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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Lewycka, Sonia Meguid, Tarek Costello, Anthony M. L. Colbourn, Tim Pagel, Christina Mwansambo, Charles Utley, Martin Chiudzu, Grace |
| Spatial Coverage | Africa South of the Sahara Malawi |
| Description | Author Affiliation: Pagel C ( Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK. c.pagel@ucl.ac.uk) |
| Abstract | BACKGROUND: Maternal mortality in Africa has changed little since 1990. We developed a mathematical model with the aim to assess whether improved community-based access to life-saving drugs, to augment a core programme of health-facility strengthening, could reduce maternal mortality due to post-partum haemorrhage or sepsis. METHODS: We developed a mathematical model by considering the key events leading to maternal death from post-partum haemorrhage or sepsis after delivery. With parameter estimates from published work of occurrence of post-partum haemorrhage and sepsis, case fatality, and the effectiveness of drugs, we used this model to estimate the effect of three potential packages of interventions: 1) health-facility strengthening; 2) health-facility strengthening combined with improved drug provision via antenatal-care appointments and community health workers; and 3) all interventions in package two combined with improved community-based drug provision via female volunteers in villages. The model was applied to Malawi and sub-Saharan Africa. FINDINGS: In the implementation of the model, the lowest risk deliveries were those in health facilities. With the model we estimated that of 2860 maternal deaths from post-partum haemorrhage or sepsis per year in Malawi, intervention package one could prevent 210 (7%) deaths, package two 720 (25%) deaths, and package three 1020 (36%) deaths. In sub-Saharan Africa, we estimated that of 182 000 of such maternal deaths per year, these three packages could prevent 21 300 (12%), 43 800 (24%), and 59 000 (32%) deaths, respectively. The estimated effect of community-based drug provision was greatest for the poorest women. INTERPRETATION: Community provision of misoprostol and antibiotics to reduce maternal deaths from post-partum haemorrhage and sepsis could be a highly effective addition to health-facility strengthening in Africa. Investigation of such interventions is urgently needed to establish the risks, benefits, and challenges of widespread implementation. FUNDING: Institute of Child Health and Faculty of Mathematical and Physical Sciences, University College London, and a donation from John and Ann-Margaret Walton. |
| ISSN | 01406736 |
| e-ISSN | 1474547X |
| Journal | The Lancet |
| Issue Number | 9699 |
| Volume Number | 374 |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2009-10-24 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Maternal Mortality Models, Statistical Postnatal Care Organization & Administration Postpartum Hemorrhage Pregnancy Complications, Infectious Sepsis Africa South Of The Sahara Epidemiology Anti-Bacterial Agents Therapeutic Use Cause Of Death Community Health Services Malawi Maternal Health Services Misoprostol Oxytocics Drug Therapy Mortality Pregnancy Program Evaluation Risk Factors Total Quality Management Research Support, Non-U.S. Gov't Medicine |
| Content Type | Text |
| Resource Type | Article |
| Subject | Medicine |
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