MATERNAL MORTALITY IN PAKISTAN: IS THERE ANY METAMORPHOSIS TOWARDS BETTERMENT?
AbstractBackground: Every year more than half million mother die due to pregnancy related preventable causes like haemorrhage, hypertensive disorders, sepsis, obstructed labour and unsafe abortion. Among these deaths 99% occur in developing countries. The study was conducted to assess the maternal death rate and to analyse its trends over a period of 20 years in tertiary care hospital in Sindh Province Pakistan. Methods: A retrospective analysis of maternal mortality records were carried out for a period of 20 years from 1986–1995 and 2011–2015 at the Department of Obstetrics and gynaecology Liaquat University of Medical and Health Sciences Hyderabad Sindh Pakistan. The record retrieved was categorized into four 5 yearly periods 1986–1990, 1991–995, 2006–2010 and 2011–2015 for comparison of trends. Results: The cumulative maternal mortality ratio (MMR) was 1521.5 per 100,000 live births. The comparison of first 5 years’ period (1986–1990) and last 5 years (2011–2015) showed downward trend in maternal mortality rate from 2368.6–1265.1. Direct causes of death have accounted for 2820 (84.78%) of total maternal death. Sepsis was the major cause of death for first 5 years accounted for 196(35.1%) of maternal death while in the last 5 years’ eclampsia causes 284 (27.84%) of direct maternal deaths.Conclusion: The reduction in the maternal deaths has been very slow. The direct causes were still the main reasons for obstetrical deaths.Keywords: Maternal Mortality; Changing trends; Women’s Health; Safe Motherhood
WHO. Maternal mortality rates: a tabulation of available information. World Health Organization, Division of Family Health; 1986.
Begum S, Aziz-Un-Nisa, Begum I. Analysis of maternal mortality in a tertiary care hospital to determine causes and preventable factors. J Ayub Med Coll Abottabad 2003;15(2):49–52.
Trends in Maternal Mortality 1990- 2015: estimated by WHO, UNICEF, UNFPA, world Bank Group and The United Nations Population Division.
Farooq N, Jadoon H, Massod TI, Wazir MS, Farooq U, Lodhi MS. An assessment study of maternal mortality ratio data bank in five districts of North western Frontier Province Pakistan. J Ayub Med Coll Abbotabad 2006;18(2):64–8.
Jafarey SN. Woman’s health in: public health and community 7th ed. Times publishers, Karachi 2006. 367-76.
Women’s health in Pakistan. Fact sheets prepared for Pakistan National forum on Women’s health. WHO November 1997;14:3-5
Pakistan's Millenium Develponment Goals Report 2006: Goal 5, Improve maternal health. (Cited 2015 March 13). Available from http://www.crprid.org/publications/goals/wise2006/start%20pages.pdf.
Midhet F, Hosang N. Risk factors of maternal mortality in Pakistan: Preliminary results from the Demographic and Health Survey (DHS), 2006-2007. URL:http://paa2009.princeton.edu/download.aspn?submisionId90588.
World Health Organization. Maternal Mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. (Online) 2015 (Cited 2015 March 12). Available from www.who.int 2000.
United Millennium Development Goals. (Online) 2015 (Cited 2015 March 13). Available from: http://www.un.org/millenniumgolas
Schvitemaker NW, Grauenthorst JB, Van Dongen. Maternal mortality and its prevention. Eur J Obstet Gynaecol 1999;42:531–5.
Motherhood: A situation analysis and recommendations for evidence based approaches. Chap 1, In: Bhutta ZA. Editor. Maternal and child health in Pakistan: challenges and opportunities. 2004, Oxford University Press, Oxford.
Rosten E, Armstrong S. Preventing maternal deaths. Geneva: WHO Publications 1989:14-8.
Khan S, Iftekhar N, Usmani AT. Maternal mortality; An analysis of determinants and causes. Prof Med J 2008;16(3):445–553.
Sami S, Baloach SN. Maternal Mortality in Balochistan; a challenge for obstetrician. J Coll Physician Surg Pak 2002;12(8):468–71.
Wasim T, Majrooh A, Siddiq S. Maternal mortality: oneyear review at Lahore General Hospital. Pak Postgrad Med 2001;12(3):113–8.
Mustafa R, Mustafa R, Hashmi H. Maternal mortality in a community based hospital. Med Forum 2008;19(5):17–25.
Shah N, Hossain N, Shoab R, Hasain A, Gillani R, Khan NH. Socio-demographic characteristics and the three delays of maternal mortality. J Coll Physicians Surg Pak 2009;19(2):95–8.
Zahr CA, Royston E. Compilers Maternal mortality - a global factbook. Geneva: WHO 1991.
Najmi RS. Maternal Mortality: A hospital based study. J Coll Physicians Surg Pak 1995;5:66–7.
Ronsmans C, Graham WJ, Maternal survival 1: Maternal mortality: Who, When, Where and Why. Lancet 2006;368:1189-1200
Society of Obstetricians and Gynaecologists of Pakistan. “Maternal and perinatal health”. SOGP and AFOG 1991 Karachi.
Farook SM. Maternal Mortality at Liaquat Medical College Hospital, Hyderabad. JCPSP, 1993; 3:8-11
Malik FR, Swati AA, Akhter S, Hadi A, Safi SI, Wazir SUI, et al. Retrospective analysis of maternal mortality at a tertiary care hospital of Peshawar, Pakistan. Khyber Med Univ J 2015;7(1): 25-29.
Ujah IA, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Ugru VE. Factors contributing to maternal mortality innorth-central Nigeria: A seventeen year review. Afr J Reprod Health 2005;9(3):27–40.
Gupta N, Kumar S, Saxena NC, Nandan D, Saxena BN. Maternal mortality in seven districts of Uttar Padres-an ICMR task force study. Indian J Public Health 2006;50(3):173–8.
Rana A, Pradhan N, Manandhar B, Bista DK, Akhidari S, Gurung G, et al. Maternal mortality over the last decade: A changing pattern of death due to alarming rise in Hepatitis in the latter 5 year period. J Obstet Gynaecol Res 2009;35(2):243–51.