R isk factors for maternal mortality in Delhi slums: A community-based case-control study.

1. Risk factors for maternal mortality in Delhi slums: A community-based case-control study. Aggarwal A, Pandey A, Bhattacharya BN. Risk factors for maternal mortality in Delhi slums: A community-based case-control study. Indian J Med Sci 2007;61:517-26

2. Learning objectives • To learn about maternal mortality indicators.

3. Introduction: • In order to develop, implement and evaluate policy for reducing maternal mortality, it is essential to study risk factors. • Pregnancy complications and childbirth-related complications are the major causes. • MMR in India is far from the desired level of 100 by 2012 set by the National Rural Health Mission (NRHM) and 109 by 2015 as per millennium development goals (MDG).

4. Objective of study: • To determine the epidemiological risk factors and its related causes associated with maternal deaths in Delhi slums.

5. Methodology Community-based case-control study 929 slums 328 slums (1.25 million) 21 health centers (50000) 6 maternity homes (2 million) 105 health post (10000) Source of information

6. Definitions of Cases and Controls: • Case : A woman who was pregnant and whose pregnancy's outcome was a live birth but the woman died within 42 days of delivery. • Control: A woman who was pregnant and whose pregnancy's outcome was a live birth and the woman was surviving at the time of survey. Method of identifying Cases and Controls: • Cases: Snowball-sampling method was used to identify the maternal deaths (cases) in the community and hospital recods. • Controls: Circular systematic random sampling procedure was used to select the controls from the same area where a maternal death was found. • Exclusion criteria: pregnancy outcome SB/abortion.

7. Snow ball sampling ANM/ basti sevika Ask about similar event occurred to respondent. Identify household of maternal death

8. Circular systematic random sampling for selection of controls: 1 case= 3 controls Then every kthhousehold of live birth was selected as control.

9. Study population:

10. Data collection: by pre-tested questionnairs

11. RESULTS

12. TABLE 1: CAUSES OF MATERNAL DEATHS (N=72)

13. TABLE 2 • No significant difference was found in household characteristics.

14. TABLE 3:SE & REPRODUCTIVE CHARACTERSTICS

15. TABLE 4:UTILIZATION OF HEALTH FACILITIES

16. TABLE 5: C/X DURING PREG & DELIVERY

17. Univariate logistic regression analysis:

18. MULTIPLE LOGISTIC REGRESSION ANALYSIS

19. Results from other studies :

20. Discussion: • Use of a cost-effective snowball-sampling technique. • The major direct causes - PPH, F.B. retained placenta and sepsis. • As per the report of the sample registration system (SRS) –hemorrhage 38%, which is much higher than this study’s estimate. • Hypertensive disorders are one of the causes of maternal deaths,our study did not find any such case. • Maternal deaths d/t retained placenta was found to be marginally higher than those reported elsewhere. Anemia -major cause of maternal death in the present study

21. Cont….. • Entire study population was from urban slums, socioeconomic characteristics do not show statistically significant differences between cases and controls. • Investing in training of untrained dies should be consideredby policy makers and donor agencies. • A high proportion of maternal deaths occurred in hospital set up - deliveries were conducted at home by untrained dais and were rushed to a hospital at the last minute.

22. Conclusion: • Mass education about the importance of antenatal registration and regular ANC checkups. • Focus on training of dais. • Encouragement for institutional deliveries to reduce maternal mortality at the community level.

23. Thanks…….