While there is some information available on the levels of maternal mortality in developing countries, much less is known about the levels of maternal morbidity, including the incidence of the main obstetric complications and their reproductive consequences. There are a number of data sources available on morbidity, but typically, these are either survey data from women’s perceived health status which tend to over-estimate the burden of direct obstetric complications, or hospital data on a biased sample of hospital users. These methodological difficulties make the comparison and production of summary measures of morbidity difficult. Yet, it is important for policy making to obtain information on the health status of women which includes the burden of maternal morbidity as well as mortality. Limited epidemiological evidence suggests that the causal pattern of morbidity is different from the cause pattern of mortality and information on morbidity could change the way interventions are prioritized in safer motherhood.
The main objective of the maternal morbidity work is to estimate the burden of diseases associated with obstetric complications and their reproductive sequelae including their long-term consequences, by calculating measures of prevalence and disability-adjusted life-years or equivalent, whenever possible by world sub-regions. While other morbidities may be prioritized later, at present, the burden of disease for hemorrhage, obstructed labor/c-section, abortion, fistulae, and prolapse will be calculated.
The methods that we will employ are desk-based and involve the systematic review of literature, the analysis of available datasets and modelling. Information on prevalence, case fatality rate, proportion of severe cases (including near-miss), relative risks/odds ratios for particular antecedents (in particular parity), proportion with sequelae and average time spent with the complications or sequelae will be collected. Links between maternal deaths and child deaths and links between near-miss complications and long-term consequences will also be evaluated.
Fottrell E, Högberg U, Ronsmans C, Osrin D, Azad K, Nair N, Meda N, Ganaba R, Goufodji S, Byass P and Filippi V. A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings: preliminary development and evaluation. Emerging Themes in Epidemiology 2014, 11:3 doi:10.1186/1742-7622-11-3.
Adler AJ, Ronsmans C, Calvert C, Filippi V. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013 Dec 30;13:246. doi: 10.1186/1471-2393-13-246.
Calvert C, Ronsmans C. HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis. PLoS One. 2013 Oct 4;8(10):e74848. doi: 10.1371/journal.pone.0074848.
Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of placenta praevia by world region: a systematic review and meta-analysis.Trop Med Int Health. 2013 Jun;18(6):712-24. doi: 10.1111/tmi.12100. Epub 2013 Apr 1.
Adler AJ, Filippi V, Thomas SL, Ronsmans C. Incidence of severe acute maternal morbidity associated with abortion: a systematic review. Trop Med Int Health. 2012 Feb;17(2):177-90. doi: 10.1111/j.1365-3156.2011.02896.x. Epub 2011 Oct 31
Adler AJ, Filippi V, Thomas SL, Ronsmans C. Quantifying the global burden of morbidity due to unsafe abortion: magnitude in hospital-based studies and methodological issues. Int J Gynaecol Obstet. 2012 Sep;118 Suppl 2:S65-77. doi: 10.1016/S0020-7292(12)60003-4.
Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG. 2012 May;119(6):653-61. doi: 10.1111/j.1471-0528.2012.03294.x.
Identifying Regional Variation in the Prevalence of Postpartum Haemorrhage: A Systematic Review and Meta-Analysis. Calvert C, Thomas SL, Ronsmans C, Wagner KS, Adler AJ, et al. PLoS ONE. 2012; 7(7): e41114. doi:10.1371/journal.pone.0041114
Women who experience obstetric haemorrhage are at higher risk of anaemia, in both rich and poor countries.Wagner KS, Ronsmans C, Thomas SL, Calvert C, Adler A, Ganaba R, Goufodji S, Filippi V. Trop Med Int Health. 2011 Sep 29. doi: 10.1111/j.1365-3156.2011.02883.x.