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Cited by 330Global Maternal and Child HealthMaternal and fetal healthcareMaternal and Neonatal Healthcare

Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

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Ahmed, Imran, Ali, Said Mohammed, Amenga-Etego, Seeba, Ariff, Shabina, Bahl, Rajiv, Baqui, Abdullah H, Begum, Nazma, Bhandari, Nita +59 more·2018·The Lancet Global Health
DOI 10.1016/s2214-109x(18)30385-1PMC PMC6227247
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Abstract

BACKGROUND: Modelled mortality estimates have been useful for health programmes in low-income and middle-income countries. However, these estimates are often based on sparse and low-quality data. We aimed to generate high quality data about the burden, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa. METHODS: In this prospective cohort study done in 11 community-based research sites in south Asia and sub-Saharan Africa, between July, 2012, and February, 2016, we conducted population-based surveillance of women of reproductive age (15-49 years) to identify pregnancies, which were followed up to birth and 42 days post partum. We used standard operating procedures, data collection instruments, training, and standardisation to harmonise study implementation across sites. Verbal autopsies were done for deaths of all women of reproductive age, neonatal deaths, and stillbirths. Physicians used standardised methods for cause of death assignment. Site-specific rates and proportions were pooled at the regional level using a meta-analysis approach. FINDINGS: We identified 278 186 pregnancies and 263 563 births across the study sites, with outcomes ascertained for 269 630 (96·9%) pregnancies, including 8761 (3·2%) that ended in miscarriage or abortion. Maternal mortality ratios in sub-Saharan Africa (351 per 100 000 livebirths, 95% CI 168-732) were similar to those in south Asia (336 per 100 000 livebirths, 247-458), with far greater variability within sites in sub-Saharan Africa. Stillbirth and neonatal mortality rates were approximately two times higher in sites in south Asia than in sub-Saharan Africa (stillbirths: 35·1 per 1000 births, 95% CI 28·5-43·1 vs 17·1 per 1000 births, 12·5-25·8; neonatal mortality: 43·0 per 1000 livebirths, 39·0-47·3 vs 20·1 per 1000 livebirths, 14·6-27·6). 40-45% of pregnancy-related deaths, stillbirths, and neonatal deaths occurred during labour, delivery, and the 24 h postpartum period in both regions. Obstetric haemorrhage, non-obstetric complications, hypertensive disorders of pregnancy, and pregnancy-related infections accounted for more than three-quarters of maternal deaths and stillbirths. The most common causes of neonatal deaths were perinatal asphyxia (40%, 95% CI 39-42, in south Asia; 34%, 32-36, in sub-Saharan Africa) and severe neonatal infections (35%, 34-36, in south Asia; 37%, 34-39 in sub-Saharan Africa), followed by complications of preterm birth (19%, 18-20, in south Asia; 24%, 22-26 in sub-Saharan Africa). INTERPRETATION: These results will contribute to improved global estimates of rates, timing, and causes of maternal and newborn deaths and stillbirths. Our findings imply that programmes in sub-Saharan Africa and south Asia need to further intensify their efforts to reduce mortality rates, which continue to be high. The focus on improving the quality of maternal intrapartum care and immediate newborn care must be further enhanced. Efforts to address perinatal asphyxia and newborn infections, as well as preterm birth, are critical to achieving survival goals in the Sustainable Development Goals era. FUNDING: Bill & Melinda Gates Foundation.

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  • The finding that PPH was the most reported direct cause of death is similar to regional estimates.

    “This is similar to regional estimates, 25 yet with adequate and timely interventions, the morbidity and mortality associated with PPH can be minimized, regardless of the cause. 14”

    From Review of maternal death audits in refugee camps in <scp>UNHCR</scp> East and Horn of Africa and Great Lakes Region, 2017–2019 (2023) · cites this paper as [25]

    The Results (page unavailable) identify obstetric haemorrhage as a leading cause of maternal death in both regions, and the Discussion says the findings were similar to previously published regional estimates. The paper does not identify postpartum haemorrhage (PPH) separately as the most reported direct cause, so the claim is more specific than its evidence. (LLM, conf=0.83)

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  1. [28]WHO WHO recommendations on antenatal care for a positive pregnancy experience http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/ 2016 28079998

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Authors
Ahmed, I., Ali, S. M., Amenga-Etego, S., Ariff, S., Bahl, R., Baqui, A. H., Begum, N., Bhandari, N., Bhatia, K., Bhutta, Z. A., Biemba, G., Deb, S., Dhingra, U., Dube, B., Dutta, A., Edmond, K., Esamai, F., Fawzi, W., Ghosh, A. K., Gisore, P., Grogan, C., Hamer, D. H., Herlihy, J., Hurt, L., Ilyas, M., Jehan, F., Kalonji, M., Kaur, J., Khanam, R., Kirkwood, B., Kumar, A., Kumar, A., Kumar, V., Manu, A., Marete, I., Masanja, H., Mazumder, S., Mehmood, U., Mishra, S., Mitra, D. K., Mlay, E., Mohan, S. B., Moin, M. I., Muhammad, K., Muhihi, A., Newton, S., Ngaima, S., Nguwo, A., Nisar, I., O'Leary, M., Otomba, J., Patil, P., Quaiyum, M. A., Rahman, M. H., Sazawal, S., Semrau, K. E., Shannon, C., Smith, E. R., Soofi, S., Soremekun, S., Sunday, V., Taneja, S., Tshefu, A., Wasan, Y., Yeboah-Antwi, K., Yoshida, S., & Zaidi, A.
Affiliations
World Health Organization (CH)
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2018-12
Volume
6
Issue
12
Pages
e1297-e1308
ISSN
2214-109X (ISSN-L)
DOI
10.1016/s2214-109x(18)30385-1
PMC
PMC6227247
OpenAlex
W2896360990
Cited by
330
References
21
Citations by year
2026: 27 · 2025: 41 · 2024: 55 · 2023: 45 · 2022: 54 · 2021: 50 · 2020: 36 · 2019: 19 · 2018: 3
FWCI
29.82
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Global Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Bill and Melinda Gates Foundation
  • National Institute of Allergy and Infectious Diseases (T32AI007358)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
maternal mortality, stillbirth, neonatal mortality, verbal autopsy, cause of death classification, maternal mortality ratio, stillbirth rate, neonatal mortality rate, South Asia, sub-Saharan Africa, women of reproductive age, pregnancy surveillance, low- and middle-income countries
MeSH terms
Adolescent, Adult, Asia, Female, Humans, Infant, Newborn, Middle Aged, Pregnancy, Prospective Studies, Africa South of the Sahara, Stillbirth, Young Adult, Maternal Death, Perinatal Death

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