Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry

An active, community-based, pregnancy surveillance mechanism

Omrana Pasha, Sarah Saleem, Sumera Ali, Shivaprasad S. Goudar, Ana Garces, Fabian Esamai, Archana Patel, Elwyn Chomba, Fernando Althabe, Janet L. Moore, Margo Harrison, Mabel B. Berrueta, K. Michael Hambidge, Nancy F. Krebs, Patricia L. Hibberd, Waldemar A. Carlo, Bhala Kodkany, Richard J. Derman, Edward A. Liechty, Marion Koso-Thomas & 2 others Elizabeth M. McClure, Robert L. Goldenberg

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network's Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries. Methods: Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan. Results: The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies. Conclusions: The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.

Original languageEnglish (US)
Article numberS15
JournalReproductive Health
Volume12
Issue number2
DOIs
StatePublished - Jun 8 2015

Fingerprint

Pakistan
Registries
Mothers
Newborn Infant
Pregnancy
Maternal Mortality
Prenatal Care
Stillbirth
Parturition
Mortality
India
Postnatal Care
Guatemala
Fetal Mortality
Zambia
Infant Health
Maternal Health
Birth Rate
Perinatal Mortality
Kenya

Keywords

  • maternal mortality
  • neonatal mortality
  • Pakistan
  • stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry : An active, community-based, pregnancy surveillance mechanism. / Pasha, Omrana; Saleem, Sarah; Ali, Sumera; Goudar, Shivaprasad S.; Garces, Ana; Esamai, Fabian; Patel, Archana; Chomba, Elwyn; Althabe, Fernando; Moore, Janet L.; Harrison, Margo; Berrueta, Mabel B.; Hambidge, K. Michael; Krebs, Nancy F.; Hibberd, Patricia L.; Carlo, Waldemar A.; Kodkany, Bhala; Derman, Richard J.; Liechty, Edward A.; Koso-Thomas, Marion; McClure, Elizabeth M.; Goldenberg, Robert L.

In: Reproductive Health, Vol. 12, No. 2, S15, 08.06.2015.

Research output: Contribution to journalArticle

Pasha, O, Saleem, S, Ali, S, Goudar, SS, Garces, A, Esamai, F, Patel, A, Chomba, E, Althabe, F, Moore, JL, Harrison, M, Berrueta, MB, Hambidge, KM, Krebs, NF, Hibberd, PL, Carlo, WA, Kodkany, B, Derman, RJ, Liechty, EA, Koso-Thomas, M, McClure, EM & Goldenberg, RL 2015, 'Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry: An active, community-based, pregnancy surveillance mechanism', Reproductive Health, vol. 12, no. 2, S15. https://doi.org/10.1186/1742-4755-12-S2-S15
Pasha, Omrana ; Saleem, Sarah ; Ali, Sumera ; Goudar, Shivaprasad S. ; Garces, Ana ; Esamai, Fabian ; Patel, Archana ; Chomba, Elwyn ; Althabe, Fernando ; Moore, Janet L. ; Harrison, Margo ; Berrueta, Mabel B. ; Hambidge, K. Michael ; Krebs, Nancy F. ; Hibberd, Patricia L. ; Carlo, Waldemar A. ; Kodkany, Bhala ; Derman, Richard J. ; Liechty, Edward A. ; Koso-Thomas, Marion ; McClure, Elizabeth M. ; Goldenberg, Robert L. / Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry : An active, community-based, pregnancy surveillance mechanism. In: Reproductive Health. 2015 ; Vol. 12, No. 2.
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abstract = "Background: Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network's Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries. Methods: Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan. Results: The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies. Conclusions: The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.",
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T1 - Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network's Maternal Newborn Health Registry

T2 - An active, community-based, pregnancy surveillance mechanism

AU - Pasha, Omrana

AU - Saleem, Sarah

AU - Ali, Sumera

AU - Goudar, Shivaprasad S.

AU - Garces, Ana

AU - Esamai, Fabian

AU - Patel, Archana

AU - Chomba, Elwyn

AU - Althabe, Fernando

AU - Moore, Janet L.

AU - Harrison, Margo

AU - Berrueta, Mabel B.

AU - Hambidge, K. Michael

AU - Krebs, Nancy F.

AU - Hibberd, Patricia L.

AU - Carlo, Waldemar A.

AU - Kodkany, Bhala

AU - Derman, Richard J.

AU - Liechty, Edward A.

AU - Koso-Thomas, Marion

AU - McClure, Elizabeth M.

AU - Goldenberg, Robert L.

PY - 2015/6/8

Y1 - 2015/6/8

N2 - Background: Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network's Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries. Methods: Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan. Results: The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies. Conclusions: The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.

AB - Background: Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn mortality rates in Pakistan remain stagnant. Using data from the Global Network's Maternal Newborn Health Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn mortality and levels of putative risk factors between the Pakistani site and those in other countries. Methods: Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya, Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan. Results: The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs 116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites. The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to 353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However, facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani site and the other sites was most pronounced amongst normal birth weight babies. Conclusions: The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013 indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.

KW - maternal mortality

KW - neonatal mortality

KW - Pakistan

KW - stillbirth

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