Epidemiologic transition in maternal mortality and morbidity: New challenges for Jamaica

作者：Affette McCaw‐Binns, Sophie Alexander, J.L.M. Lindo, Carlos Escoffery, Kelsey L. Spence, Karen Lewis‐Bell, Glyn Lewis · 发表于：International Journal of Gynecology & Obstetrics · 年份：2007 · DOI：10.1016/j.ijgo.2006.12.002 · 被引用次数：25 · 研究领域：Maternal and fetal healthcare、Global Maternal and Child Health、Maternal and Neonatal Healthcare

OBJECTIVE: Given interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998-2003. METHOD: Records of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes. RESULTS: Maternal mortality declined (p=0.023) since surveillance began in 1981-83. The fall in direct mortality (p=0.0003) included 24% fewer hypertension deaths (introduction of clinical guidelines, reorganization of antenatal services) and 36% fewer hemorrhage deaths (introduction of plasma expanders). These improvements were tempered by growing indirect mortality (p=0.057), moving to 31% of maternal deaths from 17% in 1993-95. INTERPRETATION: Declines in direct mortality may be associated with surveillance and related improvements in obstetric care. Increased indirect deaths from HIV/AIDS, cardiac disease, sickle cell disease and asthma suggests the need to improve collaboration with medical teams to implement guidelines to care for pregnant women with chronic diseases.