Bellad Mrutynjaya B, Vidler Marianne, Honnungar Narayan V, Mallapur Ashalata, Ramadurg Umesh, Charanthimath Umesh, Katageri Geetanjali, Bannale Shashidhar, Kavi Avinash, Karadiguddi Chandrashekhar, Sharma Sumedha, Lee Tang, Li Jing, Payne Beth, Magee Laura, von Dadelszen Peter, Derman Richard, Goudar Shivaprasad S
Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2017 Jan 20;12(1):e0166623. doi: 10.1371/journal.pone.0166623. eCollection 2017.
Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013-2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women's and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013-2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013-14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.
印度现有的重要健康统计登记系统无法提供有关孕产妇和新生儿死亡率及发病率的可靠估计数据，而特定地区的健康评估对于卫生干预措施的规划和监测至关重要。本研究旨在评估基线率，作为基于社区的整群随机对照试验（cRCT）——先兆子痫社区层面干预试验（CLIP试验，NCT01911494；CTRI/2014/01/004352）的前期准备。其目的是描述CLIP试验启动前的基线人口统计学特征和健康结局，并增进对人群健康水平的了解，尤其是印度卡纳塔克邦北部地区与妊娠高血压疾病相关的孕产妇和新生儿结局。这项基于人群的前瞻性调查于2013年至2014年在卡纳塔克邦贝尔高姆和巴加尔科特地区的8个群组中开展。数据收集采用了由全球妇女和儿童健康研究网络开发的孕产妇和新生儿健康登记平台。使用SAS和R软件完成描述性统计分析。在2013年至2014年期间，收集了5469名平均年龄为23.2（±3.3）岁的孕妇的前瞻性数据。从5448例已完成妊娠中收集了分娩结局。大多数妇女报告是在医疗机构分娩（96.0%），且大多由熟练的助产人员接生。在本研究期间观察到孕产妇死亡率为103（每10万活产），新生儿死亡率为每1000例活产25例，围产期死亡率为每1000例活产50例。尽管医疗机构分娩的比例很高，但死产率为2.86%。孕产妇和新生儿健康登记系统建立的早期登记以及密切随访和监测程序使得失访率可以忽略不计。这项基于人群的研究提供了2013 - 2014年卡纳塔克邦贝尔高姆和巴加尔科特地区孕产妇和新生儿健康的区域数据。死亡率和发病率信息可用于规划干预措施以及监测有效性指标，为政策制定和实践提供参考。如此处提供的全面区域流行病学数据，对于评估孕产妇健康方面的改善情况和挑战以及追踪农村地区存在的差异至关重要。
