Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T18:30:51.385Z Has data issue: false hasContentIssue false
  • English
  • Français

THE IMPORTANCE OF PUBLIC SECTOR HEALTH FACILITY-LEVEL DATA FOR MONITORING CHANGES IN MATERNAL MORTALITY RISKS AMONG COMMUNITIES: THE CASE OF PAKISTAN

Published online by Cambridge University Press:  26 March 2013

ANRUDH K. JAIN ,
ZEBA SATHAR ,
MOMINA SALIM  and
ZAKIR HUSSAIN SHAH
ANRUDH K. JAIN*
Affiliation:
Population Council, New York, USA
ZEBA SATHAR
Affiliation:
Population Council, Islamabad, Pakistan
MOMINA SALIM
Affiliation:
Center for Global Public Health, University of Manitoba, Canada
ZAKIR HUSSAIN SHAH
Affiliation:
Population Council, Islamabad, Pakistan
*
1Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

Type
Articles
Information
Journal of Biosocial Science , Volume 45 , Issue 5 , September 2013 , pp. 601 - 613
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ali, M., Hotta, M., Kuroiwa, C. & Ushijima, H. (2005) Emergency obstetric care in Pakistan: potential for reduced maternal mortality through basic EmOC facilities, services and access. International Journal of Gynaecology and Obstetrics 91, 105–112.CrossRefGoogle ScholarPubMed
Ali, M. & Kuroiwa, C. (2007) Accurate record keeping in referral hospitals in Pakistan's North West Frontier Province and Punjab: a crucial step needed to improve maternal health. Journal of the Pakistan Medical Association 57, 443–446.Google ScholarPubMed
Aziz, S. & Rao, M. H. (2002) Existing record keeping system in government teaching hospitals of Karachi. Journal of the Pakistan Medical Association 52, 163–174.Google ScholarPubMed
Bang, R. A., Bang, A. T., Reddy, M. H., Deshmukh, M. D., Baitule, S. B. & Filippi, V. (2004) Maternal morbidity during labour and the puerperium in rural homes and the need for medical attention: a prospective observational study in Gadchiroli, India. BJOG 111, 231–238.CrossRefGoogle ScholarPubMed
Farooq, N., Jadoon, H., Masood, T. I., Wazir, M. S., Farooq, U. & Lodhi, M. S. (2006) An assessment study of maternal mortality ratio databank in five districts of North Western Frontier Province Pakistan. Journal of the Ayub Medical College Abbottabad 18(2), 64–68.Google ScholarPubMed
Fauveau, V. & Donnay, F. (2006) Can the process indicators for emergency obstetric care assess the progress of maternal mortality reduction programs? An examination of UNFPA Projects 2000–2004. International Journal of Gynaecology and Obstetrics 93, 308–316.CrossRefGoogle ScholarPubMed
Fraser, H., Biondich, P., Moodley, D., Choi, S., Mamlin, B. & Szolovits, P. (2005) Implementing electronic medical record systems in developing countries. Informatics in Primary Care 13, 83–95.Google ScholarPubMed
Islam, A., Malik, F. A. & Basaria, S. (2002) Strengthening primary health care and family planning services in Pakistan: some critical issues. Journal of the Pakistan Medical Association 52, 2.Google ScholarPubMed
Islam, M. & Yoshida, S. (2009) Women are still deprived of access to lifesaving essential and emergency obstetric care. International Journal of Gynaecology and Obstetrics 106, 120–124.CrossRefGoogle ScholarPubMed
Jafarey, S., Kamal, I., Qureshi, A. F. & Fikree, F. (2008) Safe motherhood in Pakistan. International Journal of Gynaecology and Obstetrics 102, 179–185.CrossRefGoogle ScholarPubMed
Jafarey, S. N. & Korejo, R. (1993) Mothers brought dead: an enquiry into causes of delay. Social Science & Medicine 36(3), 371–372.CrossRefGoogle ScholarPubMed
Jain, A. K. (2010) Janani Suraksha Yojna and the maternal mortality ratio. Economic and Political Weekly XLV(11), 15–16.Google Scholar
Lobis, S., Fry, D. & Paxton, A. (2005) Program note: applying the UN process indicators fro emergency obstetric care to the United States. International Journal of Gynaecology and Obstetrics 88, 203–207.CrossRefGoogle Scholar
Mahmood, A. (2010) Improving Maternal and Neonatal Health: Measuring the impact of PAIMAN Project in ten Districts in Pakistan. Population Council, Islamabad, and Macro International Inc., MEASURE DHS. STATcompiler. URL: http://www.measuredhs.com (accessed 21st August 2012).CrossRefGoogle Scholar
NIPS (National Institute of Population Studies) & Macro International, Inc. (2008) Pakistan Demographic and Health Survey (PDHS) 2006–07. National Institute of Population Studies & Macro International Inc., Islamabad, Pakistan and Calverton, MD.Google Scholar
Ronsmans, C., Chowdhury, M. E., Kobilinsky, M. & Ahmed, A. (2010) Care seeking at time of childbirth, and maternal and perinatal mortality in Matlab, Bangladesh. Bulletin of the World Health Organization 88, 289–296.CrossRefGoogle ScholarPubMed
Thaddeus, S. & Maine, D. (1994) Too far to walk: maternal mortality in context. Social Science & Medicine 38(8), 1091–1110.CrossRefGoogle ScholarPubMed
World Health Organization (2009) Monitoring Emergency Obstetric Care: A Handbook. World Health Organization, Geneva.Google Scholar
World Health Organization (2010) Trends in Maternal Mortality: 1990 to 2008. Maternal Mortality Estimation Inter-Agency Group (MMEIG), WHO, Geneva.Google Scholar