Prioritising actions to address stagnating maternal mortality rates globally.
Prioritising actions to address stagnating maternal mortality rates globally.
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优先采取行动解决全球孕产妇死亡率停滞不前的问题。
DOI：
10.1016/s0140-6736(23)02290-0
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Van Den Akker T
中科院分区：
文献类型：
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作者：
Van Den Akker T
2023年早些时候发布的联合国数据显示，从2016年到2020年，133个国家的孕产妇死亡率下降停滞不前，17个国家的孕产妇死亡率上升，主要是在拉丁美洲、加勒比地区、欧洲、北美和撒哈拉以南非洲。1虽然孕产妇死亡的主要负担是在低收入和中等收入国家，但来自高收入国家的数据表明，边缘化、种族主义和移民群体面临的风险大大增加。2-4在一些被边缘化的群体中，特别是在美国，产妇死亡率超过了一些低收入中等收入国家。5这一令人关切的情况促使人们呼吁改善产妇保健的提供和质量，应对新冠肺炎大流行病对产妇保健服务的不利影响，并收集所有国家关于产妇死亡率的高质量实时数据。6几十年来，高质量的重要统计数据在确定产妇死亡率趋势和差距方面的价值已为人所知。然而，预防孕产妇死亡需要深入了解造成孕产妇死亡的社会人口、过程相关和系统相关因素。国家生命统计数据，即使是在重债穷国，也不仅低估了孕产妇死亡率，7而且也无法提供关于死亡原因的信息。这种信息需要通过深入的病例审查和在当地进行的基于标准的临床审计来获得，并提供数据共享，以促进保密的多学科审查，从而能够制定和实施有针对性的建议。世卫组织鼓励会员国通过实施孕产妇和围产期死亡监测和应对方案，以加强监测来补充其常规死亡数据收集工作。8为促进这一基层数据收集和交换而建立的区域和国家网络统称为增强产科调查系统。在解决孕产妇死亡率和加强孕产妇死亡监测的多重障碍中，有三个挑战：维持MPDSR和EOSS的成本；与数据获取和共享有关的官僚作风；卫生专业人员在报告和强调与产妇死亡率有关的关切时不受惩罚的保护不足。首先，国家围产期统计组织资金不足，无论各国的收入状况如何，都会危及稳健和及时的分析。一些小岛屿发展中国家继续依赖断断续续和不太准确的人口普查数据，因为强有力的重要统计系统成本太高，无法实施。9与此同时，母婴健康中心没有优先考虑及时提供高质量的常规围产期数据。7此外，从包括出生登记处在内的既定常规来源获取数据的财务成本很高，甚至妨碍了最基本的分析。此外，HIC或LMIC没有为支持EOSS的费用提供足够的资金，这需要建立基础设施来实施建议，制定临床实践指南，并使教育和培训成为可能。10在这个大数据时代，对死亡或濒临死亡的妇女和婴儿的知识投入不足是不可接受的。其次，对于罕见、严重的孕产妇结局的调查，研究人员需要跨境合作，结合信息，比较结局和管理实践，为国家和跨国的孕产妇保健建议做出贡献。尽管健康数据所有权的概念伴随着…
UN data released earlier in 2023 showed that from 2016 to 2020 the reduction in maternal mortality had stalled in 133 countries and there was an increase in maternal mortality in 17 countries, mainly in Latin America, the Caribbean, Europe, North America, and sub-Saharan Africa. 1 Although the primary burden of maternal mortality is in low-income and middle-income countries (LMICs), data from high-income countries (HICs) indicate that marginalised, racialised, and immigrant groups face a significantly increased risk. 2–4 In certain marginalised groups in HICs, particularly the USA, maternal mortality rates exceed those in some LMICs. 5 This concerning situation has prompted calls to improve the provision and quality of maternal health care, address the adverse impacts of the COVID-19 pandemic on maternity care services, and collect high-quality, real-time data on maternal mortality in all countries. 6 The value of high-quality vital statistics in establishing trends and disparities in maternal mortality has been known for decades. However, the prevention of maternal mortality requires an in-depth understanding of sociodemographic, process-related, and systems-related factors that contribute to maternal mortality. National vital statistics, even in HICs, not only underestimate the incidence of maternal mortality, 7 but are also unable to provide information about why deaths occurred. Such information needs to be obtained through indepth case reviews and criterion-based clinical audits conducted locally, with provisions for data sharing to facilitate confidential, multidisciplinary reviews, enabling the development and implementation of targeted recommendations. WHO encourages member states to complement their routine collection of mortality data with enhanced surveillance through the implementation of the Maternal and Perinatal Death Surveillance and Response (MPDSR) programme. 8 Regional and national networks established to facilitate this grass-roots level data gathering and exchange are collectively referred to as enhanced obstetric survey systems (EOSS). Among the multiple barriers to addressing maternal mortality and strengthening surveillance of maternal deaths are three challenges: the cost of maintaining MPDSR and EOSS; bureaucracy linked to data acquisition and sharing; and inadequate protection of health professionals from penalisation when they report and highlight concerns related to maternal mortality. First, underfunding of national perinatal statistics organisations, irrespective of countries’ income status, imperils robust and timely analyses. Several LMICs continue to rely on intermittent and less accurate census data, since robust vital statistics systems are too costly to implement. 9 Meanwhile, HICs do not prioritise timely provision of routine perinatal data of good quality. 7 Additionally, the financial cost of obtaining data from established routine sources, including birth registries, is high and hinders even the most basic analyses. Moreover, there is no adequate provision in HICs or LMICs for the costs of supporting EOSS, which requires the establishment of infrastructure to implement recommendations, develop clinical practice guidelines, and enable education and training. 10 In this era of big data, insufficient investment in knowledge about women and babies who die, or nearly die, is unacceptable.Second, for the investigation of rare, severe maternal outcomes researchers need to collaborate across borders to combine information and compare outcomes and management practices to contribute to national and cross-national recommendations for maternal care. Although the notion of health data ownership is accompanied …