consisted of 658 women between the ages of 35 and 65 years, from a stratified sample of census areas. The main outcome measure was self-reported cervical screening uptake 6 months after distribution of the comics. Seven percent (18 of 269) of women who received the intervention photocomic reported cervical screening during the 6 months follow-up, compared with 6% (25 of 389) of controls (P 5 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (nine of 53, 17%) than those who did not (19 of 429, 4%; P < 0.001). We conclude that the photo-comic was ineffective in increasing cervical screening uptake in this population. The radio-drama may have had more impact, but only a minority of women recalled being exposed to it. Future research must concentrate not only on achieving high level of exposure to health messages, but also on investigating the links between exposure and action.
The information recorded on birth certificates was validated with data from a perinatal mortality... more The information recorded on birth certificates was validated with data from a perinatal mortality case-control study, obtained from home interviews of mothers and hospital records for cases (early neonatal deaths) and controls. Sensitivity, specificity, and concordance were calculated for all variables and their estimated and real prevalence. The completeness of birth certificates was lowest for mother's parity and presence of congenital anomalies (records without information range from 23% to 31% for cases and controls). Birth certificates correctly identified low birth weight and type of delivery for cases and controls. Birth certificates showed high sensitivity and specificity to detect preterm births within cases. The number of preterm births was underestimated at 30.8% of the controls and 2.9% of the cases. Low maternal education was two times greater on birth certificates than in the mother's interview, for cases and controls. Completeness of birth certificates was higher in controls, but data quality was better in cases.
Results: Ninety percent of all condoms were used for sex within marriage (44% for spacing and 46%... more Results: Ninety percent of all condoms were used for sex within marriage (44% for spacing and 46% for limiting births). Condoms were used during 3% of marital sex acts and 15% of nonmarital sex acts. Two-thirds of the unmet need for condoms is for premarital or extramarital sex (53% and 13%, respectively). Given the current method mix, men in Orissa
Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from... more Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. The numbers of maternal deaths were determined and interviews conducted. The medical causes of death and avoidable factors were determined. Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100,000 live births). The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. Consideration of the intermediate and outcome indicators suggests that the g...
Journal of perinatology : official journal of the California Perinatal Association, 2004
To estimate stillbirth, perinatal (PMR) and neonatal mortality rates (NMR) in Egypt and to assign... more To estimate stillbirth, perinatal (PMR) and neonatal mortality rates (NMR) in Egypt and to assign main causes of death. Data were collected from a representative sample of women who gave birth from 17,521 households which were included in the Egypt Demographic and Health Survey (EDHS) 2000. Comparisons were made between three systems for classifying causes of death. The NMR was 25 per 1000 live births (17 early and eight late). Half the deaths occurred in the first two days of life. Neonatal causes of death were pre-maturity (39%), asphyxia (18%), infections (7%), congenital malformation (6%) and unclassified (29%). The PMR was 34 per 1000 births, mainly attributed to: asphyxia (44%) and prematurity (21%). The revised Wigglesworth classification agreed well with the physicians except the panel attributed more deaths to infections (20%). The WHO verbal autopsy algorithm left 48% of deaths unclassified. Infant mortality in Egypt is showing an epidemiological transition with a signific...
Methods for measuring maternal mortality at national and subnational levels in the developing wor... more Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates. We evaluated use of the national population census as a means of measuring maternal mortality by assessing data from five countries (Benin, Islamic Republic of Iran, Lao People's Democratic Republic, Madagascar, and Zimbabwe) which identified maternal deaths in their
In this paper, we take a broad perspective on maternal health and place it in its wider context. ... more In this paper, we take a broad perspective on maternal health and place it in its wider context. We draw attention to the economic and social vulnerability of pregnant women, and stress the importance of concomitant broader strategies, including poverty reduction and women's empowerment. We also consider outcomes beyond mortality, in particular, near-misses and long-term sequelae, and the implications of
Background: Obstetric practice has witnessed a worldwide trend of increasing cesarean section rat... more Background: Obstetric practice has witnessed a worldwide trend of increasing cesarean section rates in recent years. Similar trends have been observed in Lebanon, according to 2 studies conducted in 1996 and 1999. The objective of the present study was to assess the differences in predictors of cesarean delivery among nulliparous women in a "control hospital" with a low cesarean delivery rate (12.5%) and the rest of the National Collaborative Perinatal Neonatal Network (NCPNN) "study hospitals" with a higher cesarean delivery rate (31.4%).
BackgroundThe levels and origins of socio-economic inequalities in health-seeking behaviours in E... more BackgroundThe levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care.MethodsData from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private deliv...
Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-relate... more Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-related complications in poor settings. Delivery with a skilled birth attendant is a vital intervention for saving lives. Yet many women, particularly where maternal mortality ratios are highest, do not have a skilled birth attendant at delivery. In Uganda, only 58 % of women deliver in a health facility, despite approximately 95 % of women attending antenatal care (ANC). This study aimed to (1) identify key factors underlying the gap between high rates of antenatal care attendance and much lower rates of health-facility delivery; (2) examine the association between advice during antenatal care to deliver at a health facility and actual place of delivery; (3) investigate whether antenatal care services in a post-conflict district of Northern Uganda actively link women to skilled birth attendant services; and (4) make recommendations for policy- and program-relevant implementation research to enhance use of skilled birth attendance services. This study was carried out in Gulu District in 2009. Quantitative and qualitative methods used included: structured antenatal care client entry and exit interviews [n = 139]; semi-structured interviews with women in their homes [n = 36], with health workers [n = 10], and with policymakers [n = 10]; and focus group discussions with women [n = 20], men [n = 20], and traditional birth attendants [n = 20]. Seventy-five percent of antenatal care clients currently pregnant reported they received advice during their last pregnancy to deliver in a health facility, and 58 % of these reported having delivered in a health facility. After adjustment for confounding, women who reported they received advice at antenatal care to deliver at a health facility were significantly more likely (aOR = 2.83 [95 % CI: 1.19-6.75], p = 0.02) to report giving birth in a facility. Despite high antenatal care coverage, a number of demand and supply side barriers deter use of skilled birth attendance services. Primary barriers were: fear of being neglected or maltreated by health workers; long distance and other difficulties in access; poverty, and material requirements for delivery; lack of support from husband/partner; health systems deficiencies such as inadequate staffing/training, work environment, and referral systems; and socio-cultural and gender issues such as preferred birthing position and preference for traditional birth attendants. Initiatives to improve quality of client-provider interaction and respect for women are essential. Financial barriers must be abolished and emergency transport for referrals improved. Simultaneously, supply-side barriers must be addressed, notably ensuring a sufficient number of health workers providing skilled obstetric care in health facilities and creating habitable conditions and enabling environments for them.
objective To explore linkages between water, sanitation and hygiene (WASH) and maternal and perin... more objective To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review.
The European Journal of Contraception and Reproductive Health Care, 2009
Complications during pregnancy, delivery and puerperium are the most widespread causes of death a... more Complications during pregnancy, delivery and puerperium are the most widespread causes of death and disability among women of reproductive age in developing countries. In most of these, reliable estimates of maternal mortality are lacking. This paper aims to report Turkey&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s basic maternal mortality indicators derived from the National Maternal Mortality Study (NMMS). The data originate from NMMS which was an implementation of a Reproductive Age Mortality Study (RAMOS) data-collection strategy. Maternal mortality rates and ratios were estimated, and information was gathered for improving the existing recording and reporting systems. Burial data by age and sex were collected prospectively over a 12 month period. Interviews with household members, health care providers, and reviews of facility records were then used to classify the deaths as pregnancy-related or maternal or otherwise. A national pregnancy-related mortality ratio of 38 (+/- 2.8) and a maternal mortality ratio of 29 (+/- 2.5) per 100,000 live births were found. The NMMS shows that 59% of all pregnant women died from direct maternal causes, 16% from indirect causes and 23% from co-incidental causes. Maternal mortality is highest in regions with a poorer network of good roads, harsher winter conditions and longer distances to the next secondary level health facility which provides comprehensive obstetric emergency care services.
objectives To describe the biomedical and other causes of maternal death in Syria and to assess t... more objectives To describe the biomedical and other causes of maternal death in Syria and to assess their preventability.
This study is a first attempt to describe Lebanese women&amp;amp;#39;s responses to the medic... more This study is a first attempt to describe Lebanese women&amp;amp;#39;s responses to the medical management of their pregnancy and delivery. A qualitative approach in data collection and analysis was adopted to gain an in-depth view of women&amp;amp;#39;s perceptions. Women of any parity undergoing a normal vaginal delivery during the three months preceding the interview were interviewed in different areas in Lebanon: one urban, one semi-rural and two remote rural. Childbirth for all the women interviewed was managed within the medical system. Findings show that women accord total trust to their physicians, and very rarely question the usefulness of many routinely applied procedures, even those which the literature shows are unnecessary. When probed, women report that many aspects of the technical care are intimidating and that they experience discomfort with these procedures. Women are more vocal about patient-provider communication and value good interaction with their provider. The extent of passivity and feelings of discontent women have varies according to their social class and the amount of psychosocial support they receive throughout the process of childbirth.
This study assesses the prevalence and determinants of postpartum depression (PPD). 396 women del... more This study assesses the prevalence and determinants of postpartum depression (PPD). 396 women delivering in Beirut and a rural area (Beka'a Valley) were interviewed 24 hours and 3-5 months after delivery. During the latter visit, they were screened using the Edinburgh postnatal depression scale. The overall prevalence of PPD was 21% but was significantly lower in Beirut than the Beka'a Valley (16% vs. 26%). Lack of social support and prenatal depression were significantly associated with PPD in both areas, whereas stressful life events, lifetime depression, vaginal delivery, little education, unemployment, and chronic health problems were significantly related to PPD in one of the areas. Prenatal depression and more than one chronic health problem increased significantly the risk of PPD. Caesarean section decreased the risk of PPD, particularly in Beirut but also in the Beka'a Valley. Caregivers should use pre-and postnatal assessments to identify and address women at risk of PPD.
... Daniela Schoeps I ; Marcia Furquim de Almeida II ; Gizelton Pereira Alencar I ; Ivan França J... more ... Daniela Schoeps I ; Marcia Furquim de Almeida II ; Gizelton Pereira Alencar I ; Ivan França Jr. II ; Hillegonda Maria Dutilh Novaes III ; Arnaldo Augusto Franco de Siqueira II ; Oona Campbell IV ; Laura Cunha Rodrigues IV. ... 17. Reichenheim ME, Moraes CL, Hasselmann MH. ...
Successful cervical cancer prevention depends on reaching, screening and treating women with pre-... more Successful cervical cancer prevention depends on reaching, screening and treating women with pre-invasive disease. We aimed to evaluate the effectiveness of two media interventions-a photo-comic and a radio-drama-in increasing cervical screening uptake. A randomized controlled trial compared a photo-comic on cervical cancer screening with a placebo comic. One month after the comics were distributed a radiodrama paralleling the photo-comic was broadcast on the community radio station and a retrospective evaluation was carried out. The trial was set in Khayelitsha, a peri-urban squatter community near Cape Town, South Africa. A random sample consisted of 658 women between the ages of 35 and 65 years, from a stratified sample of census areas. The main outcome measure was self-reported cervical screening uptake 6 months after distribution of the comics. Seven percent (18 of 269) of women who received the intervention photocomic reported cervical screening during the 6 months follow-up, compared with 6% (25 of 389) of controls (P 5 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (nine of 53, 17%) than those who did not (19 of 429, 4%; P < 0.001). We conclude that the photo-comic was ineffective in increasing cervical screening uptake in this population. The radio-drama may have had more impact, but only a minority of women recalled being exposed to it. Future research must concentrate not only on achieving high level of exposure to health messages, but also on investigating the links between exposure and action.
The information recorded on birth certificates was validated with data from a perinatal mortality... more The information recorded on birth certificates was validated with data from a perinatal mortality case-control study, obtained from home interviews of mothers and hospital records for cases (early neonatal deaths) and controls. Sensitivity, specificity, and concordance were calculated for all variables and their estimated and real prevalence. The completeness of birth certificates was lowest for mother's parity and presence of congenital anomalies (records without information range from 23% to 31% for cases and controls). Birth certificates correctly identified low birth weight and type of delivery for cases and controls. Birth certificates showed high sensitivity and specificity to detect preterm births within cases. The number of preterm births was underestimated at 30.8% of the controls and 2.9% of the cases. Low maternal education was two times greater on birth certificates than in the mother's interview, for cases and controls. Completeness of birth certificates was higher in controls, but data quality was better in cases.
Results: Ninety percent of all condoms were used for sex within marriage (44% for spacing and 46%... more Results: Ninety percent of all condoms were used for sex within marriage (44% for spacing and 46% for limiting births). Condoms were used during 3% of marital sex acts and 15% of nonmarital sex acts. Two-thirds of the unmet need for condoms is for premarital or extramarital sex (53% and 13%, respectively). Given the current method mix, men in Orissa
Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from... more Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. The numbers of maternal deaths were determined and interviews conducted. The medical causes of death and avoidable factors were determined. Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100,000 live births). The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. Consideration of the intermediate and outcome indicators suggests that the g...
Journal of perinatology : official journal of the California Perinatal Association, 2004
To estimate stillbirth, perinatal (PMR) and neonatal mortality rates (NMR) in Egypt and to assign... more To estimate stillbirth, perinatal (PMR) and neonatal mortality rates (NMR) in Egypt and to assign main causes of death. Data were collected from a representative sample of women who gave birth from 17,521 households which were included in the Egypt Demographic and Health Survey (EDHS) 2000. Comparisons were made between three systems for classifying causes of death. The NMR was 25 per 1000 live births (17 early and eight late). Half the deaths occurred in the first two days of life. Neonatal causes of death were pre-maturity (39%), asphyxia (18%), infections (7%), congenital malformation (6%) and unclassified (29%). The PMR was 34 per 1000 births, mainly attributed to: asphyxia (44%) and prematurity (21%). The revised Wigglesworth classification agreed well with the physicians except the panel attributed more deaths to infections (20%). The WHO verbal autopsy algorithm left 48% of deaths unclassified. Infant mortality in Egypt is showing an epidemiological transition with a signific...
Methods for measuring maternal mortality at national and subnational levels in the developing wor... more Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates. We evaluated use of the national population census as a means of measuring maternal mortality by assessing data from five countries (Benin, Islamic Republic of Iran, Lao People's Democratic Republic, Madagascar, and Zimbabwe) which identified maternal deaths in their
In this paper, we take a broad perspective on maternal health and place it in its wider context. ... more In this paper, we take a broad perspective on maternal health and place it in its wider context. We draw attention to the economic and social vulnerability of pregnant women, and stress the importance of concomitant broader strategies, including poverty reduction and women's empowerment. We also consider outcomes beyond mortality, in particular, near-misses and long-term sequelae, and the implications of
Background: Obstetric practice has witnessed a worldwide trend of increasing cesarean section rat... more Background: Obstetric practice has witnessed a worldwide trend of increasing cesarean section rates in recent years. Similar trends have been observed in Lebanon, according to 2 studies conducted in 1996 and 1999. The objective of the present study was to assess the differences in predictors of cesarean delivery among nulliparous women in a "control hospital" with a low cesarean delivery rate (12.5%) and the rest of the National Collaborative Perinatal Neonatal Network (NCPNN) "study hospitals" with a higher cesarean delivery rate (31.4%).
BackgroundThe levels and origins of socio-economic inequalities in health-seeking behaviours in E... more BackgroundThe levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care.MethodsData from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private deliv...
Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-relate... more Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-related complications in poor settings. Delivery with a skilled birth attendant is a vital intervention for saving lives. Yet many women, particularly where maternal mortality ratios are highest, do not have a skilled birth attendant at delivery. In Uganda, only 58 % of women deliver in a health facility, despite approximately 95 % of women attending antenatal care (ANC). This study aimed to (1) identify key factors underlying the gap between high rates of antenatal care attendance and much lower rates of health-facility delivery; (2) examine the association between advice during antenatal care to deliver at a health facility and actual place of delivery; (3) investigate whether antenatal care services in a post-conflict district of Northern Uganda actively link women to skilled birth attendant services; and (4) make recommendations for policy- and program-relevant implementation research to enhance use of skilled birth attendance services. This study was carried out in Gulu District in 2009. Quantitative and qualitative methods used included: structured antenatal care client entry and exit interviews [n = 139]; semi-structured interviews with women in their homes [n = 36], with health workers [n = 10], and with policymakers [n = 10]; and focus group discussions with women [n = 20], men [n = 20], and traditional birth attendants [n = 20]. Seventy-five percent of antenatal care clients currently pregnant reported they received advice during their last pregnancy to deliver in a health facility, and 58 % of these reported having delivered in a health facility. After adjustment for confounding, women who reported they received advice at antenatal care to deliver at a health facility were significantly more likely (aOR = 2.83 [95 % CI: 1.19-6.75], p = 0.02) to report giving birth in a facility. Despite high antenatal care coverage, a number of demand and supply side barriers deter use of skilled birth attendance services. Primary barriers were: fear of being neglected or maltreated by health workers; long distance and other difficulties in access; poverty, and material requirements for delivery; lack of support from husband/partner; health systems deficiencies such as inadequate staffing/training, work environment, and referral systems; and socio-cultural and gender issues such as preferred birthing position and preference for traditional birth attendants. Initiatives to improve quality of client-provider interaction and respect for women are essential. Financial barriers must be abolished and emergency transport for referrals improved. Simultaneously, supply-side barriers must be addressed, notably ensuring a sufficient number of health workers providing skilled obstetric care in health facilities and creating habitable conditions and enabling environments for them.
objective To explore linkages between water, sanitation and hygiene (WASH) and maternal and perin... more objective To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review.
The European Journal of Contraception and Reproductive Health Care, 2009
Complications during pregnancy, delivery and puerperium are the most widespread causes of death a... more Complications during pregnancy, delivery and puerperium are the most widespread causes of death and disability among women of reproductive age in developing countries. In most of these, reliable estimates of maternal mortality are lacking. This paper aims to report Turkey&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s basic maternal mortality indicators derived from the National Maternal Mortality Study (NMMS). The data originate from NMMS which was an implementation of a Reproductive Age Mortality Study (RAMOS) data-collection strategy. Maternal mortality rates and ratios were estimated, and information was gathered for improving the existing recording and reporting systems. Burial data by age and sex were collected prospectively over a 12 month period. Interviews with household members, health care providers, and reviews of facility records were then used to classify the deaths as pregnancy-related or maternal or otherwise. A national pregnancy-related mortality ratio of 38 (+/- 2.8) and a maternal mortality ratio of 29 (+/- 2.5) per 100,000 live births were found. The NMMS shows that 59% of all pregnant women died from direct maternal causes, 16% from indirect causes and 23% from co-incidental causes. Maternal mortality is highest in regions with a poorer network of good roads, harsher winter conditions and longer distances to the next secondary level health facility which provides comprehensive obstetric emergency care services.
objectives To describe the biomedical and other causes of maternal death in Syria and to assess t... more objectives To describe the biomedical and other causes of maternal death in Syria and to assess their preventability.
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Papers by Oona Campbell