Determinants of Global Maternal and Neonatal Morbidity and Mortality
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CitationBoundy, Ellen O'Neal. 2015. Determinants of Global Maternal and Neonatal Morbidity and Mortality. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractIn 2013, approximately 289,000 women died from pregnancy-related causes and 2.8 million newborns died within the first 28 days of life. The vast majority of these deaths occur in resource-limited settings. This work examines risk and protective factors for the development of several perinatal complications that put mothers and their infants at risk for adverse health outcomes. We explored determinants of preeclampsia and gestational hypertension among women in Dar es Salaam, Tanzania. We also examined the effects of pregnancy spacing intervals on perinatal outcomes in that group of women. We used log binomial regression to obtain risk ratios and 95% confidence intervals for the development of the adverse pregnancy outcomes of interest. We also looked at the efficacy of an intervention aimed at improving neonatal outcomes by conducting a systematic review and meta-analysis of the effects of kangaroo mother care on neonatal morbidity and mortality.
We found that nulliparity, history of hypertension, urinary tract infection, low calcium intake, history of preeclampsia, and history of preterm birth were associated with an increased risk of developing preeclampsia among women in Dar es Salaam. Risk factors for gestational hypertension included a history of diabetes, elevated blood pressure at study enrollment, increased mid-upper arm circumference, high hematocrit, low mean corpuscular volume, a history of miscarriage or stillbirth, and older age at first pregnancy. Twin gestation and increased body mass index were risk factors for both types of hypertensive disorders of pregnancy among women in Tanzania. After a live birth, inter-pregnancy intervals less than six months were associated with an increased the risk of having a low birth weight baby in the next pregnancy; while after a stillbirth, short inter-pregnancy intervals were associated with increased risk of stillbirth and perinatal death. Providing kangaroo mother care to infants after birth was associated with decreased neonatal morbidity and mortality and increased likelihood of exclusive breastfeeding when compared to conventional care.
These findings can help identify women and infants at increased risk for developing pregnancy-related complications and contribute to informing development of evidence-based maternal, newborn, and family planning programs and policies.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:16121139