Maternal mortality ratio and predictors of maternal deaths in selected desert districts in rajasthan a community-based survey and case control study.
BACKGROUND
Reduction in maternal and child mortality has been a top priority in India, especially in light of the commitment on the part of the national government to the reach the Millennium Development Goals. Despite massive program efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high. Population-based estimates of MMR are lacking, and reliable evidence of role of socioeconomic determinants and program-related factors that mediate medical causes is not available. The present study was conducted to develop population-based estimates of MMR, and to evaluate the primary causes of maternal deaths and factors associated with excess risk of maternal mortality.


METHODS
The study was conducted in the state of Rajasthan in India, covering 25,926 households in 411 villages. It has two major components: a community-based household survey and a case-control study with cases and controls sampled from the same population. A total of 32 maternal deaths and 6,165 live births were identified. The group of women who died during pregnancy or delivery (cases) is compared with a group of women who gave birth and survived (controls).


RESULTS
MMR was estimated to be 519 (95% confidence interval [CI], 477-561). Hemorrhage was the chief cause (31%) of maternal deaths; the other causes were obstructed labor, severe anemia, puerperal sepsis, and abortion. Young age at child birth (odds ratio [OR], 2.6; 95% CI, 1.9-3.2) and poverty (OR, 2.5; 95% CI, 1.6-3.4) were independently associated with increased risk of maternal death. Presence of complications during antenatal period was an important predictor of maternal death (OR, 7.8; 95% CI, 6.8-8.8). Childbirth at home (OR, 4.4; 95% CI, 3.3-5.5) was associated with increased risk of maternal death. The study provides clear evidence for renewed program efforts and strategies for reducing complications and maternal deaths.
Gupta
Shiv D
SD
Indian Institute of Health Management Research, 1, Prabhu Dayal Marg, Near Sanganer Airport, Jaipur - 302011, India. sdgupta@iihmr.org
Khanna
Anoop
A
Gupta
Rajeshwari
R
Sharma
Nand K
NK
Sharma
Narottam D
ND
D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D003625:Data Collection / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D003889:Desert Climate; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008427:Maternal Health Services / Q000458:organization & administration; D008428:Maternal Mortality; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000401:mortality*; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult