Analysis shows that women in sub-Saharan Africa remain at higher risk of death after childbirth

Analysis shows that women in sub-Saharan Africa remain at higher risk of death after childbirth

Women in sub-Saharan Africa continue to face an increased risk of death after childbirth, long past the 42-day postpartum cutoff that the WHO uses to define pregnancy-related deaths, a new analysis shows.

Researchers analyzed data from 12 sub-Saharan African countries to examine whether the 42-day definition accurately captures postpartum deaths.

The analysis found that although the risk of death fell significantly over the 42 days after birth (compared to a comparable period of 12 to 17 months after birth), the risk of death was still 20% higher between 42 days and four months after birth. This has significant 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 & Tropical Medicine (LSHTM), the Medical Research Council Unit The Gambia at LSHTM and the Kenya Medical Research Institute-Center for Global Health Research. The research was published in The Lancet Global Health.

It is important that we have up-to-date evidence and measures to make childbirth safer for every woman. To measure pregnancy-related deaths, the definition must be time-limited, but it is concerning that the risk of death remains 20% higher from day 42 until about four months after birth. With this in mind, 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 follow-up care for women suffering from chronic morbidity should include visits after 42 days.”

Ursula Gazeley, lead author, LSHTM

Dr. Momodou Jasseh, author of The Gambia MRC Unit at LSHTM, said: "This evidence of an increased risk of maternal death beyond 42 days postpartum in sub-Saharan Africa suggests that the true burden of pregnancy-related mortality may be significantly underestimated." Unless concerned governments commit to improving health management information systems that generate the necessary data on maternal outcomes at 42 days postpartum, the true burden will remain elusive.”

Dr. Sammy Khagayi, author from the Kenya Medical Research Institute, said: "Despite the reduction in maternal and baby birth mortality in resource-limited areas such as western Kenya, it is important to go the extra mile to ensure quality care for the children." “

This large, cross-country study analyzed nearly 30 years of data from 1991 to 2020 from 30 health and demographic surveillance systems (HDSS) in 12 African countries. A total of 647,104 births and 1,967 deaths within one year of birth were recorded in the HDSS.

This analysis was based on postpartum deaths from any cause. To plan interventions and prevent deaths, the authors urgently call for further research into the causes of death 42 days after birth in low- and middle-income settings.

Limitations of the research include that HDSS data do not always include pregnancy reports and therefore prenatal pregnancy-related deaths were not included in the analysis, likely resulting in an underestimation of maternal risk.

The research was funded by the UK Economic and Social Research Council.

Source:

London School of Hygiene & Tropical Medicine (LSHTM)

Reference:

Ursula Gazeley et al., Women's risk of death beyond 42 days postpartum: a pooled analysis of longitudinal data from the Health and Demographic Surveillance System in Sub-Saharan Africa. Lancet Global Health. DOI: 10.1016/S2214-109X(22)00339-4

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