Malgré de nombreuses initiatives entreprises par le gouvernement au cours des dernières années, la mortalité maternelle demeure un véritable fléau au Cameroun. Pour cette raison, une recherche a été conduite pour déterminer l'ampleur de la mortalité maternelle dans les 7 maternités de troisième niveau du Cameroun, décrire les différentes étapes d'une intervention visant à améliorer le système de référence et la prise en charge des urgences obstétricales et évaluer son effet sur la mortalité maternelle.La recherche a été menée en trois phases. Une revue rétrospective des données agrégées de la période 2004 à 2006 a été réalisée incluant tous les accouchements, les complications obstétricales, les césariennes et les décès maternels. Ensuite une intervention de 33 mois a été mise en place dans 22 maternités périphériques ainsi que dans 3 maternités de troisième niveau où la mortalité maternelle était importante. L'évaluation de l'intervention a été faite à travers la méthode quasi expérimentale combinant l'étude avant-Après à l'étude ici-Ailleurs. Deux ans après l'intervention, les décès maternels enregistrés dans les 3 maternités cibles avaient diminué de plus de la moitié (P=0,000001). Le taux de létalité des complications obstétricales observé dans les mêmes maternités est passé de 2,2 à 0,7% (P=0,000001). Par ailleurs, le nombre de décès observés chez les femmes référées avait diminué et le taux de létalité était inférieur à 1%. Les résultats de la recherche mettent en évidence les conséquences du renforcement des compétences des prestataires, de l'amélioration du système de référence et de la qualité des soins sur la mortalité maternelle. / Despite numerous initiatives undertaken by health authorities in the past years, maternal mortality remains a major public health issue in Cameroon. Against this background, research was conducted (i) to determine the maternal mortality patterns in 7 tertiary maternity centers in Cameroon, (ii) to document various stages of an intervention for improving referral system and the management of obstetric emergencies and (ii) evaluate the effect of these measures on maternal mortality and propose future actions. The research was conducted in three phases. A retrospective review of the aggregate data for the period 2004-2006 was performed including all births, obstetric complications, caesarean sections and maternal deaths. Then 33 months intervention has been set up in 22 peripheral maternities and in three tertiary maternity centers where maternal mortality was very high. The evaluation of the intervention was made using the quasi-Experimental design. This method combined the pre- and post- intervention study as well as the study of the maternities where there was intervention compared to the control group. Two years after the intervention, maternal deaths recorded in the target tertiary maternity centers decreased by more than half (P = 0.000001). The case fatality rate decreased from 2.2 to 0.7% in the same group (P = 0.000001). Moreover, the number of deaths among referred women decreased significantly and the case fatality rate was less than 1%. The research findings highlight the impact of capacity building providers, improvement of the referral system and quality of care on maternal mortality.

The author argues that maternal mortality can easily be avoided and that the right to health and life is as much a developmental issue as it is one of human rights. Focuses on the maternal mortality ratio and relevant laws protecting women’s right to life and health in Nigeria and Ethiopia. / A Dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Dr. Salah Hammad, Faculty of Law, Addis Ababa University, Addis / Thesis (LLM (Human Rights and Democratisation in Africa))--University of Pretoria, 2009. / http://www.chr.up.ac.za/ / Centre for Human Rights / LLM

Background: Pregnancy Induced Hypertension (PIH) and its complications contribute to a significant burden of disease both in developed and developing countries of the world. Unfortunately, PIH has no cure, the delivery of the baby and the placenta is required. Early detection of pregnancy induced hypertension and close monitoring remains the key to achieving a favourable outcome. This study aimed to determine the quality of care given to women diagnosed with Pregnancy Induced Hypertension (PIH) within a care pathway spanning peri-urban primary and urban secondary level facilities. Methods: This was a retrospective clinical audit of medical records of patients diagnosed with PIH. It was conducted in the Wesfleur -New Somerset Hospital drainage area, using a locally validated data extraction tool, based on the South African Maternal Care Guidelines. The data were analyzed using descriptive methods to report on the frequencies and proportions of the variables, and analyzed to report on statistical significance of correlations. Results: The prevalence rate of pregnancy induced hypertension in this study was 12%. The overall pregnancy induced hypertension complication prevalence in the study for mothers was 7.7%, and that of babies was 30.7%. Facilities generally performed well according to the audit indicators detailing structures and processes that should be followed, as outlined by the standard guidelines used. Two process indicators were correlated with adverse outcomes: 66.1% of patients were appropriately referred, resulting in statistically better foetal outcomes (p = 0.059); and those who booked early in the pregnancy had less PIH-induced complications than those who booked late (p = 0.012) Conclusion: This study followed a standardized audit methodology and found that the quality of care in this peri-urban area is of a good standard and identified areas for quality improvement and further enquiry to ensure continual improvement in maternal and fetal outcomes.

<p>Over the last century, developed countries have been successful in enhancing maternal health and reducing Maternal Mortality Ratio (MMR). By 2018, MMR across OECD countries and World Bank Group Regions have converged towards very low levels, averaging more than 5 deaths per 100,000 live births. The United States has become an outlier among the developed countries in maternal deaths and compares unfavorably to a number of poorer countries where the ratio has declined. In 2017, the US ranked worst in MMR among the 39 industrialized nations. United States has experienced almost a 142 percent increase in MMR from 1987-2018. According to the Centers for Disease Control and Prevention (CDC), every year in the US, more than 700 women die due to the pregnancy or childbirth-related complications, with 60 percent of these deaths being preventable. Within the US, MMR varies considerably, leaving large disparities across states as well as between all racial groups. This research study aims to understand the interplay of spatial and racial impacts on the variation of maternal mortality ratios within the US. The paper estimates Ordinary Least Squares (OLS) and Spatial Lag Models for MMR using cross-sectional US state data for 2012-2017, taken from CDC. The results show that the dominant root causes of high maternal mortality differ between black and white women. </p> <p> </p>

Background: Restrictions on induced abortion varies widely across the globe and so does the rate of induced abortion and maternal mortality (MM). Safe abortions – done by trained providers in hygienic settings and early medical abortions carry fewer health risks and reduce maternal mortality rates (MMR). However, nearly 7 million women in developing countries are treated for complications from unsafe abortions annually, and at least 22,000 die from abortion-related complications every year. Aim: The aim was to explore national and regional patterns of abortion laws, the abortions percentages and the maternal mortality rates (MMR), to see if patterns could be distinguished and how they differentiate to each other. Method: With a shape-file containing polygons representing the world’s countries, and the computer program ArcMap, was used to gather and join data. Result: The result showed that many African countries has a restrictive abortion law, and they also have a high MMR. In the Nordic countries they have a liberalized abortion law and they have low MMR. Another finding is that a restricted abortion law does not correspond to a low percentage of abortions. This is clearly demonstrated in South America, where they have a high abortion percentage, and extremely restricted abortion laws. Conclusion: This result revealed patterns showing that countries with restricted abortion laws, does not contribute to a low MMR, and restricted abortion law does not decrease the percentage of abortions.

Master of Public Health - MPH / In the Maseru district, the high prevalence of unintended pregnancies among adolescents aged between 15 to 19 years may be due to non-use of modern contraceptive methods. It is therefore important to investigate possible barriers adolescents in Maseru in Lesotho face in accessing contraceptive methods and services. This research has therefore focused on the factors that affect the accessibility and usage of contraceptive services among in-school adolescent girls in Maseru City, Lesotho.The study was an observational, analytical, cross-sectional study. A sample of 10 high schools in Maseru city was selected as study sites, using computer-generated random numbers. A stratified random sampling method was used to enrol a total of 368 sexually active respondents, aged 15-19 years into the study. Data was collected using a structured one-on-one interviewer administered questionnaire and analysis was conducted using the STATA 14 statistical software programme. Ethical approval was obtained from the Biomedical Research and Ethics Committee (University of the Western Cape) and the Lesotho Ministry of Health and Social Welfare. Written parental/caregiver informed consent and written participant consent and assent, as per the Lesotho law were obtained.

Theses ( MPH.) -- University of Limpopo, 2021 / Background: Maternal mortality is a significant public health problem worldwide, and is a vital indicator of the functioning of a health system. The South African maternal mortality ratio is higher than other countries with same economic growth, despite people having free access to maternal health. How to develop relevant policies and programmes to reduce maternal mortality factors contributing to maternal mortality was investigated. Aims of the Study: To investigate the factors contributing to maternal mortality in public health institutions in the Sekhukhune District, Limpopo Province, South Africa. Methods: A quantitative, retrospective study was undertaken where 138 medical records of maternal mortality cases reported between 2013 to 2017 were reviewed. A simple random sampling method was used to select files that met the selection criteria from seven hospitals in the Sekhukhune District, Information was collected on maternal demographics and health service-related characteristics, including age, marital status, parity, antenatal care utilisation of services and delivery type. Inferential data were analysed using the student t-test and SPSS version 25. Results: The mean age of the women involved in this study was 30 years, with a standard deviation of 5.7. All the women who participated in the study were black African. The majority of maternal mortality occurred in hospital. The women in the majority of maternal mortality cases were unemployed, at 93.5%, while most of the maternal mortality cases involved single women (71%).The women involved in these maternal mortality cases booked their ANC care and the major health provider was a professional nurse (58.0%), while 57.2% of the participants attended their ANC at primary healthcare facilities. Most of the maternal deaths occurred after delivery (58.7%) and, in most deliveries, the Partogram was not used (66%). HIV testing occurred in 99% of the maternal mortality cases. The causes of maternal mortality were both direct (71.0%) and indirect (23.9%) causes. The leading cause of maternal mortality was direct haemorrhage (33%), followed by eclampsia (27%) and infection (16%). The leading indirect cause was respiratory causes (22%) and retro viral disease (RVD) (9%). The personal factor that contributed most to maternal mortality was delay in seeking help (62%). v Conclusion and Recommendations: The personal factor, delay in seeking medical help by the women, contributed to maternal mortality and it was further concluded that the majority of maternal mortality cases did not occur as a result of any complications in ANC and delivery. It is recommended that the training of healthcare providers in the utilisation of the Partogram be implemented to improve skills in the management of haemorrhage and eclampsia. Furthermore, the management of complications needs to be strengthened through a multi-sectorial approach. / SAMRC

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SAMMANFATTNING Bakgrund: Varje år dör över 300 000 kvinnor i komplikationer relaterad till graviditet och förlossning. Milleniemålen som syftar till att minska mödradödlighet med 75 procent mellan åren 2000-2015 har inte uppnåtts. Kvinnor dör i samband med graviditets och eller barnafödande och mest drabbade är kvinnor i lågresursländer, det vill säga Afrika Söder om Sahara, Nordafrika, Mellanöstern, Sydostasien, respektive Sydasien. För att främja en hållbar utveckling bör olika faktorer beaktas för att eliminera fattigdom, förbättra infrastruktur, utarbeta abortpolicier och lagar, befrämja befintliga moderskapsprogram, samarbete mellan regeringar och hälsosjukvårdssystem, öka allmänhetens medvetenhet och investeringar samt fler barnmorskor särskild på landsbygden, för att möta behoven. Syfte: Att belysa faktorer som orsakar mödradödlighet i lågresursländer samt att beskriva det preventiva arbetet för att minska mödradödligheten. Metod: En systematisk litteraturöversikt valdes att besvara studiens syfte. PubMed och Cinahl är databaserna som användes. Sjutton originalartiklar inkluderades i studien. Resultat: Tre huvudkategorier och fem underkategorier identifierades. Huvudkategorierna var: Direkta obstetriska orsaker till mödradödlighet, Indirekta orsaker till mödradödlighet samt Prevention. Underkategorierna som identifierades var: Före partus, Efter partus, Sjukdom hos modern, De tre fördröjningarna samt Kulturella faktorer. Slutsats Resultatet visade att orsakerna till mödradödlighet i lågresursländer är mångfacetterade. Det beror dels på obefintliga resurser samt hur prioriteringar görs av ländernas beslutsfattare. Faktorer som kultur, religion, utbildning och fattigdom var hinder som försvårade vårdkontakten som också bidrog till en ökad mödradödlighet. Det är viktigt att i det preventiva arbetet identifierar kvinnor i riskzon för att dö i samband med graviditet och förlossning i tid för att kunna ingripa och förhindra mödradödligheten.

Every year more and more families are choosing home birth over the hospital. There is a growing movement, in person and online, of parents opting-out of hospital birth, sharing their stories, and encouraging others to do the same. At the same time, the United States is reckoning with its abysmal maternal mortality rates- the majority of which are the result of poor management of dangerous pregnancy complications. How can these two phenomena exist within the same social and cultural conversation? The landscape of home birth in the United States is complex. Data on the safety of home birth is limited, but it appears to be more dangerous than hospital birth. Further complicating the picture is a fractured, private American healthcare system, but families choosing to birth at home are highly motivated to navigate through it. We present multiple theories to explain why so many birthing people are opting for the home, some of which include feminist philosophical arguments, the romanticization of birth, the contemporary all-natural movement, and a strong distrust of our racist medical system. These arguments shed light on the flaws and inadequacies of our maternal healthcare system, and as a medical community we must actively work to alleviate them. We need to nationally and locally address maternal safety and implement practices to dismantle systemic racism within our institutions. While we address maternal mortality, we must also take steps to make home birth an equally safe option for parents who choose it. / Urban Bioethics