Maternal near-miss and mortality in Sayaboury Province, Lao PDR

Luexay et al. BMC Public Health 2014, 14:945 http://www.biomedcentral.com/1471-2458/14/945 RESEARCH ARTICLE Open Access Maternal near-miss and mortality in Sayaboury Province, Lao PDR Phadouangdeth Luexay1, Laopaiboon Malinee2*, Lumbiganon Pisake3 and Bouvier-Colle Marie-Hélène4 Abstract Background: Maternal near-miss (MNM) incidence is the indicator reflecting maternal healthcare services. This study aimed to determine the burden of maternal near-miss and maternal deaths in Sayaboury Province, Lao PDR. Methods: A descriptive study was done in a cohort of 1215 pregnant women, who had their last normal menstrual period (LMP) between 1 August and 31 December, 2010. WHO criteria for MNM were used to identify near-miss cases and maternal deaths during February – November 2011. Data of maternal characteristics, MNM, and maternal deaths were prospectively collected by primary health care workers in the villages under supervision of health staff in local health centers and by the head nurses of the gynecology - obstetric wards in the studied hospitals. Frequencies with 95% confidence intervals (CIs) were used to describe maternal near-misses and maternal deaths. Results: Overall, 92.5% of the 1215 pregnancies were delivered, 7.5% were aborted. Eleven women were identified as near-miss cases, giving a maternal near miss (MNM) ratio of 9.8 (95% CI: 4.9 -17.5)/1,000 live births. With two maternal deaths, the maternal mortality ratio (MMR) was 178 (95% CI: 50–650)/100,000 live births. Together, these constituted 13 cases of severe maternal outcome (SMO) and given the SMO ratio of 11.6 (95% CI: 6.2 - 19.8)/1,000 live births. Conclusion: The study shows a surprisingly low MNM ratio and MMR in Sayaboury Province, Lao PDR. Generalization of the results is limited by problems in applying standard criteria for the identification of near-misses in the communities and local hospitals. However, the findings are considered to have important implications for the improvement of maternal health services in low resource settings, e.g. to obtain valid and reliable maternal near miss and maternal deaths for the whole country. Keywords: Maternal near- miss, Maternal mortality, Severe maternal outcome, Maternal complication Background The fifth Millennium Development Goal (MDG) is to improve maternal health. The two main targets for improvement are 1) to reduce the maternal mortality ratio (MMR) by three quarters between 1990 & 2015 and 2) to achieve universal access to reproductive health by 2015 [1,2]. Levels of maternal mortality have decreased, but the global maternal mortality ratio declined by only 2.3% per year between 1990 and 2008. This figure is far from what is required to achieve MDG 5 with the aim of an annual decline of 5.5% [1-3]. In spite of the efforts of international developments in maternal health care, maternal deaths and disabilities * Correspondence: 2 Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, 123 Mittapharp Road, 40002 Muaeng district, Khon Kaen, Thailand Full list of author information is available at the end of the article remain a major public health problem in developing countries. Lack of reliable and up-to-date statistics on maternal deaths also remains a major challenge to the implementation of a master plan in the developing countries to accelerate achieving the Millennium Development Goal related to maternal health (MDG-5) [2-4]. There are 14 countries in the world which have MMR of at least 1,000 per 100,000 live births. In most developing countries where there is no comprehensive registration of deaths, reliability of maternal mortality ratios is still questionable because of lack of medical certification of death [1,4]. Maternal mortality is the health indicator which shows the greatest gap between the rich and poor countries. Whereas nine maternal deaths per 100,000 live births have been reported in developed countries, 450 maternal deaths per 100,000 live births occurred in developing © 2014 Luexay et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Luexay et al. BMC Public Health 2014, 14:945 http://www.biomedcentral.com/1471-2458/14/945 countries. Approximately 13,000 maternal deaths occur annually in the Western Pacific Region, with large differences within developing countries (urban–rural, richpoor) [5]. By region, the MMR is highest in Africa (830) and some countries of the Western Pacific Region, the Middle East, followed by Asia (330), Oceania (240), Latin America and the Caribbean (190), and is lowest in the developed countries [1,6,7]. In the Lao People’s Democratic Republic, the MMR has been roughly estimated to be 400 – 600 for every 100,000 live births [4,8-10]. When compared with neighboring countries in South - East Asia, the maternal health indicators for Lao PDR are the worst in the region [5,8]. However, despite the high maternal morbidity ratios in many resource-poor settings, maternal deaths are still rare in absolute numbers [6]. The study of women who survive life-threatening complications related to pregnancy, called maternal near-miss cases, may represent a practical alternative to surveillance of maternal morbidity and mortality [11]. There have been no official reports of maternal near-miss in the Lao PDR. The Ministry of Health (MOH) of Lao PDR, in cooperation with international agencies, has recently made serious efforts to improve maternal and child health. They have attempted to reduce maternal mortality through implementing new or additional maternal and child health (MCH) servicerelated activities, such as trained traditional birth attendances (TBA) at the village, trained skill birth attendances (SBA) in the health centers, supported family planning and EPI etc. Despite the efforts, maternal health status was still relatively poor in some areas of the country, and major capacity strengthening is still required in the areas of poor MCH services for instance in mountainous remote areas. Official statistics on MCH indicators have been improving over the past decades, but they remain below international standards. The lack of reliable and up-todate statistics on maternal deaths and morbidities remains a major challenge for achieving accelerated progress towards the Millennium Development Goal related to maternal health (MDG-5) [1,4,12]. Sayaboury Province is one of the remote, mountainous provinces located in the northwestern Lao PDR. Many villages in the remote areas have limited access to health services during the wet season, especia (...truncated)