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. 2023 Apr 7:13:07001.
doi: 10.7189/jogh.13.07001.

Haemorrhage-related maternal mortality in Bangladesh: Levels, trends, time of death, and care-seeking practices based on nationally representative population-based surveys

Sabrina Jabeen  1 , Abu Bakkar Siddique  1 , Aniqa Tasnim Hossain  1 , Shusmita Khan  2 , M Moinuddin Haider  1 , Tazeen Tahsina  1 , Anisuddin Ahmed  1 , Shafiqul Ameen  1 , Nitai Chakraborty  2 , Quamrun Nahar  1 , Kanta Jamil  3 , Shams El Arifeen  1 , Ahmed Ehsanur Rahman  1
Affiliations

Haemorrhage-related maternal mortality in Bangladesh: Levels, trends, time of death, and care-seeking practices based on nationally representative population-based surveys

Sabrina Jabeen et al. J Glob Health. .

Abstract

Background: Haemorrhage is a major cause of maternal deaths globally, most of which are preventable and predominantly happen in low and middle-income countries, including Bangladesh. We examine the current levels, trends, time of death, and care-seeking practices for haemorrhage-related maternal deaths in Bangladesh.

Methods: We conducted a secondary analysis with data from the nationally representative 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys (BMMS). The cause of death information was collected through verbal autopsy (VA) interviews using a country-adapted version of the standard World Health Organization VA questionnaire. Trained physicians reviewed the VA questionnaire and assigned the cause of death using the International Classification of Diseases (ICD) codes.

Results: Haemorrhage accounted for 31% (95% confidence interval (CI) = 24-38) of all maternal deaths in 2016 BMMS, which was 31% (95% CI = 25-41) in 2010 BMMS and 29% (95% CI = 23-36) in 2001 BMMS. The haemorrhage-specific mortality rate remained unchanged between 2010 BMMS (60 per 100 000 live births, uncertainty range (UR) = 37-82) and 2016 BMMS (53 per 100 000 live births, UR = 36-71). Around 70% of haemorrhage-related maternal deaths took place within 24 hours of delivery. Of those who died, 24% did not seek health care outside the home and 15% sought care from more than three places. Approximately two-thirds of the mothers who died due to haemorrhage gave birth at home.

Conclusions: Postpartum haemorrhage remains the primary cause of maternal mortality in Bangladesh. To reduce these preventable deaths, the Government of Bangladesh and stakeholders should take steps to ensure community awareness about care-seeking during delivery.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding authors) and disclose no relevant interest.

Figures

Figure 1
Figure 1
Number of haemorrhage-specific maternal deaths identified in 2001, 2010, and 2016 BMMS.
Figure 2
Figure 2
Levels and trends in haemorrhage-specific maternal deaths in Bangladesh, presented in the number of deaths per 100 000 live births and percentage contribution of all maternal deaths.
Figure 3
Figure 3
Haemorrhage-related MMR by background characteristics and BMMS rounds, presented in the number of deaths per 100 000 live births.
Figure 4
Figure 4
Estimated number of haemorrhage-specific maternal deaths per year in Bangladesh, presented in numbers.
Figure 5
Figure 5
Timing of haemorrhage-specific maternal deaths, presented in percentage distribution (n = 53).
Figure 6
Figure 6
Place of haemorrhage-specific maternal deaths by place of birth, presented in numbers (n = 53).
Figure 7
Figure 7
Place of care seeking among maternal deaths due to haemorrhage-related complications, presented in percentage distribution (n = 53).
Figure 8
Figure 8
Sequence of care-seeking practices among women who died due to haemorrhage-related complications during pregnancy, birth, and in the postpartum period, presented in numbers (n = 53).
See this image and copyright information in PMC

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