Maternal deaths in Brazil from severe COVID-19 respiratory disease: time for a global commitment to ending health disparities.
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ABSTRACT:
SUBMITTER: Joseph NT
PROVIDER: S-EPMC7537235 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Publications
Maternal deaths in Brazil from severe COVID-19 respiratory disease: time for a global commitment to ending health disparities.
BJOG : an international journal of obstetrics and gynaecology 20201008 13
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Project description:The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.
| S-EPMC11471853 | biostudies-literature
Project description:BackgroundThe Malawian context presents multifactorial challenges that hinder the provision of high-quality maternal health services, leading to high maternal morbidity and mortality rates. Priority setting is a crucial concept that can benefit the healthcare system in Malawi by efficiently distributing limited resources and maximising gains in maternal healthcare. We undertook a national maternal health prioritisation exercise involving key stakeholders to enhance delivery of maternal care in Malawi.MethodsDuring group discussions, the Nominal Group Technique was adapted to facilitate consensus on priorities after data and real-life experiences from service users were presented. The process involved four stages: (1) Silent generation of priorities, where participants independently listed their priorities using pieces of paper, (2) Consolidation of priorities, where all individual priorities were combined into a single list on the flip chart and similar priorities merged, (3) Clarification and discussion at a group level using a prioritisation matrix, allowing participants to clarify and discuss the listed priorities, and (4) Ranking of generated priorities, where participants voted or used an online scoring system to determine the most important priorities. All papers and flip charts used were collected, and discussions were recorded to capture how decisions were made, and their rationales. Facilitators and authors met to manually analyse the summaries.ResultsSeventy-four stakeholders participated in the prioritisation workshop, forming eight groups. Through individual prioritisation exercises, 233 priorities were identified. Subsequently, the consolidation of priorities resulted in 104 priorities, which were further reduced to 40 priorities during clarification and discussion stage using the prioritisation matrix. After selecting the top two priorities from each group, 12 priorities remained, which underwent the final stage of ranking and voting, and 57 stakeholders voted. The top three priorities identified were: (1) respectful maternity care, (2) information and data management, and (3) strengthening skills of birth attendants.ConclusionAchieving national maternal health targets demands prioritising respectful maternity care, accessible information, robust data management/information, and skilled birth attendants, all of which empower staff and clients to drive positive changes. Stakeholders can leverage these priorities to guide future programme implementation, research investments, and country-specific adaptations through meaningful engagement with national stakeholders.
| S-EPMC11892317 | biostudies-literature
Project description:IntroductionPostpartum haemorrhage (PPH) remains the leading cause of maternal death. Yet there is a lack of clarity around what research is needed to determine what works and how best to deliver proven PPH interventions. This article describes a WHO-led effort to develop a global PPH research agenda for 2023-2030, to reinvigorate research and innovation while avoiding duplication and waste.MethodsPotential questions were culled from evidence gaps in a forthcoming Lancet PPH series, a pipeline analysis on PPH medicines and devices, international PPH guidelines, previous research prioritisation efforts and submissions from a reference group of PPH experts and stakeholders. Questions were deduplicated and consolidated, categorised into three tracks (innovation, implementation and cross-cutting) and subjected to an online prioritisation survey. Survey participants (n=120) assessed these questions using five criteria (answerability, effectiveness, deliverability, maximum potential for disease burden reduction and equity) following the Child Health and Nutrition Research Initiative methodology. The outcome of this exercise was complemented by an in-person consensus meeting (Global PPH Summit from 7 March 2023 to 10 March 2023 in Dubai, United Arab Emirates) to finalise the research agenda.ResultsFifteen research questions (five per track) were identified as top priority. The top question per track called for research on the comparative effectiveness and safety of alternative routes of administration (other than the intravenous route) of tranexamic acid in the treatment of PPH (innovation); identifying barriers and facilitators affecting the adoption and use of evidence-based recommendations for PPH management (implementation) and the effectiveness of a strategy of early detection and first response treatment using a bundle of recommended interventions for improving PPH-related outcomes (cross-cutting).ConclusionThis shared research agenda should guide future investments into PPH studies with high potential to transform policy and clinical practice in the near term to medium term. Funding for the new research priorities is urgently needed.
| S-EPMC11552529 | biostudies-literature
Project description:IntroductionNigeria which constitutes just one percent of the world population, accounts for 13% of the world maternal and under-five mortality. Utilization of health care services has been an important determinant of maternal and child outcomes. The vast majority of maternal and child deaths could be prevented if women utilize the available life lines. The study objective was to determine utilization of maternal and child health care services among women of child bearing age in Western Nigeria.MethodsA community based, cross sectional study was done in Oshodi/Isolo Local Government Area among women of child bearing age (15-49 years) with at least one child under five years. Multistage sampling was used to select 371 respondents. Data was collected with a structured, pretested, interviewer administered questionnaire and analyzed with Epi info 3.5.1. Summary and inferential statistics were done. Level of significance was set at 5%(p<0.05).ResultsOf the 371 respondents interviewed, the health facility was used for antenatal care (74.3% n = 276), delivery (59.9% n = 222), postnatal services (77.9% n = 289), family planning services (28.8% n = 107), immunization (95.1% n = 353), growth monitoring (77.4% n = 287), nutritional services (64.7% n = 240) and treatment of childhood illness (49.6% n = 184). Only 31.5% (n = 117) of the respondents practiced exclusive breastfeeding and 82% (n = 263) of the mothers used oral rehydration solution for diarrhoea management. Maternal education significantly influenced utilization. In addition maternal age, employment status, number of children, spouse employment and educational status played significant roles.ConclusionUtilization of maternal and child health services among respondents was above national average but not optimal, especially family planning services, exclusive breastfeeding and curative services for children. Interventions that improve maternal educational status and wealth creation should be undertaken to achieve the SDGs.
| S-EPMC5436634 | biostudies-literature
Project description:BackgroundRespiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized.MethodsThe RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital.ResultsWe studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8-3.3) was lower than in-hospital (2.4 months; IQR: 1.5-4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001).ConclusionsWe observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines.
| S-EPMC8411255 | biostudies-literature
Project description: Not available
| S-EPMC8611658 | biostudies-literature
Project description:BackgroundEvidence is accumulating that coronavirus disease 2019 increases the risk of hospitalization and mechanical ventilation in pregnant patients and for preterm delivery. However, the impact on maternal mortality and whether morbidity is differentially affected by disease severity at delivery and trimester of infection are unknown.ObjectiveThis study aimed to describe disease severity and outcomes of severe acute respiratory syndrome coronavirus 2 infections in pregnancy across the Washington State, including pregnancy complications and outcomes, hospitalization, and case fatality.Study designPregnant patients with a polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection between March 1, 2020, and June 30, 2020, were identified in a multicenter retrospective cohort study from 35 sites in Washington State. Sites captured 61% of annual state deliveries. Case-fatality rates in pregnancy were compared with coronavirus disease 2019 fatality rates in similarly aged adults in Washington State using rate ratios and rate differences. Maternal and neonatal outcomes were compared by trimester of infection and disease severity at the time of delivery.ResultsThe principal study findings were as follows: (1) among 240 pregnant patients in Washington State with severe acute respiratory syndrome coronavirus 2 infections, 1 in 11 developed severe or critical disease, 1 in 10 were hospitalized for coronavirus disease 2019, and 1 in 80 died; (2) the coronavirus disease 2019-associated hospitalization rate was 3.5-fold higher than in similarly aged adults in Washington State (10.0% vs 2.8%; rate ratio, 3.5; 95% confidence interval, 2.3-5.3); (3) pregnant patients hospitalized for a respiratory concern were more likely to have a comorbidity or underlying conditions including asthma, hypertension, type 2 diabetes mellitus, autoimmune disease, and class III obesity; (4) 3 maternal deaths (1.3%) were attributed to coronavirus disease 2019 for a maternal mortality rate of 1250 of 100,000 pregnancies (95% confidence interval, 257-3653); (5) the coronavirus disease 2019 case fatality in pregnancy was a significant 13.6-fold (95% confidence interval, 2.7-43.6) higher in pregnant patients than in similarly aged individuals in Washington State with an absolute difference in mortality rate of 1.2% (95% confidence interval, -0.3 to 2.6); and (6) preterm birth was significantly higher among women with severe or critical coronavirus disease 2019 at delivery than for women who had recovered from coronavirus disease 2019 (45.4% severe or critical coronavirus disease 2019 vs 5.2% mild coronavirus disease 2019; P<.001).ConclusionCoronavirus disease 2019 hospitalization and case-fatality rates in pregnant patients were significantly higher than in similarly aged adults in Washington State. These data indicate that pregnant patients are at risk of severe or critical disease and mortality compared to nonpregnant adults, and also at risk for preterm birth.
| S-EPMC7838012 | biostudies-literature
Project description:This study determined the association between respiratory symptoms and death from respiratory causes over a period of 45 years. In four cohorts of random samples of Norwegian populations with 103,881 participants, 43,731 persons had died per 31 December 2016. In total, 5,949 (14%) had died from respiratory diseases; 2,442 (41%) from lung cancer, 1,717 (29%) chronic obstructive pulmonary disease (COPD), 1,348 (23%) pneumonia, 119 (2%) asthma, 147 (2%) interstitial lung disease and 176 (3%) other pulmonary diseases. Compared with persons without respiratory symptoms the multivariable adjusted hazard ratio (HR) for lung cancer deaths increased with score of breathlessness on effort and cough and phlegm, being 2.6 (95% CI 2.1-3.2) for breathlessness score 3 and 2.1 (95% CI 1.7-2.5) for cough and phlegm score 5. The HR of COPD death was 6.4 (95% CI 5.4-7.7) for breathlessness score 3 and 3.0 (2.4-3.6) for cough and phlegm score 5. Attacks of breathlessness and wheeze score 2 had a HR of 1.6 (1.4-1.9) for COPD death. The risk of pneumonia deaths increased also with higher breathlessness on effort score, but not with higher cough and phlegm score, except for score 2 with HR 1.5 (1.2-1.8). In this study with >2.4 million person-years at risk, a positive association was observed between scores of respiratory symptoms and deaths due to COPD and lung cancer. Respiratory symptoms are thus important risk factors, which should be followed thoroughly by health care practitioners for the benefit of public health.
| S-EPMC8608323 | biostudies-literature
Project description:IntroductionDengue fever is expanding worldwide on the track of climate change. In 2024, more than 14 million cases were reported. Around 6.5 million of those were reported in Brazil alone, reaching a staggering number of around 6000 deaths. Dengue lethality in severe cases were particularly high in Rio Grande do Sul, a historically less affected state which has witnessed an increased incidence and outbreaks in the last 4 years.DesignIn this report, we raised some hypotheses to explain the high lethality.ResultsRio Grande do Sul has the highest proportion of elderly individuals among all states in Brazil. This factor, associated with the immunologically naive population, low levels of awareness to detect and treat severe dengue, and the difficulties in managing elderly patients, may have contributed to this higher lethality in severe dengue.ConclusionsThe expected increasing dengue incidence in the region in the subsequent years highlights the urgent need of an integrated approach to raise awareness, reduce mosquito populations, and reduce dengue burden in the region, particularly, in the most vulnerable elderly population.
| S-EPMC11869006 | biostudies-literature
Project description:Objective To compare death rates by COVID-19 between pregnant or postpartum and nonpregnant women during the first and second waves of the Brazilian pandemic.Methods In the present population-based evaluation data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe, in the Portuguese acronym), we included women with c (ARDS) by COVID-19: 47,768 in 2020 (4,853 obstetric versus 42,915 nonobstetric) and 66,689 in 2021 (5,208 obstetric versus 61,481 nonobstetric) and estimated the frequency of in-hospital death.Results We identified 377 maternal deaths in 2020 (first wave) and 804 in 2021 (second wave). The death rate increased 2.0-fold for the obstetric (7.7 to 15.4%) and 1.6-fold for the nonobstetric groups (13.9 to 22.9%) from 2020 to 2021 (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.47-0.58 in 2020 and OR: 0.61; 95%CI: 0.56-0.66 in 2021; p < 0.05). In women with comorbidities, the death rate increased 1.7-fold (13.3 to 23.3%) and 1.4-fold (22.8 to 31.4%) in the obstetric and nonobstetric groups, respectively (OR: 0.52; 95%CI: 0.44-0.61 in 2020 to OR: 0.66; 95%CI: 0.59-0.73 in 2021; p < 0.05). In women without comorbidities, the mortality rate was higher for nonobstetric (2.4 times; 6.6 to 15.7%) than for obstetric women (1.8 times; 5.5 to 10.1%; OR: 0.81; 95%CI: 0.69-0.95 in 2020 and OR: 0.60; 95%CI: 0.58-0.68 in 2021; p < 0.05).Conclusion There was an increase in maternal deaths from COVID-19 in 2021 compared with 2020, especially in patients with comorbidities. Death rates were even higher in nonpregnant women, with or without comorbidities.
| S-EPMC9948055 | biostudies-literature