Priorities in emergency obstetric care in Bolivia: maternal mortality and near-miss morbidity in metropolitan La Paz
2009 (English)In: BJOG : An International Journal of Obstetrics and Gynaecology, ISSN 1471-0528, Vol. 116, no 9, 1210-1217 p.Article in journal (Refereed) Published
OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.
Place, publisher, year, edition, pages
2009. Vol. 116, no 9, 1210-1217 p.
Bolivia, maternal mortality, near-miss, severe maternal morbidity
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-107814DOI: 10.1111/j.1471-0528.2009.02209.xISI: 000267879700010PubMedID: 19459864OAI: oai:DiVA.org:uu-107814DiVA: diva2:233228