Institutional maternal and perinatal deaths: a review of 40 low and middle income countries

Bailey, Patricia E.; Andualem, Wasihun; Brun, Michel; Freedman, Lynn; Gbangbade, Sourou; Kante, Malick; Keyes, Emily; Libamba, Edwin; Moran, Allisyn C.; Mouniri, Halima; el Joud, Dahada Ould; Singh, Kavita

doi:10.1186/s12884-017-1479-1

BMC Pregnancy and Childbirth

Table 1 EmONC assessment characteristics and facility-based rates and ratios (40 countries)

From: Institutional maternal and perinatal deaths: a review of 40 low and middle income countries

Region, country and year of data collection	Population covered	No. of health facilities providing delivery services	No. of hospitals	No. of other facilities	Institu-tional deliveries (12 mo.s)	Expected births (12 mo.s)	Institu-tional delivery rate	Percentage of deliveries with obstetric complica-tions^e	Institutional maternal deaths^f (12 mo.s)	Institu-tional MMR	MMR (2015)
LAC
Ecuador 2006^a	690,049	9	9	0	8863	NR	NR	30.0%	7	79	64
Guyana 2010	751,223	51	32	19	12,803	14,724	87.0%	7.1%	19	148	229
Haiti 2009	9,761,927	120	59	61	65,731	294,034	22.4%	20.8%	170	259	359
Nicaragua 2006	5,626,493	167	20	147	94,136	176,409	53.4%	7.2%	41	44	150
Panama 2007	2078,446	19	11	8	30,811	52,310	58.9%	7.5%	21	68	94
Western Africa
Benin 2010	8,497,827	417	34	383	203,412	349,856	58.1%	11.8%	483	237	405
Burkina Faso 2010	15,224,781	1626	61	1565	499,753	697,295	71.7%	9.6%	676	135	371
Cote d’Ivoire 2010	21,693,185	1419	86	1333	342,936	790,776	43.4%	13.7%	1416	413	645
Gambia 2012	1,839,447	98	8	90	51,518	69,899	73.7%	10.7%	169	328	706
Ghana 2010	24,232,431	1268	285	983	434,508	751,205	57.8%	20.1%	840	193	319
Guinea 2011	11,211,223	502	49	453	141,724	438,293	32.3%	8.3%	459	324	679
Liberia 2010	3,709,850	304	27	277	46,841	159,524	29.4%	11.7%	335	715	725
Mauritania 2011	3,297,000	254	18	236	83,409	159,533	52.3%	5.0%	132	158	602
Niger 2010	15,203,822	503	36	467	152,415	677,352	22.5%	11.7%	1165	970	553
Senegal 2013	12,873,601	560	29	531	237,494	496,921	47.8%	5.0%	1020	429	315
Sierra Leone 2008^a	5,532,000	145	38	107	25,447	254,472	10.0%	11.4%	212	833	1360
Togo 2012	6,191,155	864	46	818	133,119	202,451	65.8%	10.7%	225	169	368
Eastern Africa
Burundi 2010	8,246,878	274	48	226	231,293	323,278	71.5%	4.5%	220	95	712
Djibouti 2005	636,540	16	7	9	11,636	22,289	52.2%	24.4%	22	189	229
Eritrea 2008^b	3,543,578	118	18	100	25,000	NR	26.0%	22.3%	41	164	501
Ethiopia 2008–9	73,918,505	751	112	639	174,561	2,638,891	6.6%	13.9%	685	392	353
Madagascar 2009	19,378,009	294	147	147	118,774	647,226	18.4%	17.4%	357	301	353
Malawi 2014^c	15,805,239	365	87	278	476,272	790,262	60.3%	8.4%	586	123	634
Mozambique 2012^g	23,569,908	947	56	891	647,944	895,656	72.3%	4.3%	1840	284	489
Rwanda 2007^a,h	8,934,215	407	39	368	207,738	384,171	54.1%	3.4%	294	142	290
South Sudan 2013	10,864,357	407	63	344	52,842	456,303	11.6%	10.2%	497	941	789
Zanzibar 2012^a	1,460,987	79	43	36	27,102	54,057	50.1%	9.3%	62	229	NR
Zambia 2014-15^c	15,023,315	384	118	266	475,646	644,500	73.8%	5.0%	759	160	224
Central Africa
Angola 2007	18,176,685	400	84	316	248,187	872,481	28.4%	12.5%	1410	568	477
Cameroon 2010	15,544,387	607	123	484	282,486	615,558	45.9%	11.4%	744	263	596
Chad 2011	11,679,974	139	57	82	49,202	520,927	9.4%	9.3%	1048	2130	856
Congo 2012	4,085,422	240	32	208	85,038	170,362	49.9%	5.1%	246	289	442
Dem Rep Congo 2011	15,421,731	266	69	197	158,546	616,869	25.7%	10.8%	282	178	693
São Tomé & P 2013	178,739	6	1	5	5455	6166	88.5%	3.2%	6	110	156
Southern Africa
Lesotho 2015	1,954,906	160	22	138	43,165	58,197	74.2%	8.1%	66	153	487
Namibia 2005	2,028,238	100	41	59	44,592	62,875	70.9%	6.7%	57	128	265
Asia
Afghanistan 2009	23,500,000	78	69	9	192,627	993,840	19.4%	12.9%	258	134	396
Bangladesh 2012^d	43,667,450	846	234	612	253,728	NR	NR	17.3%	377	149	176
Cambodia 2014	13,388,910	180	91	89	119,931	382,830	31.3%	8.2%	57	48	161
Mongolia 2009	1,139,462	21	21	0	31,012	27,448	113.0%	28.3%	10	32	44

NR not reported, LAC Latin America and the Caribbean, MMR maternal mortality ratio, mo months, MMR (2015) see reference [7]
^aEcuador, Democratic Republic of Congo, Rwanda, São Tomé and Príncipe, Sierra Leone and Zanzibar reported only direct maternal deaths
^bEritrea: 25,000 deliveries are live births, based on 2006 data, not EmONC assessment; institutional delivery rate also not based on EmONC assessment
^cMalawi and Zambia: deaths and deliveries weighted; in Malawi unweighted deliveries = 367,738 and unwt deaths = 557; in Zambia, unweighted deliveries = 254,790 and unwt deaths = 673
^dBangladesh health facilities that performed cesareans were considered hospitals; if not, considered “other”. Sample included 24 districts
^eComplications included only major direct obstetric complications (hemorrhage, severe pre-eclampsia/eclampsia, sepsis, prolonged/obstructed labor, severe abortion complications, ruptured uterus, ectopic pregnancy)
^fMaternal deaths include all maternal deaths (direct, indirect and unknown causes)
^gMozambique: Based on 3 months of data, multiplied by 4 to show 12 months, for consistency across countries
^hRwanda: Based on 6 mo.s of data for facility births, complications and deaths, multiplied by 2 to show 12 months of data, for consistency across countries

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ISSN: 1471-2393

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