title: Effect of early detection and treatment on malaria related maternal mortality on the north-western border of Thailand 1986-2010.
abstract: BACKGROUND
  Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand.
  
  
  RESULTS
  All medical records from women who attended the Shoklo Malaria Research Unit antenatal clinics from 12(th) May 1986 to 31(st) December 2010 were reviewed, and maternal death records were analyzed for causality. There were 71 pregnancy-related deaths recorded amongst 50,981 women who attended antenatal care at least once. Three were suicide and excluded from the analysis as incidental deaths. The estimated maternal mortality ratio (MMR) overall was 184 (95%CI 150-230) per 100,000 live births. In camps for displaced persons there has been a six-fold decline in the MMR from 499 (95%CI 200-780) in 1986-90 to 79 (40-170) in 2006-10, p<0.05. In migrants from adjacent Myanmar the decline in MMR was less significant: 588 (100-3260) to 252 (150-430) from 1996-2000 to 2006-2010. Mortality from P. falciparum malaria in pregnancy dropped sharply with the introduction of systematic screening and treatment and continued to decline with the reduction in the incidence of malaria in the communities. P. vivax was not a cause of maternal death in this population. Infection (non-puerperal sepsis and P. falciparum malaria) accounted for 39.7 (27/68) % of all deaths.
  
  
  CONCLUSIONS
  Frequent antenatal clinic screening allows early detection and treatment of falciparum malaria and substantially reduces maternal mortality from P. falciparum malaria. No significant decline has been observed in deaths from sepsis or other causes in refugee and migrant women on the Thai-Myanmar border.
authors: Obstetric Department, Shoklo Malaria Research Unit, Mae Sot, Thailand. rose@shoklo-unit.com
authors: Rose
authors: R
authors: McGready
authors: Machteld
authors: M
authors: Boel
authors: Marcus J
authors: MJ
authors: Rijken
authors: Elizabeth A
authors: EA
authors: Ashley
authors: Thein
authors: T
authors: Cho
authors: Oh
authors: O
authors: Moo
authors: Moo Koh
authors: MK
authors: Paw
authors: Mupawjay
authors: M
authors: Pimanpanarak
authors: Lily
authors: L
authors: Hkirijareon
authors: Verena I
authors: VI
authors: Carrara
authors: Khin Maung
authors: KM
authors: Lwin
authors: Aung Pyae
authors: AP
authors: Phyo
authors: Claudia
authors: C
authors: Turner
authors: Cindy S
authors: CS
authors: Chu
authors: Michele
authors: M
authors: van Vugt
authors: Richard N
authors: RN
authors: Price
authors: Christine
authors: C
authors: Luxemburger
authors: Feiko O
authors: FO
authors: ter Kuile
authors: Saw Oo
authors: SO
authors: Tan
authors: Stephane
authors: S
authors: Proux
authors: Pratap
authors: P
authors: Singhasivanon
authors: Nicholas J
authors: NJ
authors: White
authors: François H
authors: FH
authors: Nosten
mesh_terms: D042241:Early Diagnosis; D005260:Female; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D063130:Maternal Death / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012036:Refugees / Q000706:statistics & numerical data; D018805:Sepsis / Q000401:mortality; D013785:Thailand / Q000453:epidemiology