Women in sub-Saharan Africa continue to be at elevated risk of death after childbirth well past the 42-day cutoff that the WHO uses to define pregnancy-related deaths, a new analysis shows.
The researchers analyzed data from 12 sub-Saharan African countries to examine whether the 42-day definition accurately captures postpartum deaths.
The analysis found that while the risk of death decreased substantially during the 42-day postpartum period (relative to a comparison period of 12 to 17 months postpartum), the risk of death was still estimated to be 20% higher among 42 days and four months later. Birth. This has important policy implications for improving maternal health in sub-Saharan Africa and other low- and middle-income countries.
The team included researchers from the London School of Hygiene and Tropical Medicine (LSHTM), the Gambia Medical Research Council Unit at LSHTM, and the Kenya Institute of Medical Research-Centre for Global Health Research. The research is published in The Lancet Global Health.
Ursula Gazeley, lead author of the LSHTM, said: “It is vital that we have up-to-date evidence and action to make childbirth safer for all women. To measure pregnancy-related deaths, there needs to be a time limit on the definition, but worryingly the risk of death remains 20% higher from 42 days to around four months postpartum. In light of this, we call on the WHO to extend the 42-day postpartum limit currently used in the definition of pregnancy-related deaths. Our results also suggest that national and international guidelines for postpartum care should include visits beyond 42 days for women experiencing chronic morbidity.”
Dr Momodou Jasseh, MRC Gambia author at LSHTM, said: “This demonstration of an increased risk of death for mothers beyond 42 days postpartum in sub-Saharan Africa suggests that the true burden of pregnancy-related mortality may be substantially underestimated in the region Unless concerned governments commit to improving health management information systems that generate the necessary data on maternal outcomes after 42 days postpartum, the real burden will remain difficult reaching”.
Dr Sammy Khagayi, author from the Kenya Medical Research Institute, said: “Despite the reduction in mortality around childbirth for both mothers and babies in resource-limited areas such as western Kenya, it is vital to give a step further to provide quality care for mothers beyond the recommended postpartum period Pregnancy monitoring before and after delivery would go a long way in reducing late maternal deaths This will be achieved if we invest in data collection platforms to monitor and track women from pregnancy to 6 months postpartum.”
This large multinational study analyzed almost 30 years of data from 1991 to 2020, from 30 Demographic and Health Surveillance Systems (HDSS), in 12 African countries. In total, 647,104 births and 1,967 deaths were registered in the HDSS within the year after delivery.
This analysis was based on postpartum deaths from any cause. To plan interventions and prevent deaths, the authors call for urgent additional research into the causes of death after 42 days postpartum in low- and middle-income settings.