Department of Public Health and Social Medicine, University of Medicine, Magwae, Myanmar.
District Public Health Department (Ministry of Health), Pyay District, Bago Region, Myanmar.
PLoS One. 2024 May 17;19(5):e0293197. doi: 10.1371/journal.pone.0293197. eCollection 2024.
A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries.
This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings.
Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited.
Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare.
孕产妇死亡率是比较各国整体孕产妇健康状况的敏感指标，其非常高的数字表明孕产妇保健工作的失败。柬埔寨、老挝、缅甸和越南-湄公河次区域国家是东南亚地区的低收入国家，其孕产妇死亡率过高。本系统评价旨在总结所有可能影响 CLMV 国家孕产妇死亡的因素。
本系统评价采用“系统评价和荟萃分析的首选报告项目（PRISMA）清单（2020 年）”，使用三个关键词：“孕产妇死亡率和健康结果”、“孕产妇保健干预措施”和“CLMV 国家”进行文献检索。从三个数据库（PubMed、Google Scholar 和 Hinari）系统地选择了 75 篇全文论文。对纳入论文的一般信息进行描述性分析和关键发现进行定性分析。
母亲家庭收入低、文盲、教育水平低、生活在贫困家庭中、从事农业和非熟练手工劳动等因素导致产前保健不足。母亲的非婚姻状况和与性别相关的工作等因素与人工流产高度相关，而农村妇女、少数民族、母亲知识和态度差、某些社会和文化信仰以及丈夫的影响直接导致了孕产妇保健服务的限制。对孕产妇保健服务较差的结果做出更多贡献的母亲因素包括较低的财富指数五分位数、母亲吸烟和饮酒行为、早婚和晚婚、35 岁以上妊娠、不良生育史、性别暴力经历、多胎和更高的生育间隔。距离医疗保健设施较远的妇女的母婴保健服务需求未得到满足的情况更多。关于孕产妇保健劳动力，医疗保健提供者的质量和数量、医疗保健基础设施的发展以及人力资源管理政策似乎存在争议。关于孕产妇保健服务的使用，流动和外展孕产妇保健服务的提供既不方便又有限。
低利用率是由于几个供应方面的限制。结果将提高人们对孕产妇保健和死亡率的认识，并为政策制定者制定促进高质量孕产妇保健的政策和战略提供有价值的总结。
