Title: Trends in Causes of Maternal Mortality in a Tertiary Care Centre in Kerala after Introduction of CRMD and Quality Standards Programme
Authors: Dr Sreekumaru U, Dr Shilpa Nair
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.97
Abstract
Background: Confidential review of maternal deaths of Kerala (CRMD) which was launched from 1st January 2004 puts in sincere efforts to discover major underlying causes of maternal deaths in the state. As a result of this process, Kerala initiated the quality standards programme. The Committee also work on a communication and training programme within the state (EMOCALS) to educate obstetricians of both Government and private sectors to manage these common causes of maternal deaths and steps to be taken to prevent them. They also invite the attention of State government to specific areas that require government led remedial measures, such as policy or legislative changes. The present study compares causes of maternal deaths that occurred in the study setting during a six year period 2004 – 2009 (group I) with that of 2012 – 2017(group II) - that is after introduction of CRMD and EMOCALS- to find out whether there is any change in trend regarding causes of death.
Methods: A descriptive a comparative study of maternal mortality cases was conducted at SAT hospital, Govt. Medical College, Thiruvananthapuram, a tertiary care centre in Kerala, India. The maternal mortality data of the study setting for a six year period from January 2004 to December 2009 was taken (group I) which was compared with that of January 2012 – December 2017(group II) of the same study setting. The data was recorded using structured proforma, entered in excel worksheet and compared between two groups. Data analysis was performed using SPSS version 16.
Results: Maternal mortality ratio in group I was 126/ 1 lakh live births where as in group II it was 157/ 1 lakh live births. Maximum number of deaths occurred in primigravidae in both the groups (41.4% in group I and 51.1% in group II) . Most of the deaths occurred in referred cases (70.7% in group I and 88.3% in group II) and cases belonging to low socio economic status (94% in group I and 77.7% group II). Regarding cause of death 59.6% of deaths occurred due to direct causes in group I whereas direct maternal deaths was reduced to 43.3% in group II which was found to be statistically significant. There is a statistically significant reduction in number of deaths due to postpartum hemorrhage (26.3% in group I and 14.4% in group II) which is still the leading cause of maternal death in India.
Conclusion: After initiation of quality standards programme there has been statistically significant reduction in direct maternal deaths in this study setting especially deaths due to postpartum hemorrhage.
Keywords: maternal mortality, CRMD, quality standards programme.
References
- Kalter HD, Mohan P, Mishra A, Gaonkar N, Biswas AB, Balakrishnan S, Arya G, Babille M. Maternal death inquiry and response in India-the impact of contextual factors on defining an optimal model to help meet critical maternal health policy objectives. Health research policy and systems. 2011 Dec;9(1):41.
- Ravichandran J, Ravindran J. Lessons from the confidential enquiry into maternal deaths, Malaysia. BJOG: An International Journal of Obstetrics &Gynaecology. 2014 Sep 1;121:47-52.
- Moodley J, Pattinson RC, Fawcus S, Schoon MG, Moran N, Shweni PM. The confidential enquiry into maternal deaths in South Africa: a case study. BJOG: An International Journal of Obstetrics & Gynaecology. 2014 Sep 1;121:53-60.
- Reducing maternal mortalityin India: A four-pronged strategy, J Jose – ideas for india in 11 June 2018 Human Development
- Paily VP, Ambujam K, Rajasekharan Nair V, Thomas B. Confidential review of maternal deaths in Kerala: a country case study. BJOG: An International Journal of Obstetrics & Gynaecology. 2014 Sep;121:61-6.
- Nair M, Nelson-Piercy C, Knight M. Indirect maternal deaths: UK and global perspectives. Obstetric medicine. 2017 Mar;10(1):10-5.
- Kumar S. Reducing maternal mortality in India: Policy, equity, and quality issues. Indian Journal of Public Health. 2010 Apr 1;54(2):57.
- Bullough C, Meda N, Makowiecka K, Ronsmans C, Achadi EL, Hussein J. Current strategies for the reduction of maternal mortality. BJOG: An International Journal of Obstetrics & Gynaecology. 2005 Sep;112(9):1180-8.
- Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. International Journal of Gynecology & Obstetrics. 2005 Feb 1;88(2):181-93.
- Holmer H, Oyerinde K, Meara JG, Gillies R, Liljestrand J, Hagander L. The global met need for emergency obstetric care: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2015 Jan 1;122(2):183-9.