Prioritizing Research on Maternal Mortality in Low-Resource Settings for Improved Health Outcomes

Maternal mortality continues to be a critical global health concern, especially in low-resource settings where access to healthcare resources is severely limited. These regions bear a disproportionate burden of high maternal mortality rates, perpetuating a cycle of poor maternal health. Despite the significance of the issue, there is a glaring lack of research specifically focused on maternal mortality in these contexts. In this piece, our analyst highlights the urgent need for more studies in low-resource settings to gain a comprehensive understanding of the unique challenges and contributing factors. By addressing this research gap, we believe that targeted interventions can be developed to reduce maternal mortality rates and improve maternal health outcomes.

Low-resource settings face numerous barriers that contribute to higher maternal mortality rates. Inadequate healthcare infrastructure, limited access to skilled healthcare providers, financial constraints, cultural beliefs and practices, and geographical barriers all play a significant role. To effectively address these challenges, it is crucial to conduct research that delves deeper into these factors and their complex interactions. Such research will enable the development of context-specific strategies tailored to the needs of women in these regions. By gaining insights into the challenges faced by women, targeted interventions can be designed to address them effectively.

The World Health Organization (WHO) reports that approximately 94% of maternal deaths occur in low-resource settings [Deneke et al (2014), Berhan et al (2014), Filippi et al (2016)]. Maternal mortality rates in these regions are significantly higher compared to resource-rich settings. For instance, Sub-Saharan Africa experiences maternal mortality rates as high as 542 per 100,000 live births, compared to the global average of 211 per 100,000 live births [Illah et al (2013)]. These statistics highlight the alarming reality of maternal mortality in low-resource settings and emphasize the urgent need for action.

Research conducted in low-resource settings has identified several key factors contributing to maternal mortality. Direct causes such as hemorrhage, sepsis, and hypertension remain prevalent [Soomro et al (2013), Der et al (2013), Ameh et al (2014)]. However, there is a diversification of causes, including complications from unsafe abortions, eclampsia, and embolism [Devi et al (2012), Halim et al (2014), Main et al (2015)]. Unsafe abortions, in particular, contribute significantly to maternal deaths in these settings [Dadipoor et al (2017)]. Understanding these factors and their impact is crucial for developing effective interventions that target the root causes of maternal mortality.

The limited research on maternal mortality in low-resource settings hinders the development of effective interventions. To address this gap, it is imperative to prioritize research efforts in these settings. The synthesized papers in our just concluded systematic literature review provide a foundation for further investigation and emphasize the importance of expanding research endeavors [Ray et al (2013), Ahmadi et al (2014), Mitchell et al (2014)]. By conducting more studies, researchers can gain comprehensive insights into the challenges faced by women in low-resource settings and identify strategies to prevent maternal deaths.

One crucial outcome of conducting research in low-resource settings is the development of targeted interventions. The synthesized papers underscore the importance of implementing comprehensive maternal health programs, improving access to quality healthcare services, strengthening healthcare infrastructure, and empowering communities [Oye-Adeniran et al (2014), Neal et al (2016), Bwana et al (2019)]. Community-based interventions, in particular, have shown effectiveness in reducing maternal mortality rates in resource-limited settings [Tessema et al (2017)]. By tailoring interventions to address the specific challenges faced by women in low-resource settings, we can make significant strides in reducing maternal mortality rates.

In conclusion, the limited research on maternal mortality in low-resource settings poses a significant challenge to improving maternal health outcomes worldwide. It is essential to conduct more studies in these contexts to gain a comprehensive understanding of the challenges and contributing factors. By bridging this knowledge gap, researchers and policymakers can develop targeted interventions that address the specific needs of women in low-resource settings. Collaborative efforts among researchers, policymakers, healthcare providers, and communities are crucial in addressing this issue. Additionally, reliance on the findings of the synthesized papers in our systematic literature review reinforces the importance of evidence-based approaches in shaping interventions. Funding agencies should prioritize supporting research initiatives in low-resource settings, recognizing the critical role of reliable data in saving the lives of mothers. By working together and addressing the urgent need for research, we can pave the way for effective interventions that reduce maternal mortality rates and improve maternal health outcomes in low-resource settings.

Understanding Maternal Mortality in Low-Resource Settings: A research gap that need to be addressed.

Maternal mortality continues to be a significant global health challenge, with countless lives lost each year. While progress has been made in reducing maternal mortality rates, certain regions, particularly those with limited healthcare resources, continue to face alarming rates of maternal deaths. This article aims to shed light on the Recently, our analyst through a systematic literature review discovered some gaps in the study of maternal mortality one of which concerning maternal mortality in low-resource settings and emphasizes the urgent need for more studies in these regions. By understanding the unique challenges and factors contributing to maternal mortality in such contexts, we can develop targeted interventions and strategies to save the lives of mothers and improve maternal health outcomes.

The Importance of Low-Resource Settings

Low-resource settings, characterized by inadequate healthcare infrastructure, lack of skilled personnel, limited access to quality maternal healthcare services, and socioeconomic challenges, pose significant barriers to safe motherhood. Women in these settings face multiple challenges that increase the risk of maternal mortality. Limited availability of healthcare facilities and qualified healthcare providers, as well as financial and transportation constraints, often prevent women from receiving essential prenatal and postnatal care. The absence of skilled birth attendants and emergency obstetric care exacerbates the risks faced by pregnant women. Understanding the specific factors influencing maternal mortality in such contexts is critical for formulating effective interventions that address the root causes and mitigate the risks.

The Research Gap

Despite the global efforts to reduce maternal mortality, our analyst observed that the research landscape on this topic remains skewed towards high-income countries or regions with better healthcare infrastructure. Consequently, the existing evidence base may not adequately capture the unique challenges and contributing factors associated with maternal mortality in low-resource settings. This research gap hinders our ability to develop contextually appropriate interventions and policies that can effectively address the problem. By narrowing this research gap, we can develop a more comprehensive understanding of the specific causes and risk factors for maternal mortality in low-resource settings.

Factors Contributing to Maternal Mortality in Low-Resource Settings

Several factors contribute to the high maternal mortality rates observed in low-resource settings. Limited access to antenatal care due to distance, financial constraints, or cultural barriers prevents women from receiving timely and appropriate care during pregnancy. Inadequate emergency obstetric care facilities and the lack of skilled birth attendants lead to delays in receiving critical medical interventions during childbirth. Poor transportation infrastructure and referral systems further hinder access to emergency obstetric care, increasing the risk of maternal deaths. Cultural and social barriers, such as gender inequalities and discriminatory practices, also play a significant role in limiting women's access to quality healthcare services. Additionally, poverty exacerbates these challenges, as women in low-resource settings often struggle to afford essential healthcare and face socioeconomic barriers to accessing care.

The Need for Targeted Interventions

To reduce maternal mortality rates in low-resource settings, it is crucial to develop targeted interventions that address the specific challenges faced by women in these contexts. Robust research focused on these settings can provide a deeper understanding of the contributing factors, help identify modifiable risk factors, and inform the development and implementation of effective interventions. By conducting studies that are specific to low-resource settings, researchers can assess the impact of interventions tailored to the local context, ultimately leading to improved maternal health outcomes.

One potential intervention is to strengthen the provision of antenatal care by implementing community-based antenatal care programs that bring essential services closer to women in remote areas. This approach can include trained community health workers who provide antenatal education, screenings, and referrals for high-risk pregnancies. Additionally, improving access to emergency obstetric care by establishing well-equipped birthing centers and ensuring the presence of skilled birth attendants can significantly reduce maternal mortality rates. Investing in infrastructure and transportation systems, such as ambulances or transportation vouchers, can help overcome geographical barriers and improve access to emergency care.

Building Research Capacity

In addition to conducting more studies, building research capacity within low-resource settings is essential. Collaborations between local researchers, international institutions, and funding agencies can help strengthen research infrastructure, develop research skills, and encourage knowledge exchange. By supporting local researchers and institutions, we can promote sustainable research efforts that address the unique challenges of maternal mortality in these settings. This can be achieved through training programs, research grants, and mentorship initiatives that empower local researchers to lead and contribute to studies focused on maternal mortality.

Policy Implications

The findings from studies conducted in low-resource settings are critical for informing evidence-based policies and guidelines. Governments and policymakers need to be aware of the specific challenges faced by women in their regions and allocate resources accordingly. By integrating research findings into policy discussions and decision-making processes, policymakers can design interventions that address the root causes of maternal mortality and work towards achieving sustainable development goals. It is crucial to prioritize maternal health within national health agendas and ensure that policies are formulated to address the unique needs of women in low-resource settings.

Addressing this research gap on maternal mortality in low-resource settings is crucial for improving maternal health outcomes and reducing unnecessary deaths. By conducting more studies in these contexts, we can gain a better understanding of the unique challenges faced by women and develop contextually appropriate interventions. The collaboration between researchers, policymakers, and funding agencies is pivotal in building research capacity and translating research findings into effective policies and programs. It is only through collective efforts that we can bridge this research gap, save the lives of mothers, and ensure a healthier future for all women worldwide. By investing in research and implementing targeted interventions, we can make significant strides towards reducing maternal mortality rates and achieving global maternal health goals.

QUALITY OF MATERNAL HEALTHCARE DELIVERY: Bar needs to be raised while utilisation is being achieved.

By: Salaudeen A I

From America to UK, China to India, Iran to Africa and back to Nigeria; factors like socioeconomic, socio-cultural, women education, inequality in healthcare accessibility, rural-urban dichotomy, level of household wealth and religion have been established as factors highly contributing to low utilization of maternal healthcare therefore contributing to high MMR most especially in Africa and some Asian countries. As expected, scholars have proferred efficiently effective solutions through their studies to mitigate effects of these factors on Maternal Mortality. The solutions ranging from abolishment of delivery fees as done in Kenya in 2013, effect of which was evaluated by a group of researchers - Gitobu et al (2018). The researchers reported a statistically significant increase in the number of facility-based deliveries with no significant change in the ratio of maternal mortality and the rate of neonatal mortality.

They concluded the result of their findings by suggesting that cost is a deterrent to healthcare facilities service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths. Another intervention was the sensitisation of women and Media strategy in Egypt, the impact of the interventions as reported by Metwally, Ammal M., et al. (2020) was highly reflected on the percent of mothers who received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%.

The work also concluded that it is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures.... China, after understanding the effect of marginalisation of rural areas on the access to maternal healthcare facilities, propagated a policy focusing facilities allocation in favour of rural communities, a policy which was as expected effective was reported to have significantly reduced rural maternal mortality, yet the work concluded that the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care. Establishment of health schemes like NRHM and NHIS in India and Nigeria respectively were other intervention policies believed to increase the utilisation of maternal healthcare and healthcare in general. In a work done on implications of maternal mortality on socioeconomic development in Nigeria, Olonade, O., et al. (2019) also concluded that maternal mortality has debilitating effects on the socioeconomic development of any nation. It is therefore pertinent for the government to improve maternal health and eradicate poverty.... Also in a work done in Iraq, the researcher attributed poor healthcare services to high rate of maternal mortality, in their report Sadoon, Ahmed Thani, and Basim Hussein Bahir, (2020) said the evaluation revealed that the level of the overall practice of antenatal care services in PHCs was fair 78.6%. Poor postpartum care was provided in 92.9% of health care centers. Poor health care services for children were provided in 67.9% of health care centers. Fair level, for immunization activities in 67.9% of health care centers and poor level concerning the practice of health education services in 85.7% of health care centers. They therefore concluded that there is a shortage in the health care services provided for maternal and child at the MCH unit in the health care centers with high maternal and infant mortality rate....

It is clear in the above cited papers that all the interventions are practicable and effective as exponential increase in utilisation of maternal healtcare were empirically confirmed in the evaluation studies. Despite the increase in the healthcare utilisation reported in the studies, there were no significant reduction in maternal mortality rate, this quests make the papers concluded suggesting that quality healthcare services has to be ensured. It is therefore pertinent to systematically evaluate the maternal healthcare delivering system to understand the situation, hence profer lasting solution to improve the service delivery quality of the last block in the chain of reducing maternal mortality to the lowest rate.

TOWARD REDUCING MATERNAL MORTALITY IN NIGERIA: The Role Researchers And Media Have To Play.

Source: World Health Organization

By: Salaudeen A I

Maternal mortality which is referred to as all death as a result of complications during pregnancy, childbirth and few months after delivery remain one of the global health challenge after the failure of the world league to meet the millennium development goal of reducing global Maternal Mortality Rate (MMR) by 75% before the end of 2015. The rate reduced globally by 44% at the end of MDG in 2015 yet no significant reduction country wise. The story has not changed despite the adoption of the goal in the SDG-3a and 3b. MMR in a robust healthcare system of the developed states such as U.S.A (which is ranked the highest among the developed nations) in 2018 was around 17.4 per 100 000 live birth, the rate is 45 plus times higher in developing and low-income nations like Nigeria - 814 per 100 000 estimated in 2020.

Source: World Health Organization

In a situation like this, academia and researchers are bound to engage themselves in rigorous and solution oriented work aimed at understanding the factors playing around this indicator and the best effective solution to curb it. Unlike the developed nations, less than 500 research articles where published till date post MGD, highest of which published in 2020 (78) and only one in this year 2022. Significant of the works believe that there are socioeconomic, education and political factors in addition to health/clinical and professionalism.

Source: Dimension; FreshtouStat, February, 2022.

Source: Dimension; FreshtouStat, February, 2022.

Scholars in this area have laid emphasis on the education and socioeconomic indicators, this two factors reflect the level of development and kind of leadership in a country. However, use of mass media for awareness and orientating women of reproductive age on which we presently have no academic paper to the best of our knowledge, need to be critically examine and adopted in curbing endangering life of our women. In a work done in Egypt to evaluate the effectiveness of their adopted intervention, the researchers - Metwally et al (2020) reported that Mass media gathering, individual teaching at health facilities, printed materials and home based care sessions were provided. The impact of the interventions according to the work was highly reflected on the percent of mothers who received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6% to 59.3%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1% to 15.1%), during delivery (24.1% to 13.1%) and during postpartum (81.7% to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%.

The statistical outcome of the work is highly significant, observing 50% reduction in the complications pre, during and post pregnancy will surely mean a meaningful reduction in MMR. Nigeria having some similarities with Egypt is an assurance that the same method if adopted and effectively done will born similar or better result.

Nigerian researchers should therefore look in that direction and as a result of collaborative studies develop a conceptual framework for the information and behavioural inlet to maternal mortality, and in the end lead to the recommendation of action policies for government.