TY - JOUR
T1 - Maternal mortality among Afghan refugees in Pakistan, 1999-2000
AU - Bartlett, Linda A.
AU - Jamieson, Denise J.
AU - Kahn, Tila
AU - Sultana, Munawar
AU - Wilson, Hoyt G.
AU - Duerr, Ann
N1 - Funding Information:
We acknowledge the contribution and support of the International Rescue Committee, including Tamana Gul Lakhta, Shamim Akhter, Nazer Mohammed, Dost Mohammed, Nosheen Jan, and Sigurd Hansen; and from the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Michelle Hynes, Basia Tomczyk, Mary Kay Larson, Timothy Johnson, Howard Goldberg, Cynthia Berg, and the members of the Steering Committee for Reproductive Health in Refugees. This study was supported by United States Agency for International Development (USAID), the Bureau of Population, Refugees and Migration, of the United States Department of State and the Centers for Disease Control and Prevention.
PY - 2002/2/23
Y1 - 2002/2/23
N2 - Background: Estimated at 3.6 million, Afghans are the largest population of refugees in the world. Information on the magnitude, causes, and preventable factors of maternal deaths among Afghan refugees may yield valuable information for prevention. Methods: Deaths were recorded between Jan 20, 1999, and Aug 31, 2000, during a census carried out in 12 Afghan refugee settlements in Pakistan. Deaths among women of reproductive age (15-49 years) were further investigated by verbal autopsy interviews to determine their cause, risk factors, and preventability, and to ascertain the barriers faced to obtaining health care. Findings: The census identified 13 4406 Afghan refugees and 1197 deaths; a crude mortality rate of 5.5 (95% CI 5.2-5.8) per thousand population. Among the 66 deaths among women of reproductive age, deaths due to maternal causes (n=27) exceeded any other cause (41% [95% CI 29-53]). 16 liveborn and nine stillborn infants were born to women who died of maternal causes; six of the liveborn infants died after birth. Therefore, 60% (15 of 24) of infants born to these women were either born dead or died after birth. Compared with women who died of non-maternal causes, women who died of maternal causes had a greater number of barriers to health care (p=0.001), and their deaths were more likely to be preventable (p<0.05). Interpretation: Maternal deaths account for a substantial burden of mortality among Afghan refugee women of reproductive age in Pakistan. The high prevalence of barriers to health care access indicates opportunities for reducing maternal deaths in refugee women and their children.
AB - Background: Estimated at 3.6 million, Afghans are the largest population of refugees in the world. Information on the magnitude, causes, and preventable factors of maternal deaths among Afghan refugees may yield valuable information for prevention. Methods: Deaths were recorded between Jan 20, 1999, and Aug 31, 2000, during a census carried out in 12 Afghan refugee settlements in Pakistan. Deaths among women of reproductive age (15-49 years) were further investigated by verbal autopsy interviews to determine their cause, risk factors, and preventability, and to ascertain the barriers faced to obtaining health care. Findings: The census identified 13 4406 Afghan refugees and 1197 deaths; a crude mortality rate of 5.5 (95% CI 5.2-5.8) per thousand population. Among the 66 deaths among women of reproductive age, deaths due to maternal causes (n=27) exceeded any other cause (41% [95% CI 29-53]). 16 liveborn and nine stillborn infants were born to women who died of maternal causes; six of the liveborn infants died after birth. Therefore, 60% (15 of 24) of infants born to these women were either born dead or died after birth. Compared with women who died of non-maternal causes, women who died of maternal causes had a greater number of barriers to health care (p=0.001), and their deaths were more likely to be preventable (p<0.05). Interpretation: Maternal deaths account for a substantial burden of mortality among Afghan refugee women of reproductive age in Pakistan. The high prevalence of barriers to health care access indicates opportunities for reducing maternal deaths in refugee women and their children.
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U2 - 10.1016/S0140-6736(02)07808-X
DO - 10.1016/S0140-6736(02)07808-X
M3 - Article
C2 - 11879858
AN - SCOPUS:0037160757
SN - 0140-6736
VL - 359
SP - 643
EP - 649
JO - Lancet
JF - Lancet
IS - 9307
ER -