McCaw-Binns, A. ; Alexander, S. F. ; Lindo, J. L. ; Escoffery, C. ; Spence, K. ; Lewis-Bell, K. ; Lewis, G.
Author Affiliation, Ana.
Epidemiologic transition in maternal mortality and morbidity: new challenges for Jamaica
Int J Gynaecol Obstet
Date of Publication
OBJECTIVE: Given interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998-2003. METHOD: Records of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes. RESULTS: Maternal mortality declined (p=0.023) since surveillance began in 1981-83. The fall in direct mortality (p=0.0003) included 24% fewer hypertension deaths (introduction of clinical guidelines, reorganization of antenatal services) and 36% fewer hemorrhage deaths (introduction of plasma expanders). These improvements were tempered by growing indirect mortality (p=0.057), moving to 31% of maternal deaths from 17% in 1993-95. INTERPRETATION: Declines in direct mortality may be associated with surveillance and related improvements in obstetric care. Increased indirect deaths from HIV/AIDS, cardiac disease, sickle cell disease and asthma suggests the need to improve collaboration with medical teams to implement guidelines to care for pregnant women with chronic diseases.....