TITLE

Quantifying the fall in mortality associated with interventions related to hypertensive diseases of pregnancy

AUTHOR(S)
Ronsmans, Carine; Campbell, Oona
PUB. DATE
January 2011
SOURCE
BMC Public Health;2011 Supplement 3, Vol. 11 Issue Suppl 3, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: In this paper we review the evidence of the effect of health interventions on mortality reduction from hypertensive diseases in pregnancy (HDP). We chose HDP because they represent a major cause of death in low income countries and evidence of effect on maternal mortality from randomised studies is available for some interventions. Methods: We used four approaches to review the evidence of the effect of interventions to prevent or treat HDP on mortality reduction from HDP. We first reviewed the Cochrane Library to identify systematic reviews and individual trials of the efficacy of single interventions for the prevention or treatment of HDP. We then searched the literature for articles quantifying the impact of maternal health interventions on the reduction of maternal mortality at the population level and describe the approaches used by various authors for interventions related to HDP. Third, we examined levels of HDP-specific mortality over time or between regions in an attempt to quantify the actual or potential reduction in mortality from HDP in these regions or over time. Lastly, we compared case fatality rates in women with HDP-related severe acute maternal morbidity with those reported historically in high income countries before any effective treatment was available. Results: The Cochrane review identified 5 effective interventions: routine calcium supplementation in pregnancy, antiplatelet agents during pregnancy in women at risk of pre-eclampsia, Magnesium sulphate (MgS04) for the treatment of eclampsia, MgS04 for the treatment of pre-eclampsia, and hypertensive drugs for the treatment of mild to moderate hypertension in pregnancy. We found 10 studies quantifying the effect of maternal health interventions on reducing maternal mortality from HDP, but the heterogeneity in the methods make it difficult to draw uniform conclusions for effectiveness of interventions at various levels of the health system. Most authors include a health systems dimension aimed at separating interventions that can be delivered at the primary or health centre level from those that require hospital treatment, but definitions are rarely provided and there is no consistency in the types of interventions that are deemed effective at the various levels. The low levels of HDP related mortality in rural China and Sri Lanka suggest that reductions of 85% or more are within reach, provided that most women give birth with a health professional who can refer them to higher levels of care when necessary. Results from studies of severe acute maternal morbidity in Indonesia and Bolivia also suggest that mortality in women with severe pre-eclampsia or eclampsia in hospital can be reduced by more than 84%, even when the women arrive late. Conclusions: The increasing emphasis on the rating of the quality of evidence has led to greater reliance on evidence from randomised controlled trials to estimate the effect of interventions. Yet evidence from randomised studies is often not available, the effects observed on morbidity may not translate in to mortality, and the distinction between efficacy and effectiveness may be difficult to make. We suggest that more use should be made of observational evidence, particularly since such data represent the actual effectiveness of packages of interventions in various settings.
ACCESSION #
60440489

 

Related Articles

  • We can do better at reducing U.S. infant mortality rates. Walker, Deborah Klein // Nation's Health;Apr2007, Vol. 37 Issue 3, p3 

    The author reflects on the infant mortality rates in the U.S. According to the author, there is no guaranteed set of comprehensive services available nationwide for the four key periods related to infant mortality which is before pregnancy, during pregnancy, at birth and during the first year of...

  • Regional perinatal mortality differences in the Netherlands; care is the question. Tromp, Miranda; Eskes, Martine; Reitsma, Johannes B.; Erwich, Jan Jaap H. M.; Brouwers, Hens A. A.; Rijninks-van Driel, Greta C.; Bonsel, Gouke J.; Ravelli, Anita C. J. // BMC Public Health;2009, Vol. 9 Issue 1, p1 

    Background: Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory...

  • Costs affected by adolescents giving birth. LER // Caribbean Business;8/3/2000, Vol. 28 Issue 30, p28 

    Focuses on the impact of teenage pregnancies on health care costs in Puerto Rico. Increase in the number of adolescent pregnancies; Lack of proper care during pregnancy; Notion on the decline of mortality rates among babies; Estimation of out-of-wedlock births; Concern over the malpractice...

  • Experts Say Japan's Medical Delivery System Is Partly To Blame for High Level of Maternal Mortality There. Hollander, D. // Family Planning Perspectives;Nov/Dec2000, Vol. 32 Issue 6, p309 

    This article focuses on the high level of maternal mortality rate in Japan and the inadequacies in Japan's system of delivering obstetric care. In 1991-1992, 230 Japanese women died while pregnant or within 42 days after their pregnancy ended; the resulting maternal mortality rate of 95 deaths...

  • The tip of the iceberg: Evidence of seasonality in institutional maternal mortality and implications for health resources management in Burkina Faso. Hounton, Sennen H.; Sombie, Issiaka; Townend, John; Ouedraogo, Thomas; Meda, Nicolas; Graham, Wendy J. // Scandinavian Journal of Public Health;May2008, Vol. 36 Issue 3, p3 

    Aims: The aims of this study were to investigate seasonal patterns of institutional maternal deaths and complications, and to test for an association with malaria seasons, rainfall, and household income. Methods: A systematic case review of hospital records in the Boucle du Mouhoun health region...

  • Suffer the children. Sibbald, Barbara // CMAJ: Canadian Medical Association Journal;3/5/2013, Vol. 185 Issue 4, pE187 

    The article discusses health aspects of children's in Swaziland where 31 percent of adults are HIV positive and 47 percent are unemployed. It discusses the impact of increased mortality rate on children's health care, teen pregnancy and education. It mentions that non-existence of orphanages in...

  • Community perceptions of the causes and prevention of maternal mortality. Adegooke, Adetoro A.; Ogundeji, Martins O.; Lawoyin, Taiwo O.; Campbell, Malcolm; Thomson, Ann M. // African Journal of Midwifery & Women's Health;Jan-Mar2010, Vol. 4 Issue 1, p23 

    The objective was to identify community members' perceptions of the causes and prevention of maternal mortality in Ibadan, North East Local Government Area of Oyo State, Nigeria. Reported in this article are the results from a pilot study, carried out in 2005, of the views of 418 community men...

  • The Safe Motherhood Initiative: Why Has It Stalled? Maine, Deborah; Rosenfield, Allan // American Journal of Public Health;Apr99, Vol. 89 Issue 4, p480 

    Complications of pregnancy and childbirth are still the leading cause of death and disability among women of reproductive age in developing countries. After decades of neglect, the founding of the Safe Motherhood Initiative in 1987 promised action on this problem. A dozen years later, there is...

  • Criteria-Based Audit of Quality of Care to Women with Severe Pre-Eclampsia and Eclampsia in a Referral Hospital in Accra, Ghana. Browne, Joyce L.; van Nievelt, Sabine W.; Srofenyoh, Emmanuel K.; Grobbee, Diederick E.; Klipstein-Grobusch, Kerstin // PLoS ONE;Apr2015, Vol. 10 Issue 4, p1 

    Objectives: Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics