Maqbool Ahmad Ahsan, Shah Iqbal H, Mir Ali Muhammad, Sadiq Maqsood, Bosan Muddassir Altaf
PRIME Consulting, Islamabad, Pakistan.
Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
PLoS One. 2025 Jan 3;20(1):e0290492. doi: 10.1371/journal.pone.0290492. eCollection 2025.
Pakistan has experienced a significant reduction in maternal mortality with a decline of 33 percent between 2006 and 2019. However, the country still grapples with a high number (186 per 100,000 live births) of maternal deaths each year. This study aims to identify socio-demographic and health system related factors associated with maternal mortality.
Using the nested case-control design, we conducted an in-depth analysis of Pakistan Maternal Mortality Survey (PMMS) 2019. We identified 147 maternal deaths occurring within three years prior to the PMMS 2019 as "cases" and 724 women who gave birth and were alive during the same period as "controls". Socio-demographic characteristics of cases and controls were compared, and multivariate regression was employed to investigate the predictors of maternal mortality in Pakistan.
Cases and controls were similar on access to antenatal care (ANC) and ANC provider but differed on age, education, number of pregnancies, type of delivery, tetanus toxoid vaccination during last pregnancy, and contraceptive usage. A higher proportion of cases had deliveries by skilled birth attendants (83% compared to 63% among controls) while home deliveries were more common among controls (32% compared to 25% among cases). Odds of maternal death were lowest among women aged 20-29 years (odds ratio-OR: 0.5; 95% CI 0.23-1.07) and those with secondary or higher education (OR: 0.35; 95% CI 0.17-0.74). Surprisingly, deliveries attended by skilled birth attendants were associated with higher odds of maternal death (OR: 4.07; 95% CI 2.19-7.57) compared to those who were not.
This study identifies secondary or higher maternal education, having had tetanus injection during the last pregnancy, ever-used contraception or being in the age group of 20-29 years were factors associated with lower risk of maternal mortality. Conversely, skilled birth attendance increases the risk of maternal death in Pakistan. Further investigation is needed into the determinants of high maternal mortality.
巴基斯坦的孕产妇死亡率显著下降，2006年至2019年间下降了33%。然而，该国每年仍面临着大量（每10万例活产中有186例）孕产妇死亡。本研究旨在确定与孕产妇死亡相关的社会人口统计学和卫生系统相关因素。
采用嵌套病例对照设计，我们对2019年巴基斯坦孕产妇死亡率调查（PMMS）进行了深入分析。我们将2019年PMMS之前三年内发生的147例孕产妇死亡确定为“病例”，将同期分娩且存活的724名妇女确定为“对照”。比较了病例组和对照组的社会人口统计学特征，并采用多变量回归分析来调查巴基斯坦孕产妇死亡的预测因素。
病例组和对照组在获得产前护理（ANC）和ANC提供者方面相似，但在年龄、教育程度、怀孕次数、分娩类型、上次怀孕时的破伤风类毒素疫苗接种情况以及避孕措施使用方面存在差异。病例组中由熟练助产士接生的比例更高（83%，而对照组为63%），而在家分娩在对照组中更为常见（32%，而病例组为25%）。20至29岁的妇女（优势比-OR：0.5；95%置信区间0.23-1.07）以及接受过中等或高等教育的妇女（OR：0.35；95%置信区间0.17-0.74）的孕产妇死亡几率最低。令人惊讶的是，与未由熟练助产士接生的妇女相比，由熟练助产士接生的产妇死亡几率更高（OR：4.07；95%置信区间2.19-7.57）。
本研究确定，中等或高等孕产妇教育程度、上次怀孕时接种过破伤风疫苗、曾经使用过避孕措施或年龄在20至29岁之间是与较低孕产妇死亡风险相关的因素。相反，在巴基斯坦，熟练助产反而增加了孕产妇死亡的风险。需要进一步调查孕产妇高死亡率的决定因素。
