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Epidemiologic transition in maternal mortality and morbidity: New challenges for Jamaica
Author(s) -
McCawBinns A.,
Alexander S.F.,
Lindo J.L.M.,
Escoffery C.,
Spence K.,
LewisBell K.,
Lewis G.
Publication year - 2007
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2006.12.002
Subject(s) - medicine , pregnancy , incidence (geometry) , psychological intervention , maternal morbidity , disease , public health , pediatrics , mortality rate , surgery , genetics , physics , nursing , psychiatry , optics , biology
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.