2. Objectives
• To describe baseline maternal and
perinatal morbidity/ complications
in four study districts
• To estimate cost of care for
common maternal/perinatal
complications
3. How we obtained information
• Standard clinical definition of complications
read to each woman
• Woman responded “Yes” if she experienced
consistent symptoms/ signs during last
pregnancy
• Complication cross-checked with medical
diagnosis in health passports/ discharge slips
where possible
4. Results
• N= 1887 : Complete data
• 36% (676): Ever experienced a
complication during past pregnancy
• 25% (414) : One or more complications
during Antenatal period
• 20% (374) : One or more complications
during delivery
One purpose of the baseline was to collect data that would feed into the cost effectiveness evaluation studies. Community level of estimates of baseline morbidity rates and cost of care seeking the complications important. Describe objectives.
Details of HH methods described by Jacob. Just to highlight how morbidly data was collected and validated. Standard case definitions of complications, e.g. experience of fever + chills, lower abdominal pains associated with foul vaginal discharge= sepsis, translated into Chichewa. Each case definition read to clients by nurses and nurse supervised enumerators. Reported cases to be cross checked with formal diagnosis by health workers to assess validity.
Generally high reported burden of maternal and perinatal ill health; 1 in 3 women experience a complication during course of pregnancy. 1 in 4 women experience an ANC complication and 1 in 5 has a complication during delivery.
This chart shows % of complications among women who reported an ANC complication(N=414). HTN, Abortion, and Symptomatic anaemia common. Abortion underestimated as early and some may have been underreported. Mention the two biases 1) selection bias with with symptoms self selecting to place of delivery and 2) information biase, clients with confirmed diagnoses more likely to remember. Biases may work in each direction.
This charts illustrates % ANC complications among women who reported complications by district. Comparable results across the districts except: ? HTN high in Mchinji, Abortion high in Dedza and Anaemia high in Balaka.
This graph shows % ANC complication by place of birth. Abortion at home, selection?
Usual pattern: high PPH, Obstructed lobour maternal sepsis for mothers: high asphixia, neonatal sepsis and prematurity for neonates.
Variations on morbidly patterns across the districts. Of note :Ntheu, high maternal sepis and PPH. Balaka high prolonged labor and SB, Mchinji high neonatal sepsis
Proportionately more asphixia, stillbirths and ruptured uterus taking place at homes.
