Delivery as Trauma: A Prospective Time-Cohort Study of Maternal and Perinatal Mortality in Rural Cambodia

The majority of maternal and perinatal deaths are preventable, but still women and newborns die due to insufficient Basic Life Support in low-resource communities. Drawing on experiences from successful wartime trauma systems, a three-tier chain-of-survival model was introduced as a means to reduce...

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Bibliographic Details
Published in:Prehospital and disaster medicine 2017-04, Vol.32 (2), p.180-186
Main Authors: Houy, Chandy, Ha, Sam Ol, Steinholt, Margit, Skjerve, Eystein, Husum, Hans
Format: Article
Language:English
Subjects:
Adolescent
Adult
Cambodia
Childbirth & labor
Cohort Studies
Delivery, Obstetric
Emergency Medical Services
Female
Health technology assessment
Humans
Infant
Infant mortality
Infant Mortality - trends
Infant, Newborn
Male
Maternal mortality
Maternal Mortality - trends
Medically Underserved Area
Original Research
Outcome Assessment (Health Care)
Perinatal Care
Poverty
Pregnancy
Pregnancy Complications - mortality
Pregnancy Complications - prevention & control
Preventable deaths
Prospective Studies
Risk factors
Rural health care
Rural Population
Survival
Trauma care
Young Adult
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Summary:The majority of maternal and perinatal deaths are preventable, but still women and newborns die due to insufficient Basic Life Support in low-resource communities. Drawing on experiences from successful wartime trauma systems, a three-tier chain-of-survival model was introduced as a means to reduce rural maternal and perinatal mortality. A study area of 266 villages in landmine-infested Northwestern Cambodia were selected based on remoteness and poverty. The five-year intervention from 2005 through 2009 was carried out as a prospective study. The years of formation in 2005 and 2006 were used as a baseline cohort for comparisons with later annual cohorts. Non-professional and professional birth attendants at village level, rural health centers (HCs), and three hospitals were merged with an operational prehospital trauma system. Staff at all levels were trained in life support and emergency obstetrics. Findings The maternal mortality rate was reduced from a baseline level of 0.73% to 0.12% in the year 2009 (95% CI Diff, 0.27-0.98; P
ISSN:1049-023X
1945-1938
DOI:10.1017/S1049023X1600145X