Cargando…

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

BACKGROUND: Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obs...

Descripción completa

Detalles Bibliográficos
Autores principales: McCaw-Binns, Affette, Campbell, Leroy, Harris, Ardene, James, Lesley-Ann, Asnani, Monika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683691/
https://www.ncbi.nlm.nih.gov/pubmed/34977515
http://dx.doi.org/10.1016/j.eclinm.2021.101238
_version_ 1784617470831624192
author McCaw-Binns, Affette
Campbell, Leroy
Harris, Ardene
James, Lesley-Ann
Asnani, Monika
author_facet McCaw-Binns, Affette
Campbell, Leroy
Harris, Ardene
James, Lesley-Ann
Asnani, Monika
author_sort McCaw-Binns, Affette
collection PubMed
description BACKGROUND: Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. METHODS: Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. FINDINGS: Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008–17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07–5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36–3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). INTERPRETATION: MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. FUNDING: No external funding was provided.
format Online
Article
Text
id pubmed-8683691
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-86836912021-12-30 Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017) McCaw-Binns, Affette Campbell, Leroy Harris, Ardene James, Lesley-Ann Asnani, Monika EClinicalMedicine Research paper BACKGROUND: Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. METHODS: Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. FINDINGS: Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008–17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07–5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36–3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). INTERPRETATION: MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. FUNDING: No external funding was provided. Elsevier 2021-12-15 /pmc/articles/PMC8683691/ /pubmed/34977515 http://dx.doi.org/10.1016/j.eclinm.2021.101238 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research paper
McCaw-Binns, Affette
Campbell, Leroy
Harris, Ardene
James, Lesley-Ann
Asnani, Monika
Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)
title Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)
title_full Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)
title_fullStr Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)
title_full_unstemmed Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)
title_short Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)
title_sort maternal mortality among women with sickle cell disease in jamaica over two decades (1998–2017)
topic Research paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683691/
https://www.ncbi.nlm.nih.gov/pubmed/34977515
http://dx.doi.org/10.1016/j.eclinm.2021.101238
work_keys_str_mv AT mccawbinnsaffette maternalmortalityamongwomenwithsicklecelldiseaseinjamaicaovertwodecades19982017
AT campbellleroy maternalmortalityamongwomenwithsicklecelldiseaseinjamaicaovertwodecades19982017
AT harrisardene maternalmortalityamongwomenwithsicklecelldiseaseinjamaicaovertwodecades19982017
AT jameslesleyann maternalmortalityamongwomenwithsicklecelldiseaseinjamaicaovertwodecades19982017
AT asnanimonika maternalmortalityamongwomenwithsicklecelldiseaseinjamaicaovertwodecades19982017