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Rööst, Mattias
Publications (7 of 7) Show all publications
Urquia, M. L., Glazier, R. H., Mortensen, L., Nybo-Andersen, A.-M., Small, R., Davey, M.-A., . . . Essén, B. (2015). Severe maternal morbidity associated with maternal birthplace in three high-immigration settings. European Journal of Public Health, 25(4), 620-625
Open this publication in new window or tab >>Severe maternal morbidity associated with maternal birthplace in three high-immigration settings
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2015 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 4, p. 620-625Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Maternal mortality and morbidity vary substantially worldwide. It is unknown if these geographic differences translate into disparities in severe maternal morbidity among immigrants from various world regions. We assessed disparities in severe maternal morbidity between immigrant women from various world regions giving birth in three high-immigration countries.

METHODS:

We used population-based delivery data from Victoria; Australia and Ontario, Canada and national data from Denmark, in the most recent 10-year period ending in 2010 available to each participating centre. Each centre provided aggregate data according to standardized definitions of the outcome, maternal regions of birth and covariates for pooled analyses. We used random effects and stratified logistic regression to obtain odds ratios (ORs) with 95% confidence intervals (95% CIs), adjusted for maternal age, parity and comparability scores.

RESULTS:

We retrieved 2,322,907 deliveries in all three receiving countries, of which 479,986 (21%) were to immigrant women. Compared with non-immigrants, only Sub-Saharan African women were consistently at higher risk of severe maternal morbidity in all three receiving countries (pooled adjusted OR: 1.67; 95% CI: 1.43, 1.95). In contrast, both Western and Eastern European immigrants had lower odds (OR: 0.82; 95% CI: 0.70, 0.96 and OR: 0.64; 95% CI: 0.49, 0.83, respectively). The most common diagnosis was severe pre-eclampsia followed by uterine rupture, which was more common among Sub-Saharan Africans in all three settings.

CONCLUSIONS:

Immigrant women from Sub-Saharan Africa have higher rates of severe maternal morbidity. Other immigrant groups had similar or lower rates than the majority locally born populations.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-242883 (URN)10.1093/eurpub/cku230 (DOI)000359159900016 ()25587005 (PubMedID)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved
Litorp, H., Kidanto, H. L., Rööst, M., Abeid, M., Nyström, L. & Essén, B. (2014). Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy and Childbirth, 14(1), 244
Open this publication in new window or tab >>Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania
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2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 1, p. 244-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications.

METHODS:

We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated.

RESULTS:

We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33-39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460-730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6-11) of the MNM events and 13% (95% CI 6.4-23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12-37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8-12) (risk ratio 3.2, 95% CI 1.5-6.6).

CONCLUSIONS:

The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-229946 (URN)10.1186/1471-2393-14-244 (DOI)000340799000001 ()25056517 (PubMedID)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2017-12-05Bibliographically approved
Wahlberg, Å., Rööst, M., Haglund, B., Högberg, U. & Essén, B. (2013). Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study. British Journal of Obstetrics and Gynecology, 120(13), 1605-1612
Open this publication in new window or tab >>Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study
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2013 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 13, p. 1605-1612Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To determine if immigrant women from low-, middle- and high-income countries have an increased risk of severe maternal morbidity (near-miss) when they deliver in Sweden.

DESIGN:

Population register-based study.

SETTING:

Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007.

POPULATION:

Women with a near-miss event; all women with a singleton delivery ≥28 weeks of gestation during the same period acted as reference group.

METHODS:

Near-miss was defined by a combined clinical and management approach with use of International Classification of Diseases, 10th revision codes for severe maternal morbidity. A woman's country of origin was designated as low-, middle- or high-income according to the World Bank Classification of 2009. Unconditional logistic regression models were used in the analysis.

MAIN OUTCOME MEASURES:

Maternal near-miss frequencies per 1000 deliveries and odds ratios with 95% confidence intervals.

RESULTS:

There were 914 474 deliveries during the study period and 2655 near-misses (2.9 per 1000 deliveries). In comparison to Swedish-born women, those from low-income countries had an increased risk of near-miss (odds ratio 2.3, 95% confidence interval 1.9-2.8) that was significant in all morbidity groups except for cardiovascular diseases and sepsis. Women from middle- and high-income countries showed no increased risk of near-miss.

CONCLUSIONS:

Women from low-income countries have an increased risk of maternal near-miss morbidity compared with women born in Sweden. Although the rate is low it should alert healthcare providers.

Keywords
Immigration, maternal near-miss, severe maternal morbidity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-208309 (URN)10.1111/1471-0528.12326 (DOI)23786308 (PubMedID)
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved
Rööst, M. (2012). Maternal near miss incidents. Acta Obstetricia et Gynecologica Scandinavica, 91, 31-31
Open this publication in new window or tab >>Maternal near miss incidents
2012 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, p. 31-31Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-177429 (URN)000304987600039 ()
Available from: 2012-12-13 Created: 2012-07-13 Last updated: 2017-12-06Bibliographically approved
Rööst, M. (2010). Pre-hospital Barriers to Emergency Obstetric Care: Studies of Maternal Mortality and Near-miss in Bolivia and Guatemala. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Pre-hospital Barriers to Emergency Obstetric Care: Studies of Maternal Mortality and Near-miss in Bolivia and Guatemala
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[es]
Barreras pre-hospitalarias para la atención obstétrica de emergencia : Estudios de mortalidad materna y morbilidad obstétrica severa en Bolivia y Guatemala
Abstract [en]

Maternal mortality is a global health concern but inequalities in utilization of maternal health care are not clearly understood. Severe morbidity (near-miss) is receiving increased attention due to methodological difficulties in maternal mortality studies.

The present thesis seeks to increase understanding of factors that impede utilization of emergency obstetric care (EmOC) in Bolivia and Guatemala. Studies I and IV employed qualitative interviews to explore the role of traditional birth attendants (TBAs) and the care-seeking behaviour of women who arrived at hospital with a near-miss complication. Studies II–III documented maternal mortality and near-miss morbidity at the hospital level and investigated the influence of socio-demographic factors and antenatal care (ANC) on near-miss upon arrival.

The studies identified unfamiliarity with EmOC among TBAs and a lack of collaboration with formal care providers. A perception of being dissociated from the health care system and a mistrust of health care providers was common among near-miss women from disadvantaged social backgrounds. In the Bolivian setting, 187 maternal deaths per 100,000 live births and 50 cases of near-miss per 1000 were recorded. Causes of near-miss differed from those of maternal deaths. Most women with near-miss arrived at hospital in critical condition: severe preeclampsia, complications after childbirth at home and abortions were mostly encountered among them. Lack of ANC, low education, and rural residence were interactively associated with near-miss. ANC reduced socio-demographic differentials for near-miss.

Complementing maternal mortality reviews with data on near-miss morbidity increases the understanding of priority needs and quality of maternal health care. Additionally, focusing on near-miss upon arrival was found useful in exploring pre-hospital barriers to EmOC. The findings identified subgroups of women who seemed especially vulnerable to pre-hospital barriers. They also underscored the need for initiatives to reduce the effect of social marginalization and to acknowledge the influential role of formal and informal care providers on the utilization of EmOC.

Abstract [es]

La mortalidad materna es un tema de inquietud global, sin embargo la comprensión de las desigualdades en la utilización de los servicios de salud materna es limitada. La morbilidad obstétrica severa (near-miss) está recibiendo creciente atención, producto de problemas metodológicos en los estudios de mortalidad materna.

El objetivo de la presente tesis es aumentar la comprensión de factores que impiden la utilización de la atención obstétrica de emergencia en Bolivia y Guatemala. Los estudios I y IV usaron metodologías cualitativas en un esfuerzo por explorar el rol de las parteras tradicionales y las estrategias de las mujeres que arriban a los hospitales con una morbilidad obstétrica severa. Los estudios II–III documentaron la mortalidad materna y la morbilidad obstétrica severa en el marco hospitalario e investigaron el impacto de los factores socio-demográficos y el control prenatal en la llegada a los establecimientos de salud con complicaciones severas.

Los estudios identificaron la falta de familiaridad con atención obstétrica de emergencia entre las parteras tradicionales y la falta de cooperación con los profesionales de salud formales. La sensación de estar distanciadas del sistema de salud y la desconfianza hacia los profesionales de la salud eran aspectos comunes entre las mujeres de sectores marginales con experiencias de complicaciones severas. En el contexto boliviano, 187 muertes maternas por cada 100,000 nacidos vivos y 50 casos de morbilidad obstétrica severa por cada 1000 fueron registradas. Las causas de la morbilidad obstétrica severa y las muertes maternas se distinguieron. La major parte de las mujeres con morbilidad obstétrica severa llegaron al hospital en condiciones críticas: preeclampsia severa, complicaciones después de partos domiciliarios y abortos eran causas más frecuentes en esta categoría. Combinaciones del bajo nivel de educación con la falta de controles prenatales o la residencia en zonas rurales fueron asociadas con la morbilidad obstétrica severa. El control prenatal redujo diferencias socio-demográficas en lo concerniente a la morbilidad obstétrica severa.

La complementación de estudios de mortalidad materna con datos sobre morbilidad obstétrica severa aumenta la comprensión de las prioridades y de la calidad en la atención de la salud materna. Además, centrándose en la morbilidad obstétrica severa a la llegada al establicimiento de salud, ha sido útil para investigar las barreras pre-hospitalarias en relación a la atención de emergencia obstétrica. Los resultados permiten identificar categorías específicas de mujeres que parecen ser especialmente vulnerables a las barreras pre-hospitalarias. Los resultados, también subrayan la necesidad de iniciativas que reduzcan los efectos de la marginalización social, y que reconozcan el importante rol que tanto el personal de salud formal como informal cumplen en la utilización de los servicios de atención obstétrica de emergencia.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. p. 74
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 515
Keywords
pre-hospital barriers, maternal mortality, near-miss, traditional birth attendants, social marginalization, Bolivia, Guatemala, barreras pre-hospitalarias, mortalidad materna, morbilidad obstétrica severa, parteras tradicionales, marginalización social, Bolivia, Guatemala
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-112481 (URN)978-91-554-7709-7 (ISBN)
Public defence
2010-03-12, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2010-02-19 Created: 2010-01-13 Last updated: 2010-02-19Bibliographically approved
Rööst, M., Jonsson, C., Liljestrand, J. & Essén, B. (2009). Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia. Reproductive health, 6, 13
Open this publication in new window or tab >>Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia
2009 (English)In: Reproductive health, ISSN 1742-4755, Vol. 6, p. 13-Article in journal (Refereed) Published
Abstract [en]

ABSTRACT: BACKGROUND: Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. METHODS: Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. RESULTS: The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. CONCLUSION: The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-107815 (URN)10.1186/1742-4755-6-13 (DOI)19640286 (PubMedID)
Available from: 2009-08-31 Created: 2009-08-31 Last updated: 2011-03-28Bibliographically approved
Rööst, M., Johnsdotter, S., Liljestrand, J. & Essén, B. (2004). A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala. British Journal of Obstetrics and Gynaecology, 111(12), 1372-1377
Open this publication in new window or tab >>A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala
2004 (English)In: British Journal of Obstetrics and Gynaecology, ISSN 0306-5456, E-ISSN 1365-215X, Vol. 111, no 12, p. 1372-1377Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors. STUDY: design Qualitative in-depth interview study. SETTING: Rural Guatemala. SAMPLE: Thirteen traditional birth attendants from 11 villages around San Miguel Ixtahuacán, Guatemala. METHOD: Interviews with semi-structured, thematic, open-ended questions. Interview topics were: traditional birth attendants' experiences and conceptions as to the causes of complications, attitudes towards hospital care and referral of obstetric complications. MAIN OUTCOME MEASURES: Conceptions of obstetric complications, hospital referrals and maternal mortality among traditional birth attendants. RESULTS: Pregnant women rather than traditional birth attendants appear to make the decision on how to handle a complication, based on moralistically and fatalistically influenced thoughts about the nature of complications, in combination with a fear of caesarean section, maltreatment and discrimination at a hospital level. There is a discrepancy between what traditional birth attendants consider appropriate in cases of complications, and the actions they implement to handle them. CONCLUSION: Parameters in the referral system, such as logistics and socio-economic factors, are sometimes subordinated to cultural values by the target group. To have an impact on maternal mortality, bilateral culture-sensitive education should be included in maternal health programs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-112474 (URN)10.1111/j.1471-0528.2004.00270.x (DOI)15663121 (PubMedID)
Available from: 2010-01-13 Created: 2010-01-13 Last updated: 2017-12-12Bibliographically approved
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