An Analysis of Pregnancy-Related Mortality in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya
An Analysis of Pregnancy-Related Mortality in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya
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DOI：
10.1371/journal.pone.0068733
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发表时间：
2013-07-16
期刊：
影响因子：
3.7
通讯作者：
Laserson, Kayla F.
中科院分区：
文献类型：
--
作者：
Desai, Meghna;Phillips-Howard, Penelope A.;Laserson, Kayla F.
背景资料：妊娠相关（PR）的死亡往往是由于直接产科并发症发生在bridging.Methods和调查结果：估计的负担和特征的危险因素PR死亡率，我们评估了死亡发生在2003年和2008年之间的育龄妇女（15至49岁）使用健康和人口监测系统的数据在肯尼亚西部农村。使用了WHO ICD对PR死亡率的定义：“妇女在妊娠期间或终止妊娠后42天内死亡，无论死因如何”。此外，还使用世卫组织推断尸检方法对死亡时的症状和事件进行了检查。死亡被分类为（i）直接PR：主要死亡原因归因于产科，或（ii）间接PR：主要死亡原因为非产科。在15至49岁的3，223例女性死亡中，249例（7.7%）为PR。其中三分之一（34%）是由于直接产科原因，主要是产后出血，流产并发症和产后败血症。三分之二是间接的;四分之三是由于人体免疫机能丧失病毒（艾滋病毒/艾滋病）、疟疾和结核病。在较低的社会经济群体中死亡的妇女中，有更多的人寻求传统助产士的护理（p = 0.034），而贫困程度较低的妇女更有可能寻求医院护理（p = 0.001）。PR死亡率在6年内为740（95%CI 651-838）每100，000活产，没有证据表明随着时间的推移减少（卡方（2）线性趋势= 1.07; p = 0.3）。结论：这些数据补充了目前缺乏的信息之间的关系传染病和贫困的孕产妇在非洲的结果。这些数据表明，在怀孕和产后死亡的妇女中，孕产妇保健干预措施的利用率较低，这表明改善获得熟练产科护理的机会并增加其利用率，以及在所有育龄妇女中采取预防艾滋病毒/艾滋病、疟疾和结核病的措施，可能有助于降低与怀孕有关的死亡率。
Background: Pregnancy-related (PR) deaths are often a result of direct obstetric complications occurring at childbirth.Methods and Findings: To estimate the burden of and characterize risk factors for PR mortality, we evaluated deaths that occurred between 2003 and 2008 among women of childbearing age (15 to 49 years) using Health and Demographic Surveillance System data in rural western Kenya. WHO ICD definition of PR mortality was used: "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death''. In addition, symptoms and events at the time of death were examined using the WHO verbal autopsy methodology. Deaths were categorized as either (i) directly PR: main cause of death was ascribed as obstetric, or (ii) indirectly PR: main cause of death was non-obstetric. Of 3,223 deaths in women 15 to 49 years, 249 (7.7%) were PR. One-third (34%) of these were due to direct obstetric causes, predominantly postpartum hemorrhage, abortion complications and puerperal sepsis. Two-thirds were indirect; three-quarters were attributable to human immunodeficiency virus (HIV/AIDS), malaria and tuberculosis. Significantly more women who died in lower socio-economic groups sought care from traditional birth attendants (p = 0.034), while less impoverished women were more likely to seek hospital care (p = 0.001). The PR mortality ratio over the six years was 740 (95% CI 651-838) per 100,000 live births, with no evidence of reduction over time (chi(2) linear trend = 1.07; p = 0.3).Conclusions: These data supplement current scanty information on the relationship between infectious diseases and poor maternal outcomes in Africa. They indicate low uptake of maternal health interventions in women dying during pregnancy and postpartum, suggesting improved access to and increased uptake of skilled obstetric care, as well as preventive measures against HIV/AIDS, malaria and tuberculosis among all women of childbearing age may help to reduce pregnancy-related mortality.