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" Facility and Community Based Maternal Death Review to Understand and Contextualize the Maternal Mortality in West Bengal "
Sk, Md. Illias Kanchan
Paswan, Balram
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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1111893
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| Doc. No
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TLpq2505399267
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| Main Entry
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Paswan, Balram
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Sk, Md. Illias Kanchan
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| Title & Author
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Facility and Community Based Maternal Death Review to Understand and Contextualize the Maternal Mortality in West Bengal\ Sk, Md. Illias KanchanPaswan, Balram
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| College
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International Institute for Population Sciences University
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| Date
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2019
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| student score
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2019
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| Degree
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Ph.D.
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| Page No
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256
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| Abstract
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Earlier studies have manifested a high magnitude of maternal deaths attributed to obstetric haemorrhage in West Bengal, but recently there is a paradigm shift in pattern of maternal mortality. In the last few decades, the State has marked a unique recognition for having the highest maternal mortality caused by eclampsia in the country as well as in the globe. West Bengal's women carry a high risk of pre-eclampsia and eclampsia with the substantial burden of maternal mortality and morbidity. The frequently cited statistics revealed that West Bengal is experiencing 10 to 30 times higher incidence and case fatality rate of eclampsia than what the developed nations are observing today. Looking at enormity of the issue, this study was aimed to examine the etiology and circumstances behind the mortality associated with antepartum, intrapartum and post-partum cases. An attempt was also made in this study to identify the confounding factors associated with eclamptic maternal deaths. The design employed for this study was a retrospective mixed method. This retrospective study delineates the implementation of the facility-based maternal death reviews as well as community-based maternal deaths reviews approaches. It was the manifestation of a multicentre facility-based study conducted between November 2013 and October 2015, involving two major tertiary level healthcare referral centres in West Bengal. During this two-year study period, a total of 317 pregnancy and childbirth associated deaths were recorded. This study also captured 40 family members of deceased women to accomplish the community-based maternal deaths audit. Besides the ‘demand side’ (family members), 12 more in-depth interviews were also conducted with ‘provider or supply side’ (service providers) who were associated with maternal deaths or who engaged in the provision of care to the deceased. Bivariate analysis, Chi-square test (χ2), Student’s t-test and binary logistic regression model were employed to accomplish the study objectives. The study found that the selected region, West Bengal had a very high health facilitybased maternal mortality ratio (561 per 100,000 live births) with an unsteady declining trend. The estimated maternal mortality ratio in the study was higher than the national and state averages. The average distance for travelling to reach the final hospital was 47.37 km. The high magnitude of maternal deaths among referred cases (80 percent), postpartum cases (almost three-fourths), antenatal care absence cases (59 percent), patients (50 percent) hospitalized within 12 hours of developing complications, and women between 37 and 42 weeks of pregnancy were reported in this study. Eclampsia or hypertensive disorders of pregnancy contributed to one-third of deaths and it was accounted for the leading cause of maternal deaths in West Bengal. The study found 1998 cases of eclampsia, yielding an overall incidence of 2.55 percent. The result also confirmed a high level of case fatality rate (CFR- 8.63 percent). The occurrence of eclamptic deaths was highest (n=61) in monsoon and post-monsoon (July to Oct), and it was also found that humidity (p<0.000) was significantly varied between winter and monsoon & post monsoon seasons. The majority, three-fourths (75 percent) of maternal deaths occurred among those patients who developed eclampsia during the postpartum period. Pulmonary edema was associated with an increased risk of maternal complications among eclamptic women and reflected as most common (43.2 percent) cause of eclamptic maternal deaths in the study. The women belonged to <24 years age group (65%), primigravidas (40%) and C-section delivered mothers were noted to have an increased risk of eclamptic deaths as compared to their counterparts. Verbal autopsies indicated that majority of pregnant women had the irregular AN Check-ups history, particularly during the second trimester of pregnancy. Most of the eclamptic deceased women had been taken to at least three health facilities. Gravidity, the number of ANC, mode of delivery and any delay were appeared as the significant confounders of eclamptic deaths in the study. The likelihood of having eclamptic maternal deaths was two times higher among delay observing group as compared to their counterparts. The study revealed that the delay related to user factors (patients and/or their family) was the most significant contributor, and approximately half of the women died due to this. The delay in reaching first level health facility (Type 2 delay) had contributed to one-third of deaths, while delay related to receiving the quality of medical care at the health facility (Type 3 delay) had a role in 19 percent of maternal deaths. Women belonged to Muslim community were 2.5 times and 1.6 times more likely to experience type 1 and 2 delays than Hindu women. The verbal autopsies revealed that the type 1 delay is attributed to the underestimation of the gravity of the complications, cultural belief and customs and unfavorable experiences with the health system. The incidence of eclampsia among pregnant women in West Bengal was observed to be on the higher side of rates reported in Indian settings and remained as the leading cause of maternal mortality in the study. Our findings of excess mortality attributed to eclampsia in gestational age should not detract from the message that reproductive health should remain a priority for both national governments and the global health community. Finally, we can conclude by emphasizing the hypertensive disorders of pregnancy or eclampsia is a life-threatening complication of pregnancy possessing the centre stage of obstetric attention.
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| Subject
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Health care management
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Obstetrics
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Public health
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Southeast Asian studies
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Womens studies
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