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Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi

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McCauley, Mary ORCID: https://orcid.org/0000-0003-1446-0625, Madaj, Barbara ORCID: https://orcid.org/0000-0002-4073-3191, White, Sarah, Dickinson, Fiona ORCID: https://orcid.org/0000-0002-5298-9127, Bar-Zev, Sarah, Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Godia, Pamela, Mittal, Pratima, Zafar, Shamsa and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2018) 'Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi'. BMJ Global Health, Vol 3, Issue 3, e000625.

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Abstract

Introduction For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low-resource settings. We sought to assess the extent and types of maternal morbidity. Methods Descriptive observational cross-sectional study at primary-level and secondary-level healthcare facilities in India, Pakistan, Kenya and Malawi to assess physical, psychological and social morbidity during and after pregnancy. Sociodemographic factors, education, socioeconomic status (SES), quality of life, satisfaction with health, reported symptoms, clinical examination and laboratory investigations were assessed. Relationships between morbidity and maternal characteristics were investigated using multivariable logistic regression analysis. Results 11 454 women were assessed in India (2099), Malawi (2923), Kenya (3145), and Pakistan (3287). Almost 3 out of 4 women had ≥1 symptoms (73.5%), abnormalities on clinical examination (71.3%) or laboratory investigation (73.5%). In total, 36% of women had infectious morbidity of which 9.0% had an identified infectious disease (HIV, malaria, syphilis, chest infection or tuberculosis) and an additional 32.5% had signs of early infection. HIV-positive status was highest in Malawi (14.5%) as was malaria (10.4%). Overall, 47.9% of women were anaemic, 11.5% had other medical or obstetric conditions, 25.1% reported psychological morbidity and 36.6% reported social morbidity (domestic violence and/or substance misuse). Infectious morbidity was highest in Malawi (56.5%) and Kenya (40.4%), psychological and social morbidity was highest in Pakistan (47.3%, 60.2%). Maternal morbidity was not limited to a core at-risk group; only 1.2% had all four morbidities. The likelihood of medical or obstetric, psychological or social morbidity decreased with increased education; adjusted OR (95% CI) for each additional level of education ranged from 0.79 (0.75 to 0.83) for psychological morbidity to 0.91 (0.87 to 0.95) for infectious morbidity. Each additional level of SES was associated with increased psychological morbidity (OR 1.15 (95% CI 1.10 to 1.21)) and social morbidity (OR 1.05 (95% CI 1.01 to 1.10)), but there was no difference regarding medical or obstetric morbidity. However, for each morbidity association was heterogeneous between countries. Conclusion Women suffer significant ill-health which is still largely unrecognised. Current antenatal and postnatal care packages require adaptation if they are to meet the identified health needs of women.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WQ Obstetrics > WQ 100 General works
WQ Obstetrics > WQ 20 Research (General)
WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2017-000625
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 04 May 2018 10:38
Last Modified: 22 Jun 2018 10:38
URI: http://archive.lstmed.ac.uk/id/eprint/8572

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