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Surgically avertable burden of obstetric conditions in low‐ and middle‐income regions: a modelled analysis
Author(s) -
Higashi H,
Barendregt JJ,
Kassebaum NJ,
Weiser TG,
Bickler SW,
Vos T
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13198
Subject(s) - medicine , neonatal encephalopathy , burden of disease , disease burden , case fatality rate , epidemiology , environmental health , population , epidemiological transition , demography , encephalopathy , psychiatry , sociology
Objective To quantify the burden of maternal and neonatal conditions in low‐ and middle‐income countries ( LMIC s) that could be averted by full access to quality first‐level obstetric surgical procedures. Design Burden of disease and epidemiological modelling. Setting LMIC s from all global regions. Population The entire population in 2010. Methods We included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion 1 ; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability‐adjusted life years ( DALY s) of these conditions into surgically ‘avertable’ and ‘non‐avertable’ burdens. We applied the lowest age‐specific fatality rates from all global regions to each LMIC region to estimate the avertable deaths, assuming that the differences of death rates between each region and the lowest rates reflect the gap in surgical care. Main outcome measures Deaths and DALY s avertable. Results Of the estimated 56.6 million DALY s (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million DALY s (37%) are avertable by full coverage of quality obstetric surgery in LMIC s. The avertable burden in absolute term is substantial given the size of burden of these conditions in LMIC s. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million DALY s) among the five conditions, followed by abortion (2.1 million DALY s). Conclusions Improving access to quality surgical care at first‐level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMIC s.