Trends of in-hospital maternal mortality during the COVID-19 pandemic in southern Morocco – analysis of a time series from 2016–2022
DOI:
https://doi.org/10.15584/ejcem.2024.4.8Keywords:
COVID-19 pandemic, maternal mortality, southern Morocco, time seriesAbstract
Introduction and aim. The aim of this study was to compare trends of in-hospital maternal mortality in southern Morocco be fore and after the COVID-19 pandemic emerged in the Kingdom in March 2020.
Material and methods. We conducted a retrospective study of a time series of hospital maternal deaths from January 2016 to December 2022. Data were collected from maternal death registers and monthly reports from maternity departments of six public hospitals in Souss Massa region (one regional and five provincial hospitals).
Results. 216 maternal deaths occurred during the study period, 112 before and 104 during the pandemic. The highest annual maternal mortality ratio (MMR) was observed in 2021 (207.41 deaths/100,000 live births). Trends of monthly MMR showed a significant increase during the pandemic compared with the pre-pandemic period (p=0.002). Furthermore, an extremely high MMR value (977.57/100,000 live births) was noted in August 2021 (the Delta wave). There was a significant difference in the distribution of causes of maternal death. Proportion of indirect causes were tripled during the pandemic (from 8% to 24%), with 17/104 (16.3%) deaths related to SARS-CoV-2 pneumonia.
Conclusion. In-hospital MMR increased in public hospitals of the Souss Massa region during the COVID-19 pandemic, particu larly in the third quarter of 2021.
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References
Patwardhan M, Eckert LO, Spiegel H, et al. Maternal death: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2016;34(49):6077-6083. doi: 10.1016/j.vaccine.2016.03.042
Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-e333. doi: 10.1016/S2214-109X(14)70227-X
Oliveira IMGD de, Fonseca EP da, França FMG, et al. Age and Type of Delivery as Risk Indicators for Maternal Mortality. Rev Bras Ginecol E Obstet-Gynecol Obstet. 2023;45(03):134-141. doi: 10.1055/s-0043-1768456
Souza JP, Day LT, Rezende-Gomes AC, et al. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health. 2024;12(2):e306-e316. doi: 10.1016/S2214-109X(23)00468-0
MacDorman MF, Declercq E, Thoma ME. Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006–2015. Birth Berkeley Calif. 2018;45(2):169-177. doi: 10.1111/birt.12330
Ruiz-Cantero MT, Guijarro-Garvi M, Bean DR, Martínez-Riera JR, Fernández-Sáez J. Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries. Health Place. 2019;57:313-320. doi: 10.1016/j.healthplace.2019.05.012
Kulczycki A. Maternal Mortality and Morbidity. In: Quah SR, ed. International Encyclopedia of Public Health (Second Edition). Second Edition. Academic Press; 2017:553-564. doi: 10.1016/B978-0-12-803678-5.00269-1
Merkt PT, Kramer MR, Goodman DA, et al. Urban-rural differences in pregnancy-related deaths, United States, 2011–2016. Am J Obstet Gynecol. 2021;225(2):183.e1-183.e16. doi: 10.1016/j.ajog.2021.02.028
WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. Trends in Maternal Mortality 2000 to 2020. www.who.int. Accessed January 15, 2024.
Strong K, Noor A, Aponte J, et al. Monitoring the status of selected health related sustainable development goals: methods and projections to 2030. Glob Health Action. 2020;13(1):1846903. doi: 10.1080/16549716.2020.1846903
Abouzahir H, Samir N, Belhouss A, Benyaich H. Medico-Legal Investigations in Maternal Deaths. Moroc J Public Health. 2022;9(14).
DHSA. Confidential survey on maternal deaths in 2015 in Morocco’s six priority regions. Moraccan Ministry of Health; 2015.
DPRF. Health in figures 2022. www.sante.gov.ma. Accessed January 15, 2024.
Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130-137. doi: 10.1038/s41586-022-05522-2
Pathirathna ML, Samarasekara BP, Dasanayake TS, Saravanakumar P, Weerasekara I. Adverse perinatal outcomes in COVID-19 infected pregnant women: a systematic review and meta-analysis. Healthcare (Basel). 2022;10(2):203. doi: 10.3390/healthcare10020203
Roy CM, Bollman EB, Carson LM, Northrop AJ, Jackson EF, Moresky RT. Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review. Eur J Public Health. 2021;31(3):634-640. doi: 10.1093/eurpub/ckab047
Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021;9(6):e759-e772. doi: 10.1016/S2214-109X(21)00079-6
Bouchriti Y, Kabbachi B, Sine H, et al. COVID-19 prevention and control interventions: What can we learn from the pandemic management experience in Morocco? Int J Health Plann Manage. 2022;37(3):1827-1831. doi: 10.1002/hpm.3398
Partnership for Evidence-Based Response to COVID-19. Finding a Balance: Social and Public Health Measures Morocco. https://preventepidemics.org/perc/. Accessed January 15, 2024.
Moraccan Ministry of Health. Circular 030/ 2020: Maintaining the Activity of National Maternal and Child Health Programmes during the COVID-19 Pandemic. 2020.
Population Department, Moraccan Ministry of Health. National guidelines for pregnancy, childbirth and post-partum management during the pandemic COVID-19. Accessed January 15, 2024.
Assarag B, Dujardin B, Delamou A, Meski FZ, De Brouwere V. Determinants of maternal near-miss in Morocco: too late, too far, too sloppy? PLoS One. 2015;10(1):e0116675. doi: 10.1371/journal.pone.0116675
Adu PA, Stallwood L, Adebola SO, Abah T, Okpani AI. The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review. Glob Health Res Policy. 2022;7(1):1-14.
Huntley BJF, Mulder IA, Di Mascio D, et al. Adverse Pregnancy Outcomes Among Individuals With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Systematic Review and Meta-analysis. Obstet Gynecol. 2021;137(4):585-596. doi: 10.1097/AOG.0000000000004320
Tekin AB, Yassa M, İlter PB, et al. COVID-19 related maternal mortality cases in associated with Delta and Omicron waves and the role of lung ultrasound. Turk J Obstet Gynecol. 2022;19(2):88. doi: 10.4274/tjod.galenos.2022.36937
Takemoto MLS, Menezes MDO, Andreucci CB, et al. The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting. Int J Gynecol Obstet. 2020;151(1):154-156. doi: 10.1002/ijgo.13300
Mendez-Dominguez N, Santos-Zaldívar K, Gomez-Carro S, Datta-Banik S, Carrillo G. Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year. BMC Public Health. 2021;21(1):1-9. doi: 10.1186/s12889-021-11325-3
Atak Z, Rahimli Ocakoglu S, Topal S, Macunluoglu AC. Increased maternal mortality in unvaccinated SARS-CoV-2 infected pregnant patients. J Obstet Gynaecol. 2022;42(7):2709-2714. doi: 10.1080/01443615.2022.2099255
Lumbreras-Marquez MI, Fields KG, Campos-Zamora M, et al. A forecast of maternal deaths with and without vaccination of pregnant women against COVID-19 in Mexico. Int J Gynecol Obstet. 2021;154(3):566-567. doi: 10.1002/ijgo.13788
High Commission for Planning. Sustainable Development Goals in Morocco in the Context of the COVID-19 Pandemic. www.hcp.com. Accessed January 15, 2024.
Moraccan Ministry of Health, DPRF/DPE/SEIS. National Population and Family Health Survey (NPFHS - 2018). www.sante.gov.ma. Accessed January 15, 2024.
Ackerman CM, Nguyen JL, Ambati S, et al. Clinical and Pregnancy Outcomes of Coronavirus Disease 2019 among Hospitalized Pregnant Women in the United States. Open Forum Infect Dis. 2022;9(2). doi: 10.1093/ofid/ofab429
Torres-Torres J, Martinez-Portilla R, Espino-y-Sosa S, et al. Comorbidity, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS-CoV-2 infection: analysis of 13 062 positive pregnancies including 176 maternal deaths in Mexico. Ultrasound Obstet Gynecol. 2022;59(1):76-82. doi: 10.1002/uog.24797
Snelgrove JW, Simpson AN, Sutradhar R, Everett K, Liu N, Baxter NN. Preeclampsia and Severe Maternal Morbidity During the COVID-19 Pandemic: A Population-Based Cohort Study in Ontario, Canada. J Obstet Gynaecol Can. 2022. doi: 10.1016/j.jogc.2022.03.008
Papageorghiou AT, Deruelle P, Gunier RB, et al. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol. 2021;225(3):289.e1-289.e17. doi: 10.1016/j.ajog.2021.05.014
Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis. J Pregnancy. 2021;2021:8870129. doi: 10.1155/2021/8870129
Howell DEA, Ahmed MZN. Eight steps for narrowing the maternal health disparity gap: Step-by-step plan to reduce racial and ethnic disparities in care. Contemp Obgyn. 2019;64(1):30.
Abouchadi S, Godin I, Zhang WH, De Brouwere V. Eight-year experience of maternal death surveillance in Morocco: qualitative study of stakeholders’ views at a subnational level. BMC Public Health. 2022;22(1):2111. doi: 10.1186/s12889-022-14556-0
Boukhalfa C, Ouakhzan B, Masbah H, Acharai L, Zbiri S. Investing in midwifery for sustainable development goals in low-and middle-income countries: a cost-benefit analysis. Cost Eff Resour Alloc. 2024;22(1):1. doi: 10.1186/s12962-023-00507-y
Main EK, Markow C, Gould J. Addressing maternal mortality and morbidity in California through public-private partnerships. Health Aff (Millwood). 2018;37(9):1484-1493. doi: 10.1377/hlthaff.2018.0463
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