Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986–2010

McGready, Rose, Boel, Machteld, Rijken, Marcus J., Ashley, Elizabeth A., Cho, Thein, Moo, Oh, Paw, Moo Koh, Pimanpanarak, Mupawjay, Hkirijareon, Lily, Carrara, Verena I., Lwin, Khin Maung, Phyo, Aung Pyae, Turner, Claudia, Chu, Cindy S., van Vugt, Michele, Price, Richard N., Luxemburger, Christine, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Tan, Saw Oo, Proux, Stephane, Singhasivanon, Pratap, White, Nicholas J. and Nosten, François H. (2012) 'Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986–2010'. PLoS ONE, Vol 7, Issue 7, e40244.

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Abstract

Introduction
Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand.

Methods and Findings
All medical records from women who attended the Shoklo Malaria Research Unit antenatal clinics from 12th May 1986 to 31st December 2010 were reviewed, and maternal death records were analyzed for causality. There were 71 pregnancy-related deaths recorded amongst 50,981 women who attended antenatal care at least once. Three were suicide and excluded from the analysis as incidental deaths. The estimated maternal mortality ratio (MMR) overall was 184 (95%CI 150–230) per 100,000 live births. In camps for displaced persons there has been a six-fold decline in the MMR from 499 (95%CI 200–780) in 1986–90 to 79 (40–170) in 2006–10, p<0.05. In migrants from adjacent Myanmar the decline in MMR was less significant: 588 (100–3260) to 252 (150–430) from 1996–2000 to 2006–2010. Mortality from P.falciparum malaria in pregnancy dropped sharply with the introduction of systematic screening and treatment and continued to decline with the reduction in the incidence of malaria in the communities. P.vivax was not a cause of maternal death in this population. Infection (non-puerperal sepsis and P.falciparum malaria) accounted for 39.7 (27/68) % of all deaths.

Conclusions
Frequent antenatal clinic screening allows early detection and treatment of falciparum malaria and substantially reduces maternal mortality from P.falciparum malaria. No significant decline has been observed in deaths from sepsis or other causes in refugee and migrant women on the Thai–Myanmar border.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WC Communicable Diseases > Tropical and Parasitic Diseases > WC 770 Therapy WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0040244
Depositing User:	Martin Chapman
Date Deposited:	07 May 2014 14:12
Last Modified:	31 May 2018 13:47
URI:	https://archive.lstmed.ac.uk/id/eprint/3688

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