Browsing by Author "Modi, D"

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    Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG-5
    (TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2014) Shah, P; Shah, S; Kutty, RV; Modi, D
    ObjectiveTo understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. MethodsThis study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios (IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. ResultsThirty-two thousand eight hundred and ninety-three pregnancies, 29817 live births and 80 maternal deaths were recorded. Maternal mortality ratio improved from 607 (19 deaths) in 2002-2003 to 161 (five deaths) in 2010-2011. The institutional delivery rate increased from 23% to 65%. The trend of falling maternal deaths was significant over time, with an annual reduction of 17% (adjusted IRR 0.83 CI 0.75-0.91, P-value <0.001). There were significant reductions in adjusted incidence rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes. ConclusionGains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritise management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5. ObjectifComprendre les changements dans l'epidemiologie de la mortalite maternelle en zone rurale en Inde, dans le contexte de l'augmentation des accouchements institutionnels et la mise en OEuvre des interventions communautaires pouvant eclairer les politiques pour atteindre l'OMD-5. MethodeCette etude est une analyse secondaire de donnees communautaires recueillies de facon prospective pour chaque grossesse et ses resultats de 2002 a 2011, dans une region rurale tribale du Gujarat, en Inde dans le cadre du programme de maternite sans danger mis en OEuvre par l'organisation volontaire SEWA Rural'. Le programme comprenait des interventions communautaires soutenues par une premiere unite de reference et la promotion des accouchements institutionnels. Pour chaque deces maternel, une autopsie verbale a ete menee. Les taux d'incidence de la mortalite maternelle selon le lieu, la cause et le moment du deces maternel par rapport a la grossesse ont ete calcules. Les rapports annuels des taux d'incidence (IRR) et les intervalles de confiance a 95% ajustes pour la caste et l'education maternelle, ont ete estimes par la regression de Poisson afin de tester la tendance lineaire dans la reduction de la mortalite au cours de la periode d'etude. Resultats32893 grossesses, 29817 naissances vivantes et 80 deces maternels ont ete enregistres. Le taux de mortalite maternelle (TMM) est passe de 607 (19 deces) en 2002-2003 a 161 (5 deces) en 2010-2011. Le taux des accouchements institutionnels a augmente de 23% a 65%. La tendance a la baisse des deces maternels a ete significative au fil du temps, avec une reduction annuelle de 17% (IRR ajuste: 0,83; IC: 0,75 a 0,91; P<0,001). Il y avait des reductions significatives des taux d'incidence ajustes des deces maternels dus a des causes directes, pendant les periodes d'intra- et de post-partum, et pour ceux qui ont eu lieu a domicile. Toutefois, les reductions de l'incidence des deces maternels dus a des causes indirectes, a l'hopital et pendant la periode ante-partum n'etaient pas statistiquement significatives. La plupart des deces maternels surviennent maintenant dans les hopitaux et sont dus a des causes indirectes. ConclusionLes gains dans les accouchements institutionnels et des interventions communautaires resultant en moins de deces maternels dus a des causes directes devraient etre maintenus. Cependant, il serait essentiel de donner la priorite maintenant a la gestion des causes indirectes de mortalite maternelle pendant la grossesse dans la communaute et dans les hopitaux pour une reduction supplementaire de la mortalite maternelle afin d'atteindre l'OMD-5. ObjetivoEntender los cambios en la epidemiologia de la mortalidad materna en zonas rurales de la India, dentro del contexto de un aumento de partos intrahospitalarios y la implementacion de intervenciones comunitarias que puedan ayudar a tomar decisiones informadas para reorientar las politicas necesarias con el fin de alcanzar los ODM-5. MetodosEste estudio es un analisis secundario de datos comunitarios recogidos de forma prospectiva de cada embarazo entre el 2002 y 2011, en un area rural y tribal de Gujarat, India, como parte de un programa de maternidad segura implementado por una organizacion voluntaria, SEWA Rural. El programa consiste en intervenciones comunitarias apoyadas por una primera unidad de referencia, y la promocion de partos hospitalarios. Para cada muerte materna se realizo una autopsia verbal. Se calcularon las tasas de incidencia de la mortalidad materna segun el lugar, la causa y el momento de las muertes maternas con relacion al embarazo. La razon de tasas de incidencia (RTI) anuales e intervalos de confianza del 95%, ajustados segun las casta y el nivel de educacion materna, se calcularon utilizando una regresion de Poisson, para evaluar un tendencia lineal en la reduccion de la mortalidad durante el periodo de estudio. ResultadosSe registraron 32893 embarazos, 29817 nacidos vivos y 80 muertes maternas. La tasa de mortalidad materna (TMM) mejoro de 607 (19 muertes) en 2002-03 a 161 (5 muertes) en 2010-11. La tasa de partos hospitalarios aumento del 23% al 65%. La tendencia en el descenso de muertes maternas fue significativa a lo largo del tiempo, con una reduccion anual del 17% (RTI ajustado 0.83 IC 0.75-0.91, P<0.001). Hubo una reduccion significativa en la tasa de incidencia ajustada de muertes maternas por causa directa durante el intraparto y en el postparto, asi como en aquellos que ocurrieron en el hogar. Sin embargo, la reduccion en la incidencia de muertes maternas debido a las causas indirectas, en el hospital y durante el periodo del anteparto no era estadisticamente significativa. La mayoria de las muertes maternas ocurren ahora en los hospitales y debido a causas indirectas. ConclusionEl aumento de partos hospitalarios e intervenciones comunitarias que han tenido como resultado un menor numero de muertes maternas debidas a causas directas, deberia mantenerse. Sin embargo, seria esencial priorizar ahora el manejo de las causas indirectas de mortalidad materna durante el embarazo, tanto en la comunidad como en los hospitales, para reducir aun mas las muertes maternas y alcanzar el ODM-5.
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    Chnaging epidemiology of maternal mortality in rural India: time to reset strategies for MDG-5.
    (Tropical Medicine and International Health. 2014; 19:568-575, 2014-03) Shah, P; Shah, S; Kutty, VR; Modi, D
    Objective To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. Methods This study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios (IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. Results Thirty-two thousand eight hundred and ninety-three pregnancies, 29 817 live births and 80 maternal deaths were recorded. Maternal mortality ratio improved from 607 (19 deaths) in 2002–2003 to 161 (five deaths) in 2010–2011. The institutional delivery rate increased from 23% to 65%. The trend of falling maternal deaths was significant over time, with an annual reduction of 17% (adjusted IRR 0.83 CI 0.75–0.91, P-value <0.001). There were significant reductions in adjusted incidence rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes. Conclusion Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritise management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5.
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    Reducing Neonatal Mortality in Jhagadia Block, Gujarat: We Need to go Beyond Promoting Hospital Deliveries
    (JOURNAL OF TROPICAL PEDIATRICS, 2013) Kutty, VR; Shah, P; Modi, D; Shah, S; Ramanathan, M; Archana, AR
    Background and Methods: We examined data from a cohort of births that occurred in the period 2004-08 in the SEWA-Rural project area, covering a population of similar to 175 000, in Gujarat, India, to assess the trends and risk factors for neonatal mortality. Results: In this population living in 168 villages, there has been a significant declining trend in infant and neonatal mortality, more marked in the tribal population, in whom this paralleled a rise in the proportion of women delivering in hospitals. The more important risk factors for neonatal mortality risk to emerge from multivariate analysis are low birth weight, prematurity, young age of mother, older mother and high birth order. Conclusion: Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health.