Title: Levels and Correlates of Self-reported Maternal Morbidity in Women in a Community outreach area of a Teaching Hospital in Bihar

Authors: Dr Manasij Mitra, Dr Gautam Sarker, Dr Maitraye Basu

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.06

Abstract

Background: Globally, maternal mortality ratio (MMR) dropped from 385 maternal deaths per 100,000 live births in 1990 to 216 in 2015, a 44% reduction. Despite substantial progress, maternal mortality still remains a matter of great public health importance. Maternal mortality indicates only the tip of the iceberg. For each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. Consistent with the higher rates of maternal mortality in LMICs, maternal morbidity rates are also higher in LMICs than HICs.

Objectives: The objectives of the study was to estimate the levels and correlates of self-reported maternal morbidity. The data was entered in Microsoft Excel and exported and analyzed in SPSS (v19.0). Descriptive statistics, bivariate and multivariate analysis were used to arrive at the conclusions in the study.

Methodology: This was a cross-sectional study on Maternal Morbidity using self reports without clinical examinations among women living in the community being served by MGM Medical College and LSK Hospital, Kishanganj, Bihar. The sample size of the study was calculated as 200 considering the prevalence of maternal morbidity in the state and after considering the possibility of nonresponse to the study.

Results: The prevalence of antenatal morbidity was found to be 23.5%, morbidity during labor was 16.5% while post partum morbidity was 25.5%. The overall maternal morbidity was 44.5%. Religion, occupation, past history of ailments, decision taking obtaining healthcare, access to pocket money, type of past delivery, type of last delivery, wantedness of the index pregnancy, food intake during the antenatal period, physical activity during the antenatal period and awareness of danger signs of pregnancy came out as significant correlates of maternal morbidity in the bivariate analysis. Finally food intake and physical activity during the antenatal period, awareness of danger signs of pregnancy and type of last delivery came out as significant correlates of maternal morbidity in the multivariate analysis.

Conclusion: It is evident from the findings of the study that the causes of maternal morbidity are deeply entrenched in the sociocultural milieu. The findings bring out the socio-economic context in which the women suffer from maternal morbidity and stresses on the importance of self-reported community based studies on maternal morbidity to understand the social determinants of maternal morbidity more and thus come up with plausible solutions. 

Keywords: Maternal morbidity; Women’s autonomy; Antenatal; Labor; Post partum; Correlates.

References

  1. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ Lancet. 2010 May 8; 375(9726):1609-23.
  2. WHO, UNICEF, UNFPA et al. Trends in maternal mortality: 1990 to 2015. Geneva, Switzerland: Executive Summary; 2015.
  3. WHO, UNICEF, UNFPA, et al. Trends in maternal mortality : 1990 to 2010. Geneva, Switzerland, 2012.
  4. The Sustainable Development Goals 2015 – 2030. 2018. [Last accessed on 2019 Nov 20]. Available from: https://una-gp.org/the-sustainable-development-goals-2015-2030/
  5. Pregnancy-related mortality in the United States, 2006-2010. Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM Obstet Gynecol. 2015 Jan; 125(1):5-12.
  6. Frequency of and factors associated with severe maternal morbidity. Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW, Thorp JM Jr, Leveno KJ, Caritis SN, Iams JD, Tita AT, Saade G, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Van Dorsten JP, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Obstet Gynecol. 2014 Apr; 123(4):804-10.
  7. The prevalence of maternal near miss: a systematic review. Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L BJOG. 2012 May; 119(6):653-61.
  8. WHO (World Health Organization). 2010. ICD-10: International Classification of Diseases and Related Health Problems. 10th Revision, Vol. 2, Instruction Manual. Geneva: WHO.
  9. An Examination of the Maternal Health Quality of Care Landscape in India. March 2, 2017 So O’Neil Katie NaeveRajaniVed. Last accessed on 20.11.2019. Url: https://www.macfound.org/media/files/50268_Landscape_Report_2017.03.02.pdf
  10. Mohapatra A, Gomare M. A critical appraisal of the maternal and child health scenario in a metropolitan city in India with reference to achievements of millennium development goals. J Family Med Prim Care 2019;8:995-1001.
  11. Filippi V, Chou D, Ronsmans C, et al. Levels and Causes of Maternal Mortality and Morbidity. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361917/ doi: 10.1596/978-1-4648-0348-2_ch3
  12. McCauley M, Madaj B, White SA, et al Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi. BMJ Global Health 2018;3:e000625.

Corresponding Author

Dr Maitraye Basu

Associate Professor, Department of Anesthesiology, MGM Medical College and LSK Hospital, Kishanganj