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.

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.