Maternal mortality and access to obstetric services in West Africa
| Autor: | L. Høj, Alexandre Dumont, Carine Ronsmans, Belco Kodio, L. de Bernis, G. Walraven, Jean-François Etard |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Pediatrics
medicine.medical_specialty medicine.medical_treatment Population Developing country Health Services Accessibility NAISSANCE Health facility Pregnancy GROSSESSE EVALUATION Urban Health Services ETUDE COMPARATIVE medicine Humans Maternal Health Services Caesarean section education Developing Countries MILIEU URBAIN Home Childbirth education.field_of_study business.industry Delivery Rooms Pregnancy Outcome Public Health Environmental and Occupational Health Ecological study Obstetric transition medicine.disease ACCES AUX SOINS Africa Western MORTALITE ACCOUCHEMENT Maternal Mortality Outcome and Process Assessment Health Care Infectious Diseases Evaluation Studies as Topic FEMME Female Parasitology Rural Health Services Rural area business MILIEU RURAL Demography |
| Zdroj: | Tropical Medicine and International Health. 8:940-948 |
| ISSN: | 1365-3156 1360-2276 |
| DOI: | 10.1046/j.1365-3156.2003.01111.x |
| Popis: | OBJECTIVES: Process evaluation has become the mainstay of safe motherhood evaluation in developing countries, yet the extent to which indicators measuring access to obstetric services at the population level reflect levels of maternal mortality is uncertain. In this study we examine the association between population indicators of access to obstetric care and levels of maternal mortality in urban and rural West Africa. METHODS: In this ecological study we used data on maternal mortality and access to obstetric services from two population-based studies conducted in 16 sites in eight West African countries: the Maternal Mortality and Obstetric Care in West Africa (MAMOCWA) study in rural Senegal, Guinea-Bissau and The Gambia and the Morbidite Maternelle en Afrique de l'Ouest (MOMA) study in urban Burkina Faso, Cote d'Ivoire, Mali, Mauritanie, Niger and Senegal. RESULTS: In rural areas, maternal mortality, excluding early pregnancy deaths, was 601 per 100,000 live births, compared with 241 per 100,000 for urban areas [RR = 2.49 (CI 1.77-3.59)]. In urban areas, the vast majority of births took place in a health facility (83%) or with a skilled provider (69%), while 80% of the rural women gave birth at home without any skilled care. There was a relatively close link between levels of maternal mortality and the percentage of births with a skilled attendant (r = -0.65), in hospital (r = -0.54) or with a Caesarean section (r = -0.59), with marked clustering in urban and rural areas. Within urban or rural areas, none of the process indicators were associated with maternal mortality. CONCLUSION: Despite the limitations of this ecological study, there can be little doubt that the huge rural-urban differences in maternal mortality are due, at least in part, to differential access to high quality maternity care. Whether any of the indicators examined here will by themselves be good enough as a proxy for maternal mortality is doubtful however, as more than half of the variation in mortality remained unexplained by any one of them. |
| Databáze: | OpenAIRE |
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