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Introduction OOPE for healthcare services is a major concern within the Indian healthcare system. 30% of the population remains uninsured despite increasing health insurance coverage. For obstetrics and gynaecology (OBG) patients financial obstacles like OOPE can delay access to health care, evaluating spending patterns can inform policies to enhance accessibility, affordability and equitable health. Methodology A retrospective study was conducted at a tertiary care teaching hospital in Karnataka state of India to analyze OOPE for 905 OBG patients who underwent Cesarean Section(C-Section), Laparoscopic Hysterectomy, Laparoscopic Cystectomy, Laparoscopic Myomectomy and Laparoscopic Assisted Vaginal Hysterectomy (LAVH). These were the top five most performed obstetrics and gynecology surgeries in the tertiary care teaching hospital between January 2023 and July 2023. Data was collected across AB-PMJAY, private health insurance, uninsured patients and analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for data normality. Results The study analyzed OOPE across 905 OBG patients. Findings show AB-PMJAY provided full coverage with zero OOPE for all surgeries. Though private health insurance reduced OOPE compared to uninsured patients under private health insurance still faced significant financial burden. Variations existed in minimum and maximum OOPE and percentage of OOPE across different private insurances. All the uninsured patients incurred 100% OOPE, with a median OOPE of Rs. 33,257 (405.67 USD) to Rs. 57,053 (695.76 USD) and a mean OOPE of Rs. 39,848 (485.95 USD) to Rs. 60,687 (740 USD) across the surgeries. Discussion Findings of the study show that AB-PMJAY is highly effective in reducing OOPE and enhancing financial risk protection for OBG patients. Patients covered by private health insurance incurred less OOPE, yet the burden remained considerable. High OOPE rates for uninsured patients (100%) and private health insurance (38.15%) compared to 0% OOPE in AB-PMJAY emphasizes the need for the continued expansion of AB-PMJAY.

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity on a global scale. Ethnic background is known to be a determinant of variation in the outcomes of women receiving maternity care across the world. Despite free maternity healthcare in the UK National Health Service, women with an ethnic minority background giving birth have an increased risk of PPH, even when other characteristics of the mother, the baby and the care received are considered. Improving PPH care has significant implications for improving health equity. The underlying causes of ethnic disparities are complex and multifaceted. It requires a deep dive into analysing the unique patient factors that make these women more likely to suffer from a PPH as well as reflecting on the efficacy of intra and postpartum care and prophylactic treatment these women receive.

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity on a global scale. Ethnic background is known to be a determinant of variation in the outcomes of women receiving maternity care across the world. Despite free maternity healthcare in the UK National Health Service, women with an ethnic minority background giving birth have an increased risk of PPH, even when other characteristics of the mother, the baby and the care received are considered. Improving PPH care has significant implications for improving health equity. The underlying causes of ethnic disparities are complex and multifaceted. It requires a deep dive into analysing the unique patient factors that make these women more likely to suffer from a PPH as well as reflecting on the efficacy of intra and postpartum care and prophylactic treatment these women receive. [ABSTRACT FROM AUTHOR]

Background: An effective referral system is key to access timely emergency obstetric care in order to prevent maternal and perinatal mortality. The criticality of referrals makes it necessary to understand its pattern at the health system level. This study was conducted with an objective to document the patterns, primary reasons of obstetric case referral and the maternal and perinatal outcome of the referred cases in Government Medical College, Mahasamund in rural Chhattisgarh. As a systematic monitoring of referrals majorly helps to identify current gaps and timeliness of referral in providing essential obstetric care. Methods: The study is based on the health records and details on referral forms from referral center and peripheral health facilities. This follow-up study was conducted in between July 2022 and June 2023 (12 months). All referred patients for obstetrics indications above 20 weeks and patients with postpartum indications were included. Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes. Results: According to our study, out of a total of 5,962 delivered patients, 1,281 (20.5%) cases were referred patients. Maximum cases, i.e., 567 (44.2%) were in the age-group of 24-29 years. The major reasons for referring patient were hypertensive disorders of pregnancy (11.2%), previous cesarean section (9.8%), and PPH (9.5%). There were six maternal deaths (0.5%) and discharge rate was 96.2%. Conclusion: The present study showed that illiteracy and ignorance of female regarding healthcare requirements and poor infrastructure came out to be a major contributor of poor pregnancy outcome. Timely referral is crucial for a satisfactory maternal and fetal outcome. To reduce the number of unnecessary referrals and to reduce burden on tertiary care hospitals, healthcare workers should be trained in essential and emergency obstetric care which will help in reducing morbidity and mortality. [ABSTRACT FROM AUTHOR]

High-risk pregnancy is the leading cause of maternal mortality in Indonesia. The role of community health workers (CHWs) is crucial in efforts to improve maternal health through the early detection of high-risk pregnancies. When CHWs are provided with the appropriate training and knowledge, they can help detect high-risk pregnancies. PANAH SRIKANDI program was conducted as a community service activity with the aim of providing information to enhance the knowledge and skills of health cadres in screening for early detection of high-risk pregnancies in pregnant women. The program utilized various teaching methods, including lectures, demonstrations, simulations. Impact was evaluated through pre-tests and post-tests. The results showed an improvement in the abilities, knowledge, and understanding of health cadres regarding high-risk pregnancies, with 77% of cadres demonstrating an increase in their knowledge. Additionally, four out of five simulation groups scored above 80%. In conclusion, the educational intervention for CHWs in this program significantly improved their knowledge and skills of the early detection of high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Objectives: The causes for persistently high and increasing maternal mortality rates in the United States have been elusive. Methods: We use the shift in the ideological direction of the Republican and the Democratic parties in the 1960s, to test the hypothesis that fluctuations in overall and race-specific maternal mortality rates (MMR) follow the power shifts between the parties before and after the Political Realignment (PR) of the 1960s. Results: Using time-series data analysis methods, we find that, net of trend, overall and race-specific MMRs were higher under Democratic administrations than Republican ones before the PR (1915–1965)—i.e., when the Democratic Party was a protector of the Jim Crow system. This pattern, however, changed after the PR (1966–2007), with Republican administrations underperforming Democratic ones—i.e., during the period when the Republican Party shifted toward a more economically and socially conservative agenda. The pre-post PR partisan shifts in MMRs were larger for Black (9.5%, p <. 01 ) relative to White mothers (7.4%, p <. 05 ) during the study period. Conclusions for Practice: These findings imply that parties and the ideological direction of their agendas substantively affect the social determinants of maternal health and produce politized health outcomes. Significance: What Is Already Known on This Subject?: The causes for persistently high and increasing maternal mortality rates in the United States have been elusive. What This Study Adds?: We find that, net of trend, MMRs are higher under the most racially-conservative party of the period: The Democratic Party before the Political Realignment, the Republican Party after. Institutionalized racism—in the form of racialized federal-level policy—has detrimentally affected the health of all in the past century. Our findings bear important implications for political science, medical sociology, public health, and policy: A deep understanding of political processes is necessary for promoting health equity. [ABSTRACT FROM AUTHOR]

The aim of the present study was to calculate maternal mortality rates by analyzing pregnancy-related death cases in Samsun over the last 20 years, to identify causes of death and preventability, and to examine the change over the years. The Samsun Provincial Health Directorate's pregnancy-related mortality data from 2002 to 2021 were examined retrospectively. Causes of maternal death were classified as direct, indirect, undecided, and incidental. The maternal mortality rate was calculated as the number of maternal deaths per 100,000 live births. Between 2002 and 2021, Samsun experienced a total of 344,324 live births juxtaposed with 79 pregnancy-related deaths. The computed maternal mortality rate is 19.16 per 100,000 live births across the two-decade span. Detailed analysis reveals that 30 deaths (38%) were attributable to direct causes, 31 (39.2%) to indirect causes, 13 (16.5%) were incidental, and 5 (6.3%) remained inconclusive post-autopsy. A breakdown of the direct causes unveils obstetric bleeding as the primary culprit (18.2%), trailed by cardiovascular diseases (13.6%). Moreover, incidental causes, represented by traffic accidents, account for a 7.6% fatality rate. While the observed decline in maternal deaths, particularly from preventable direct causes, over the previous twenty years signifies the efficacy of the instated health policies, the persistent mortality underscores the imperative for ongoing research and strategy recalibration. Identifying fluctuations in causative factors through comparative analyses is pivotal in strategizing future preventive studies on pregnancy-related deaths. The results advocate a pronounced emphasis on continuous professional development to curtail mortalities from avoidable sources, especially postpartum hemorrhage, thereby fortifying existing health policies with reinforced, data-driven interventions. [Med-Science 2023; 12(4.000): 1252-7]

Introduction: Indonesia's maternal mortality rate is still above the target of the Sustainable Development Goals (SDGs). Meanwhile, the trend of maternal mortality in Indonesia during the COVID- 19 pandemic in 2021 increased sharply from 4,627 to 6,865 cases in 2021. Aims: This study was conducted to analyze the relationship between the quality of maternal health services on the incidence of maternal COVID and maternal mortality during the COVID pandemic in East Java, Indonesia. Methods: The research was conducted in East Java Province in 2021. The sample was randomly selected as many as 35 samples from a total of 38 samples of Regencies / Cities. The data used secondary data sourced from data from the East Java Health Office. Data analysis used Person Correlation analysis with Chi-Square analysis method. Results: The first hypothesis did not find a relationship between quality of Antenatal Care services and Maternal COVID cases (p- value: 0.195, r: -0.087). The second hypothesis has a significant relationship between the Maternal COVID and the Maternal Mortality (p- value: 0.040, r: 0.548). Also, the third hypothesis showed a substantial correlation between Maternal Mortality and quality of Antenatal Care (p- value: 0.001, r: -0.555). Conclusion: There is a strong relationship between the high Maternal COVID cases and the quality of access to antenatal care services to the high Maternal COVID cases during the pandemic. There needs to be a strategy to improve the quality and access of antenatal care services in reducing the high maternal mortality rate.

With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

The aim of the present study was to calculate maternal mortality rates by analyzing pregnancy-related death cases in Samsun over the last 20 years, to identify causes of death and preventability, and to examine the change over the years. The Samsun Provincial Health Directorate's pregnancy-related mortality data from 2002 to 2021 were examined retrospectively. Causes of maternal death were classified as direct, indirect, undecided, and incidental. The maternal mortality rate was calculated as the number of maternal deaths per 100,000 live births. Between 2002 and 2021, Samsun experienced a total of 344,324 live births juxtaposed with 79 pregnancy-related deaths. The computed maternal mortality rate is 19.16 per 100,000 live births across the two-decade span. Detailed analysis reveals that 30 deaths (38%) were attributable to direct causes, 31 (39.2%) to indirect causes, 13 (16.5%) were incidental, and 5 (6.3%) remained inconclusive post-autopsy. A breakdown of the direct causes unveils obstetric bleeding as the primary culprit (18.2%), trailed by cardiovascular diseases (13.6%). Moreover, incidental causes, represented by traffic accidents, account for a 7.6% fatality rate. While the observed decline in maternal deaths, particularly from preventable direct causes, over the previous twenty years signifies the efficacy of the instated health policies, the persistent mortality underscores the imperative for ongoing research and strategy recalibration. Identifying fluctuations in causative factors through comparative analyses is pivotal in strategizing future preventive studies on pregnancy-related deaths. The results advocate a pronounced emphasis on continuous professional development to curtail mortalities from avoidable sources, especially postpartum hemorrhage, thereby fortifying existing health policies with reinforced, data-driven interventions. [ABSTRACT FROM AUTHOR]

Copyright of China Tropical Medicine is the property of China Tropical Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Results based financing as a component of health financing is one of the endorsed panacea to maternal mortality rate globally. The study undergoes a systematic review on the impact of results-based financing on maternal mortality rate in SSA. The study draws the results from the Scopus search database which has been argued to be more friendly and accurate than PubMed and Web of Science. The Scopus reported that there have been more publications and citations in the area of maternal health care and results-based financing during the period under study, this shows that, results based financing has becoming an interesting topic since its inception in SSA. The Scopus search database indicated that on 58 bibliometric studies retrieved on maternal health care, more were focusing on health delivery systems, maternal health services and health financing. The study also shows that despite the role played SSA countries in promoting maternal health care, the maternal mortality rate is still far beyond the United Nations target of reaching 70 deaths per 100 000 live births. Therefore, it is recommended that, SSA countries should source enough finance from local stakeholders, international organisations, among others in order to finance health system delivery. More so, they should develop other financing models that will capacitate the health sector to reduce maternal mortality.

With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target. [ABSTRACT FROM AUTHOR]

IntroductionUnder-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a country or region, and are research priorities for promoting maternal and infant safety and maternal and child health. This paper aimed to analysis and predict the trends of U5MR and MMR in China, to explore the impact of social health services and economic factors on U5MR and MMR, and to provide a basis for relevant departments to formulate relevant policies and measures.MethodsThe JoinPoint regression model was established to conduct time trend analysis and describe the trend of neonatal mortality rate (NMR), infant mortality rate (IMR), U5MR and MMR in China from 1991 to 2020. The linear mixed effect model was used to assess the fixed effects of maternal health care services and socioeconomic factors on U5MR and MMR were explored, with year as a random effect to minimize the effect of collinearity. Auto regressive integrated moving average models (ARIMA) were built to predict U5MR and MMR from 2021 to 2025.ResultsThe NMR, IMR, U5MR and MMR from 1991 to 2020 in China among national, urban and rural areas showed continuous downward trends. The NMR, IMR, U5MR and MMR were significantly negatively correlated with gross domestic product (GDP), the proportion of the total health expenditure (THE) to GDP, system management rate, prenatal care rate, post-natal visit rate and hospital delivery rate. The predicted values of national U5MR from 2021 to 2025 were 7.3 ‰, 7.2 ‰, 7.1 ‰, 7.1 ‰ and 7.2 ‰ and the predicted values of national MMR were 13.8/100000, 12.1/100000, 10.6/100000, 9.6/100000 and 8.3/100000.ConclusionChina has made great achievements in reducing the U5MR and MMR. It is necessary for achieving the goals of Healthy China 2030 by promoting the equalization of basic public health services and further optimizing the allocation of government health resources. China’s experience in reducing U5MR and MMR can be used as a reference for developing countries to realize the SDGs.

Maternal Mortality Rate (MMR) is one of the national health indicators to achieve the success of maternal health efforts where the number of MMR in Indonesia reached 305 per 100,000 live births. Family planning services including Post Partum Family Planning/Keluarga Berencana Pascapersalinan (KBPP) can effectively reduce maternal mortality by reducing births and reducing high risk. The high number of KBPP users in DKI Jakarta can be caused by many things such as local government support, level of service by health workers, and others. Therefore, this study aims to analyze and find out the special causes that cause the number of KBPP participants in DKI Jakarta and as a lesson learned for other local governments. This research is a descriptive study to see the variety of data on the number of KBPP participants in DKI Jakarta. Univariate analysis was used to describe the number of KBPP participants and bivariate analysis to explain the characteristics of the variables studied based on time, namely in the form of a run chart. Based on four tests that have been carried out on the data on the number of KBPP participants in DKI Jakarta, it can be said that there is one test that meets the requirements as a variation of system data so that there is a special cause that causes the number of KBPP participants in 2019-2020. The existence of policy support from the DKI Jakarta Provincial Government, and various stakeholders has resulted in high coverage of the use of postpartum family planning.

HIGHLIGHTS 1. One indicator of progress in a country's health is maternal mortality rate. 2. The characteristics of maternal mortality were examined in a regional hospital in North Sulawesi, Indonesia 3. Eclampsia was found to provide the most contribution to maternal mortality cases in the hospital. ABSTRACT Objectives: To determine the characteristics of maternal deaths at Prof. dr. R.D. Kandou Hospital, Manado, Indonesia, from January 1 to December 31, 2019. Materials and Methods: This was a retrospective descriptive study. Data were taken from the patient's medical record at Prof. dr. R.D. Kandou Hospital, Manado, in the period of January 1, to December 31, 2019. Results: From January 1 to December 31, 2019 in Prof. dr. R.D. Kandou Hospital, Manado, there were1.215 single live births, with maternal mortality of 22 cases. In the distribution of characteristics based on age, most patients had age range of 20-34 years with a total of 15 patients (68.18%) and parity 2 - 4 with a total of 21 patients (95,45%), Antenatal Care (ANC) of 1 – 3 times visit in a total of 11 cases (50%), and most came from outside the city of Manado with a total of 12 patients (54.54%). The most common cause of maternal death was due to eclampsia, comprising 8 cases (36.36%). Conclusion: Maternal death cases in Obstetrics and Gynecology Department of Prof. dr. R.D. Kandou Hospital, Manado, Indonesia, in 2019 reached 22 cases per 1.215 live births. Eclampsia was still the leading cause of maternal death.

According to WHO in year 2019 the maternal mortality rate is the number of maternal deaths due to the process of pregnancy, childbirth, and postpartum which is used as an indicator of the degree of women's health. The Maternal Mortality Rate (MMR) is one of the global targets of the Sustainable Development Goals (SDGs) in reducing the maternal mortality rate (MMR) to 70 per 100,000 live births by 2030. The government in an effort to reduce maternal mortality is always in the process of finding effective solutions by involving the role of cadres. If we trace the death of mothers with Pre Eclampsia is usually caused by improper early detection, lack of knowledge of the management of handling pregnant women with Pre Eclampsia, poor childbirth planning and late referral decisions. From the above causes, it is necessary to make comprehensive prevention and treatment efforts between health workers, cadres, pregnant women who always go hand in hand and collaboratively. This form of innovation that is effective in involving all elements is called assistance for High-Risk Pregnant Women (Bumil Resti). To find out the level of knowledge of health cadres about mentoring and efforts to handle pregnant women with Pre Eclampsia in Lumajang Regency in Lumajang Regency. [ABSTRACT FROM AUTHOR]

Background: According to the Sample Registration System report, India has reduced the maternal mortality rate from 130 per 100,000 live births in 2014–2016 to 113 per 100,000 live births in 2016–2018. The main purpose of antenatal care is to identify “high-risk” cases as early as possible from a large group of antenatal mothers and provide them skilled and appropriate care. Objective: To determine the prevalence of high-risk pregnancy (HRP) in pregnant females availing services under pradhan mantri surakshit matritva abhiyan (PMSMA) and to assess awareness of pregnant mothers about services provided under PMSMA in district Etawah of Uttar Pradesh. Material and Methods: Community-based cross-sectional study was carried out among 400 female beneficiaries who were registered under the PMSMA scheme and delivered their baby at any government health facility during one year of study period. Results: It was observed that from all the antenatal women visiting the community health center for HRP day under the PMSMA scheme, 162 (40.5%) were categorized as HRPs and 238 (59.6%) of them were nonhigh-risk pregnancies. A statistically significant association was observed (P-value = 0.005 at 95% CI) between the difference in the proportion of HRPs and the educational status of the pregnant mothers. Out of 400 beneficiaries, 167 (41.75%) were aware of the PMSMA scheme. Conclusion: Regular antenatal care (ANC) check-ups, early identification of HRP, health education, and timely screening are needed to reduce maternal mortality.

Copyright of Jurnal Biometrika dan Kependudukan is the property of Universitas Airlangga and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: According to the Sample Registration System report, India has reduced the maternal mortality rate from 130 per 100,000 live births in 2014–2016 to 113 per 100,000 live births in 2016–2018. The main purpose of antenatal care is to identify "high-risk" cases as early as possible from a large group of antenatal mothers and provide them skilled and appropriate care. Objective: To determine the prevalence of high-risk pregnancy (HRP) in pregnant females availing services under pradhan mantri surakshit matritva abhiyan (PMSMA) and to assess awareness of pregnant mothers about services provided under PMSMA in district Etawah of Uttar Pradesh. Material and Methods: Community-based cross-sectional study was carried out among 400 female beneficiaries who were registered under the PMSMA scheme and delivered their baby at any government health facility during one year of study period. Results: It was observed that from all the antenatal women visiting the community health center for HRP day under the PMSMA scheme, 162 (40.5%) were categorized as HRPs and 238 (59.6%) of them were nonhigh-risk pregnancies. A statistically significant association was observed (P-value = 0.005 at 95% CI) between the difference in the proportion of HRPs and the educational status of the pregnant mothers. Out of 400 beneficiaries, 167 (41.75%) were aware of the PMSMA scheme. Conclusion: Regular antenatal care (ANC) check-ups, early identification of HRP, health education, and timely screening are needed to reduce maternal mortality. [ABSTRACT FROM AUTHOR]

Funding of public hospitals and access to quality health care is a universal problem especially in developing countries. This paper aims to examine the relationship between government financial grants, internal revenue and maternal mortality rate. Previous literature has suggested that to achieve better health outcomes, multiple factors including but not limited to finance must be taken into consideration. Secondary data from audited annual health reports (2014/15 – 2018/19) of the nine South African Provinces was analyzed with the employment of the panel data regression technique. Internal Government Revenue was statistically significant at a 5% level of significance (p < 0.05) and Government Financial Grant was not statistically significant (p >0.05). Maternal mortality rate is therefore dependent on internal revenue and not on government financial grants. The findings change the ancient saying that maternal health outcomes shall improve when the government pumps more finances into the health system. Instead, the study reveals that internal revenue generation has an impact on the maternal mortality rate thus bringing in another approach in the fight against maternal mortality. The study adds value to the public health administration in that it brings a different perspective on the fight against maternal mortality in South Africa.

An effective healthcare sector essentially relies on a strong primary healthcare system. The primary healthcare system governs all major aspects of preventive healthcare and family planning services including immunization, hygiene, communicable disease prevention, sanitation, etc. In addition to this, a major bottleneck limiting the quality of healthcare at secondary and tertiary health facilities is the very high patient footfall that these hospitals. The primary healthcare facilities arc designed to be the first tier of facility that a patient falls onto, and hence is cither treated there or referred to higher level facilities by screening and limiting patient How to next levels. Supporting this tier hence helps reduce burden on secondary' and tertiary facilities of patients that could have been treated at primary facilities and hence exponentially improve the quality of health services in these lager hospitals. The document discusses some of the major issues faced by the primary' healthcare sector in Punjab. 'Hicsc issues were studied and analyzed in detail at South Punjab 11 cal th Department, which is an arm of the provincial health department governing 11 districts of Southern Punjab - districts where socio-economic conditions arc generally much poorer than the rest of Punjab. This document discusses the initiative of Sehat Ghar, its model, potential to ensure basic health services delivery to the local population and its direct & indirect contribution to tackle major issues of primary healthcare in Punjab. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To date, the United States (U.S.) maternal mortality rate (MMR) is almost 30% higher than that of its global counterparts. With disproportionate maternal morbidities and mortalities across the U.S., the people look to governmental legislation to remedy the steadily rising cases of maternal and infant demise across various states. Health outcomes like postpartum hemorrhage, hypertension, and maternal infection during pregnancy are now important causes of maternal death across the U.S., conditions that were once sustai- nably treated and, therefore, preventable. Though maternal surveillance and legislation imparted by the Affordable Care Act (ACA) stipulated minor governance of maternal healthcare, indeed, rising maternal death tolls counter its effectiveness, showing disparate discrepancies across ethnicities. Comparative global country analysis reveals effective methods that need to be communicated in U.S. legislation for maternal care standardization and sustenance. States like California also offer tangible evidence of legislative change and maternal and infant outcome success. This paper provides an overview of the maternal and infant crisis in the U.S., provides insight into the current state of maternal surveillance and the ACA, compares the pros and cons of effective maternal healthcare in global countries, and offers a tangible solution to correct the maternal healthcare crisis in the United States of America.

Portia Maphale Marabele, Maria Sonto Maputle, Dorah Ursula Ramathuba, Lizzy Netshikweta Department of Advanced Nursing Science, University of Venda, Thohoyandou, South AfricaCorrespondence: Maria Sonto MaputleDepartment of Advanced Nursing Science, University of Venda, Private Bag X5050, Thohoyandou 0950, South AfricaTel +27 15 9628125Fax +27 866671337Email sonto.maputle@univen.ac.zaIntroduction: The understanding of the link between cultural affairs and maternal health is critical to save the lives of women. The South African maternal mortality rate (MMR) target for 2015 was 38/100,000 live births. In 2017, South Africa had 1,222 maternal deaths. The purpose was to determine the perceived cultural factors contributing to MMR in rural villages in Mopani District.Methods: This qualitative research and non-probability purposive sampling was used to select participants who met the inclusion criteria. Thirty women, age 40 years and above childbearing age, who had given birth in their lifetime, were sampled. Data were collected through in-depth individual interviews at the women’s homes. Probing to elicit more information was conducted focusing on hemorrhage, hypertension and risk of contracting human immunodeficiency virus (HIV). Data were analyzed through open coding methods. Trustworthiness was ensured by Guba and Lincoln’s criteria, credibility, dependability, confirmability, and transferability.Results: From the study three themes emerged from the data as cultural factors relating to heavy, red post-delivery bleeding perceived as cleaning-out of the womb. With hypertension, gaining weight rapidly before the 20th week of gestation not reported as a pregnancy was still culturally concealed. Contracting HIV, women were exposed to unsafe sex practices due to cultural expectations of having children as a sign of femininity.Discussion: The formulation of culture congruent interventions to promote good and acceptable cultural practices that cannot harm the physical and mental status of women was recommended to reduce unplanned deaths among them.Keywords: hemorrhage, human immunodeficiency virus, hypertension, maternal mortality rate, perceived cultural factors

Acute febrile illness (AFI) in pregnancy is a neglected cause of maternal and foetal mortality and morbidity in low-and middle-income countries. This prospective cohort studied antenatal and postpartum women admitted with acute fever to a tertiary care university teaching hospital from July 2014 to March 2015 for aetiology, maternal and foetal complications, and the impact on maternal mortality ratio (MMR) and perinatal mortality rate. Among the 180 women admitted with AFI, urinary tract infection 54(30%) was the commonest cause, followed by airborne infections (67; 37.2%), peripartum or wound infections (25; 13.8%) and vector-borne diseases (21; 11.6%). Maternal deaths were 4 (2%) and foetal deaths 9 (5%). Post-operative gram-negative sepsis was the most common cause of maternal mortality. The MMR was ten times higher with AFI 2778 against 197 ( p  < 0.0001) among the other hospital deliveries during the same period. Screening for asymptomatic bacteriuria , maintaining aseptic precautions, and vaccination may impact maternal and foetal morbidity significantly., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The high maternal mortality rate in Indonesia is still a problem that needs serious attention from all parties. The government cannot run alone by relying on various networks of government-owned Public Health Centers and Hospitals, it needs the involvement of the private sector in suppressing this high number. In addition, it is also necessary to involve all parties who have attention to this problem, especially universities in creating various breakthroughs in various fields of science. The Community-Based Hospital System is a concept that involves all Community Health Centers, Hospitals and policy makers in viewing a map of the problems of pregnant women based on patient data that controls the Community Health Center. The results of processing patient data at the Community Health Center will be monitored by the Hospital in the cluster and if there is a problem at a particular Public Health Center, the Hospital will send a specialist doctor to come and provide consultation to the patient according to a predetermined schedule. The application of this method is expected to anticipate the reluctance of patients to come to the hospital for various reasons. The results of this research development have been tested in several Public Health Centers in Cirebon and it is hoped that the dissemination and sharing sessions at the Cimenyan Community Health Center can add insight and generate various ideas in tackling the high maternal mortality rate. [ABSTRACT FROM AUTHOR]

This study discusses the development of Zero Inflated Generalized Poisson Regression (ZIGPR) with two response variables, that is Bivariate ZIGPR (BZIGPR). The extension of the ZIGPR model by considering spatial factor called Geographically Weighted Zero Inflated Generalized Poisson Regression (GWBZIGPR). The GWBZIGPR produces a local parameter estimator for each location of observation. The parameter estimation using the Maximum Likelihood Estimation (MLE) method obtained an equation that did not closed-form so that the numerical iteration of Berndt Hall Hall Hausman (BHHH) is used. The data used in this study are the number of pregnant maternal mortality and postpartum maternal mortality data in 91 sub-districts in Pekalongan Residency, Central Java Province. The results showed that the Akaike Information Criterion Corrected (AICc) value in the GWBZIGPR model is smaller than BZIGPR, so it means that the GWBZIGPR is better than the BZIGPR for modeling the number of pregnant maternal mortality and postpartum maternal mortality in Pekalongan Residency. The results of this study will assist local governments in anticipating the causes of maternal mortality.

Objectives: To estimate the maternal mortality rate and to study the related factors responsible for the maternal deaths during the period from 2011 to 2016. Materials and methods: The present study was a retrospective record based study carried out from maternal death registers and Maternal Death Review (MDR) forms. The live birth records were obtained from labour room registers. Results: The institutional MMR was calculated to be 468.18 per 1,00,000 live births. The most common age (mode) of death was seen among women of 20 years; with 92.2% of deaths among women of rural area and 55% deaths were recorded in the tea tribe community alone. Most (54.4%) of the deaths were found amongst the primigravida. It was observed that 36.1% of the deaths occurred due to hypertensive disorder followed by haemorrhage (20.6%) and sepsis (10.6%). Anemia contributed 7.7% to the deaths and 1.7% was due to obstructed labor. Other causes included ruptured ectopic, ARDS, pulmonary embolism, DIC, rupture uterus. Conclusion: In the present study, many deaths have occurred due to hypertension, haemorrhagic and anaemic causes and many of them did not receive adequate antenatal attention.

Background: Maternal mortality is an indicator of state of maternal health services, status of women, women's health, and above all developments of nation. Objectives: The objectives of the study were to identify the patterns and causes, medical as well as sociocultural, of maternal death as well as consider and list out the rights realization perspective of the mothers, their immediate families and the community at large. Materials and Methods: A cross-sectional study was conducted in three districts of Madhya Pradesh, India, for 1 year. One hundred and two maternal deaths were covered, and verbal autopsy was conducted. Human right perspective was assessed using questionnaire. Results: Majority (64.7%) of maternal deaths occurred between 18 and 25 years of age. About 50.9% were primigravida, and postpartum hemorrhage was the most common cause. Nearly 53.9% had visited more than one facility before death. Conclusion: Poor antenatal care and lack of human resources posed major reasons for death in all facilities. Rights realization among the beneficiaries was found to be very poor.

Abstract Background Reducing Maternal Mortality Rate (MMR) is considered by the international community as one of the eight Millennium Development Goals. Based on previous studies, Skilled Assistant at Birth (SAB), General Fertility Rate (GFR) and Gross Domestic Product (GDP) have been identified as the most significant predictors of MMR in South Sudan. This paper aims for the first time to develop profile limits for the MMR in terms of significant predictors SAB, GFR, and GDP. The paper provides the optimal values of SAB and GFR for a given MMR level. Methods Logarithmic multi- regression model is used to model MMR in terms of SAB, GFR and GDP. Data from 1986 to 2015 collected from Juba Teaching Hospital was used to develop the model for predicting MMR. Optimization procedures are deployed to attain the optimal level of SAB and GFR for a given MMR level. MATLAB was used to conduct the optimization procedures. The optimized values were then used to develop lower and upper profile limits for yearly MMR, SAB and GFR. Results The statistical analysis shows that increasing SAB by 1.22% per year would decrease MMR by 1.4% (95% CI (0.4–5%)) decreasing GFR by 1.22% per year would decrease MMR by 1.8% (95% CI (0.5–6.26%)). The results also indicate that to achieve the UN recommended MMR levels of minimum 70 and maximum 140 by 2030, the government should simultaneously reduce GFR from the current value of 175 to 97 and 75, increase SAB from the current value of 19 to 50 and 76. Conclusions This study for the first time has deployed optimization procedures to develop lower and upper yearly profile limits for maternal mortality rate targeting the UN recommended lower and upper MMR levels by 2030. The MMR profile limits have been accompanied by the profile limits for optimal yearly values of SAB and GFR levels. Having the optimal level of predictors that significantly influence the maternal mortality rate can effectively aid the government and international organizations to make informed evidence-based decisions on resources allocation and intervention plans to reduce the risk of maternal death.

Introduction: The world's second most populous country-India, witnesses 20-30% pregnancies that belong to the high-risk category out of the total pregnancies in the country. 12% of the global maternal deaths are attributed to India. The Rural areas of the country are further vulnerable to high maternal and infant mortality rates due to a rural-urban divide and unavailability of health resources. Objectives: The rationale of this paper is to understand and illustrate common High Risk Pregnancies (HRPs) in the rural area of Shorapur and to gauge the preparedness of the health facility in the area to help deliver safe child birth for the mother and the child. Materials and Methods: A cross-sectional study was conducted in pregnant women attending the Antenatal Care (ANC) clinic in sub-district hospital of northern Karnataka over a period of 03 months. Results: A total of 601 high risk conditions were identified in ANC women. Of the total ANC women with HRP 44.1% (n= 265) had previous Caesarean Section, 15.1% (n=91) had RH incompatibility, 12.6% (n=76) were observed to be Short Primi, 9.7% (n= 58) experienced Bad Obstetric History/Antepartum Haemorrhage, 8.2%% (n=49) had Gestational Hypertension, 5.8%% (n=35), were severely Anaemic, 4.2% (n= 25) had Multiple pregnancy and the remaining 0.3% (n=3) had tumour, Gestational DM and Rheumatoid Arthritis. Discussion: As per the observed HRPs and respective health facility preparedness, two main barriers to safe pregnancy and childbirth emanated during the study - inadequate infrastructure and services for blood transfusion, dearth of trained health professionals. Conclusion: Direct referral of high risk cases to appropriate facilities that have the required capacity to support such cases must be made. Tele-medicine can be considered as an efficient alternative to connect the ANC women with the specialist doctor remotely for evaluation of HRPs. A blood storage unit must be established in all SDH hospitals as a minimum requirement. [ABSTRACT FROM AUTHOR]

The study aims to analyze impact of Lady Health Worker program on use of maternal health services in community with a lady health worker. The main focus was the rural districts of Sindh for this case study. The maternal health service is determined by at least four Antenatal care (ANC) visits provided to mother and receipt of at least two Tetanus Toxoid (TT) injections to mother during pregnancy. These have direct impact on maternal mortality rate and infant mortality rate. Secondary data pertaining to all districts of Sind for three years (2017-2019) was collected from the Sindh Lady Health Worker program office Hyderabad for analysis purpose. Further secondary data of Pakistan Demographic and Health Survey (2017-18) was also used to see the impact of intervention of LHW program implemented by Ministry of Health Pakistan in 1994 and then devolved to provinces after the implementation of 18th Constitutional Amendment in 2010. The study found that the services provided by the lady health workers in communities in these districts has positively influenced the uptake of maternal health services as determined by the variables like antenatal visits by pregnant mothers to nearest health facilities and receipt of Tetanus Toxoid injection during pregnancy. [ABSTRACT FROM AUTHOR]

Female literacy plays a critical role on the overall growth and development of society. It has been proved from research that children who are taken care of by literate mothers get all round development in every aspect of their life. This paper analysed the impact of female literacy rate on the infant mortality and maternal mortality rate in different districts of Kashmir valley. For this linear regression method was used which shows the impact of female literacy rate on infant mortality rate and maternal mortality rate. From the result it has been observed that there is inverse relationship between female literacy rate and infant mortality and maternal mortality rate in districts of Kashmir valley. This study analysed that female literacy has immense contribution in declining the infant mortality rate and maternal mortality rate and thus help in improving the health status of both women and child. [ABSTRACT FROM AUTHOR]

This study aims to analyze the indirect causes of maternal death. This type of research is qualitative with a case study approach. Data collection was carried out by document search, community visits, and interviews. The results showed that the total number of maternal deaths in Luwu district totaled 19 were spread across 13 sub-districts, and maternal deaths generally occurred during labor and the puerperium. The indirect causes of maternal death can be seen from the close and far determinants. The close determinants were reviewed from three too late and four too, infectious diseases, far more determinant nutritional status in terms of distance, and the presence of obstetricians in obstetric emergencies. Efforts to reduce maternal mortality are the main focus on the prevention of complications, immediately make referrals when maternal conditions are still optimal. Empowering mothers and families. [ABSTRACT FROM AUTHOR]

The relevance of women in contributing to inclusive growth and consequently economic development in Nigeria cannot be overemphasized. Women play important social, economic and productive roles in any economy. Maternal mortality rate refers to the annual number of deaths of women from pregnancy-related causes per 100,000 live births, and Nigeria's rate is still relatively high at about 630 when compared with the figures of the developed countries. For inclusive growth to be achieved in Nigeria, women should not be neglected and marginalized so they can contribute their quota to the growth of the country, but maternal mortality rate needs to be reduced because it is only the living that can make contributions to growth. Thus, this study examined the long run effect of gender inequality, maternal mortality and inclusive growth in Nigeria using time series data spanning from 1985 to 2017, and employed the ARDL econometric technique. The results showed that gender inequality and maternal mortality have negative impacts on inclusive growth in Nigeria. Therefore, the study recommends that women should be properly taken care of during pregnancy so that the maternal mortality rate can be reduced and hence they will be able to make meaningful contributions to the growth of the Nigerian economy. [ABSTRACT FROM AUTHOR]

Since the People’s Republic of China founded, especially over the last 15 years, maternal mortality rate (MMR) has fallen dramatically. In 2014, China has achieved the target of a reduction of 75% MMR from 1990 to 2015 (MDG 5) ahead of schedule. This achievement can be attributed to the improvement of legislation and policy, government commitment and investment on maternal health, extensive international cooperation, implementation of the maternal health program, development of maternal and child health (MCH) service system and development of MCH surveillance systems. Although China has achieved MDG 5, there are many kinds of difficulties and challenges in achieving the post-2015 Sustainable Development Goals (SDGs). Therefore, multi-strategy actions need to be considered to seize the opportunities to further reduce the MMR in the future.

Abstract Background The maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions (east, central and west regions), and the mortality in the western region remains high. This study aims to examine how much disparity in the health system and MMR between ethnic minority and non-minority counties exists in Sichuan province of western China and measures conceivable commitments of the health system determinants of the disparity in MMR. Methods The MMR and health system data of 67 minority and 116 non-minority counties were taken from Sichuan provincial official sources. The 2-level Poisson regression model was used to identify health system determinants. A series of nested models with different health system factors were fitted to decide contribution of each factor to the disparity in MMR. Results The MMR decreased over the last decade, with the fastest declining rate from 2006 to 2010. The minority counties experienced higher raw MMR in 2002 than non-minority counties (94.4 VS. 58.2), which still remained higher in 2014 (35.7 VS. 14.3), but the disparity of raw MMR between minority and non-minority counties decreased from 36.2 to 21.4. The better socio-economic condition, more health human resources and higher maternal health care services rate were associated with lower MMR. Hospital delivery rate alone explained 74.5% of the difference in MMR between minority and non-minority counties. All health system indicators together explained 97.6% of the ethnic difference in MMR, 59.8% in the change trend, and 66.3% county level variation respectively. Conclusions Hospital delivery rate mainly determined disparity in MMR between minority and non-minority counties in Sichuan province. Increasing hospital birth rates among ethnic minority counties may narrow the disparity in MMR by more than two-thirds of the current level.

Indah Lestari,1 Heni Frilasari,1 Heru Santoso Wahito Nugroho2 1Nursing Department, STIKes Bina Sehat PPNI Mojokerto, Mojokerto, Indonesia; 2Midwifery Department, Poltekkes Kemenkes Surabaya, Surabaya, IndonesiaCorrespondence: Indah LestariSTIKes Bina Sehat PPNI Mojokerto, Jl-Raya Jabon Km-6, Mojokerto, Jawa Timur 61371, IndonesiaTel +6282139388912Fax +62321390203Email ns.indah@yahoo.com I have carefully studied the results of a study recently published in this journal on the contribution of cultural factors to maternal mortality rate in the rural villages of Limpopo Province South Africa. The results of this study indicated that cultural factors that contributed to maternal mortality. They were perceived cultural factors, which included culture and knowledge to seek care, perceived beliefs, decisionmaking process, and culture expectations regarding bleeding, hypertension and HIV-AIDS.1 The critical points explored in this study are limited to “cultural practices that are practiced for women during the childbirth period in Limpopo”. View the original paper by Marabele and colleagues

Background: Every five minutes one woman somewhere in India dies due to pregnancy-related complications, amounting to one lakh maternal deaths and 10 lakh new-born deaths each year. The Janani shishu suraksha karyakram(JSSK)programme was launched to aid in endeavor of decrease in MMR by giving various entitlements to pregnant mother and children. Objective: To assess the factors affecting functioning of the Janani shishu suraksha karyakram program in community. Methodology: The cross sectional study was carried in Ahmedabad District out during the period of January 2014 to December 2015. The 235 beneficiaries were interviewed from the government health centers. Result: More than one third of beneficiaries were not aware about all the entitlements (benefits) of the programme.60% mothers had done USG in private set up. More than 70% mothers had to spend money for getting USG done followed by transport facility, medicine and laboratory investigations. Conclusion: The factors affecting functioning of JSSK program were out of pocket expenditure incurred during pregnancy. The beneficiaries have to spend money because of laboratory investigations, transport facility, medicines and complication etc.