Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 15:43:101238.
doi: 10.1016/j.eclinm.2021.101238. eCollection 2022 Jan.

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998-2017)

Affette McCaw-Binns  1 , Leroy Campbell  2 , Ardene Harris  3 , Lesley-Ann James  3 , Monika Asnani  4
Affiliations

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998-2017)

Affette McCaw-Binns et al. EClinicalMedicine. .

Abstract

Background: Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998-2007 their maternal mortality ratio was 7-11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care.

Methods: Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open.

Findings: Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008-17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07-5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36-3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051).

Interpretation: MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children.

Funding: No external funding was provided.

Keywords: Direct Deaths; Jamaica; Maternal Deaths; Sickle Cell Disease; Surveillance.

PubMed Disclaimer

Conflict of interest statement

We the authors have no conflicts of interest.

Figures

Fig 1
Figure 1
Distribution of public hospitals attending births in Jamaica, by region and level of care available, 2021.
Fig 2
Figure 2
Case selection process – Jamaica maternal mortality surveillance database, 1998–2017.
Fig 3
Figure 3
Direct and indirect maternal mortality trends, by sickle cell status: Jamaica, 1998–2017 maternal mortality ratios (MMR) per 100,000 live births.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Colah R.B., Mehta P., Mukherjee M.B. Newborn screening for sickle cell disease: Indian experience. Int J Neonatal Screen. 2018;4(4):31. - PMC - PubMed
    1. El-Hazmi M.A., Al-Hazmi A.M., Warsy A.S. Sickle cell disease in middle east Arab countries. Indian J Med Res. 2011;134(5):597–610. - PMC - PubMed
    1. Karacaoglu P.K., Asma S., Korur A., et al. East mediterranean region sickle cell disease mortality trial: retrospective multicenter cohort analysis of 735 patients. Ann Hematol. 2016;95(6):993–1000. - PubMed
    1. Knight-Madden J., Lee K., Elana G., et al. Newborn screening for sickle cell disease in the caribbean: an update of the present situation and of the disease prevalence. Int J Neonatal Screen. 2019;5(1):5. - PMC - PubMed
    1. Serjeant G.R., Serjeant B.E. 3rd ed. Oxford University Press; Oxford: 2001. Sickle cell disease.

LinkOut - more resources