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Epidemiological Study of Maternal Mortality in Al-Najaf Governor, Iraq

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Epidemiological Study of Maternal Mortality in Al-Najaf Governor, Iraq Hameed & Hassoun (2020): Epidemiology of maternal mortality Dec, 2020 Vol. 23 Issue 24 Epidemiological Study of Maternal Mortality in Al-Najaf Governor, Iraq Ghufran Majeed Hameed*1; Suhair Mohammed Hassoun *2 1*Master degree students, Middle Technical University, Iraq 2*Assistant Professor Middle Technical University, Iraq Abstract: Background: Mother's death is a tragic and traumatic event and it has a severe impact on the family, community and eventually the nation. Maternal mortality refers to the death of a woman who dies during pregnancy or within six weeks after delivery. Objectives: To determine the trend of maternal mortality, explore the main causes of maternal mortality and identify the factors associated with maternal mortality for ten years’ period in the Al-Najaf governorate/South of Iraq. Materials and Methods: A retrospective descriptive, cross-sectional study that utilized all maternal mortality data for the period from 2009 to 2018. Data were collected by using a structured questionnaire and get information from hospital records in the statistics departments and forensic medicine reports also contact the family by phone as needed. The duration of data collection continued for the period from December 2019 to March 2020. Reviewed (158) records of maternal death occurred in public hospitals of the Al-Najaf governorate. Result: The maternal mortality ratio trend in the Al-Najaf increased sharply during 2016 (66.76/100.000 live births) compared to that of 2010 (18.34/100.000 live births). The most direct and indirect causes of maternal death were hemorrhage (26.58%) and heart diseases (13. 29%). Most of the maternal deaths were from women aged 20-24 years old (24.7%) with Mean±SD (Range) 29.5±7.4 (15-47), residence in urban areas (63.3%) with primary educational level (55.7%) and housewives (94.3%). Regarding the obstetrics characteristics, most of the maternal deaths were irregular antenatal care (62.3%), with gravidity ≥ 5 (27.5%), gestational age 36-42 weeks (66.0%), and (43.7%) terminate a pregnancy by cesarean section. Most of the death (60.1%) occurred after delivery or during the puerperium period. Conclusions: According to the present findings, the trend line of maternal mortality was increasing during the period of the study. Hemorrhage and heart diseases are the main causes of maternal mortality. Educational level, gravidity and number of previous cesarean sections are factors increased risk of maternal mortality. Recommendations: It is necessary to determine the trend of maternal mortality for all governorates of Iraq for different period to assist the authorities for proper decision-making and resource allocation to achieve the Millennium development goals in addition to strengthening and monitoring the registration system of maternal mortality and their exact causes in all health facilities of the Al-Najaf governorate are the main recommendations of the study. Key words: Maternal mortality, MMR, Al-Najaf governorate How to cite this article: Hameed GM, Hassoun SM (2020): Epidemiological study of maternal mortality in Al-Najaf Governor, Iraq, Ann Trop Med & Public Health; 23(S24): SP232426. DOI: http://doi.org/10.36295/ASRO.2020.232426 Introduction: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes (1).Maternal mortality is considered a sentry event, reflecting the state of maternal health. The maternal mortality ratio (MMR) that expressed as the number of maternal deaths per 100.000 live births is one of the most important and globally-recognized indicators for measuring the state of a country’s, economy, culture, and healthcare system (2). Maternal mortality can be classified as direct and indirect mortality. It is well-known that the most important direct causes of maternal death are obstetrical hemorrhage, sepsis, hypertensive disorders of pregnancy, and abortion. Indirect maternal deaths are from non-pregnancy related causes which become aggravated by the pregnancy (for example cardiac diseases and respiratory Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.232426 Hameed & Hassoun (2020): Epidemiology of maternal mortality Dec, 2020 Vol. 23 Issue 24 disorders) (3). Most maternal deaths can be prevented if pregnant women have access to good- quality of antenatal and postnatal care, and also if, certain harmful birth practices are avoided (4). In Iraq, maternal mortality remains unacceptable and remained as high as 83 per 100,000 live births in 2015 (5). Sustainable Development Goals (SDGs) accepted by the global community set a target of less than 70 maternal deaths per 100.000 live births by the 2030s (6).In order to achieve that, more researches should be done to know the magnitude of maternal mortality, causes and determinants factors that influence maternal deaths in each area to aid prioritization of available resources and facilitate achieving the goals in decreasing maternal deaths in each country (7). Objectives of study: To determine the trend of maternal mortality in Al-Najaf governorate for ten years’ period, to explore the main causes of maternal deaths and to identify the association between socio-demographic, obstetrics characteristics and maternal deaths. Materials and methods: Study design: A retrospective descriptive, cross-sectional study that utilized all maternal mortality data for the period from 2009 to 2018. Duration of the Study: The duration of data collection from all places of study continued for the period from December 2019 to March 2020. Place of study: Maternal mortality data were obtained from statistical departments in the public hospitals of the Al-Najaf governorate. Study Sample: This study used retrospective method to investigate (158) records of maternal death and included all live births for ten years. Inclusion and Exclusion criteria of study: Inclusion Criteria :( 1) Mothers who died while pregnant or within 42 days of termination of pregnancy. (2)Any gestational age or site of the pregnancy. (3)All causes related to or aggravated by the pregnancy or its management. Exclusion Criteria: (1) Mothers who died to accidental and incidental causes. (2) Late maternal deaths. Data Collection: To collect information about each maternal death case the researchers develop a structured questionnaire included the date of death and three parts: the first part concerned with the socio-demographic characteristics, the second was about obstetrics characteristics and the third part dealt with direct and indirect causes of maternal mortality. To filling the questionnaire and get all information the researcher depended on the following: File inpatient of each mother. Hospital records in the statistics departments. Records of maternal mortality in each hospital. Forensic medicine reports. Maternal death statistics form designated from the Iraqi ministry of health. Contact the family by phone as needed especially when missing information was found in the medical records. Other statistical information (total number of live births for ten years in Al-Najaf governorate) obtained from Al-Najaf Health Directorate/ Statistics Department. Where multiple causes of death were recorded, the primary cause was identified and the time spent to fill the questionnaire required about 15-20 minutes. Statistical Analysis: Data was tabulated on Microsoft Office Excel 2016 and analyzed by using the available statistical package of SPSS-25 (Statistical Packages for Social Sciences- version 25). All variables were entered as categorical. The results were presented in simple measures frequencies, percentages, and descriptive summary statistics. To determine the trend of maternal deaths in Al-Najaf governorate for ten years the following measure is used: Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.232426 Hameed & Hassoun (2020): Epidemiology of maternal mortality Dec, 2020 Vol. 23 Issue 24 Maternal mortality ratio (MMR) = 푵풐. 풐풇 풎풂풕풆풓풏풂풍 풅풆풂풕풉풔 (풑풓풆품. , 풍풂풃풐풓 풂풏풅 풑풖풆풓풑. ) 풊풏 풂 풔풑풆풄풊풇풊풄 풚풆풂풓 × ퟏퟎퟎퟎퟎퟎ 푻풐풕풂풍 풏풐. 풐풇 풍풊풗풆 풃풊풓풕풉풔 풊풏 풕풉풆 풔풂풎풆 풚풆풂풓 The Maternal Morality Ratio was calculated for each year and for the entire period of study and the evolution analysis was performed by the graphical representation of the trend curve. Results and discussion: 1. The Trend of Maternal Mortality in Al-Najaf Governorate for Ten-Year Period (2009-2018) MMRatio Linear (MMRatio) 80 70 66.76 60 50 35.14 37.17 40 31.81 28.22 30.45 30 23.03 25.09 22.56 18.34 20 10 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Figure 1: Maternal mortality ratio in Al-Najaf, 2009-2018 Figure 1 shows that maternal mortality ratio trend in Al-Najaf increased sharply during 2016 (66.76/100.000 live births) compared to that of 2010 (18.34/100.000 live births). Also, there was increasing in the trend line of MMR during the reference period in the study area. The reasons for this result are not clear but may have something to do with the relatively higher number of pregnancies and increased number of poor pregnancy outcomes in 2016 compared with 2010 or may be due to poor quality of maternal services and low socio-economic status that made women not receive required care during pregnancy period. 2. Causes of Maternal Mortality in Al- Najaf governorate (2009-2018): Table 1 shows direct causes of mortality were presents in 100 cases with a percentage (63.3%) of maternal deaths in the Al-Najaf for the period (2009-2018), indirect causes were present in 49 cases accounting (31%) and unknown causes present in 9 cases (5.7%). Among the direct causes of maternal deaths, the majority (26.58%) was from postpartum and antepartum hemorrhage this result consistent with other studies were conducted in Iran and Iraq(8) (9). A major of these cases occurred may due to inappropriate diagnosis or delayed referral to hospitals with advanced complications such as obstructed labour, or major of these women were anemic and occurred delay in replacing blood and blood products when she needed it, also not managed properly during antenatal care.
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