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Table 2 Burden of postpartum hemorrhage and current management in the E-MOTIVE study sites

From: Formative research to design an implementation strategy for a postpartum hemorrhage initial response treatment bundle (E-MOTIVE): study protocol

Global estimates indicate that between the years 2000 and 2017 global maternal deaths reduced by 35%, from 451 000 to 295,000 maternal deaths in 2017 [40]. During this 17 year period the global maternal mortality dropped by 2.9% on average each year. The global lifetime risk of maternal mortality in 2017 was estimated at 1 in 190 [40]
Nigeria
Nigerian women have a 1 in 21 lifetime risk of maternal death, much higher than the global average. In 2017, 23% of global maternal deaths occurred in Nigeria alone, with 67,000 reported maternal deaths. Nigeria had the fourth highest maternal mortality ratio (MMR) globally in 2017, with 917 deaths per 100,000 live births (Uncertainty Interval (UI) 658 to 1320). With an average Annual Reduction Rate (ARR) point estimate of less than 1.6% (UI -0.8 to 3.5) between 2000 and 2017, Nigeria’s annual rate of reduction in maternal deaths per 100,000 live births dropped at a lower rate than the global average during the same time period [40]. Results from a retrospective study of medical deaths in a tertiary institution in Northern Nigeria indicated that PPH accounted for 14.2% of 112 maternal deaths during a five year period [41]. Further secondary analysis research concluded that PPH was a significant contributor to obstetric hemorrhage and severe maternal outcomes in Nigerian hospitals. PPH occurred in 2.2% of births over a 1 year period, and was the most frequent obstetric complication across all facilities [9]
Tanzania
The United Republic of Tanzania reported approximately 11,000 (UI 8,100 to 14,000) maternal deaths in 2017, this was the fifth highest number of maternal deaths worldwide. Women in Tanzania are estimated to have a 1 in 36 risk of maternal death. Figures indicate that in 2017, Tanzania was estimated to have an MMR of 524 deaths per 100,000 live births (UI 399 to 712), as well as an ARR point estimate of 2.9% (UI 0.9 to 4.4) between 2000 and 2017, in line with the global average [40]. Retrospective research from 34 public hospitals in Tanzania found that of the 1,987 maternal deaths over a ten year period (2006–2015), 34% were due to eclampsia, followed by 24.6% due to obstetric hemorrhage. During this ten year period, the number of maternal deaths increased, with MMR increasing from 40.24 in 2006 to 57.94 per 100, 000 live births in 2015 [42]. Further descriptive retrospective tertiary research between 2003 and 2012 at a single center in Northern Tanzania reported an MMR of 492.1 per 100,000 live deliveries, in line with previously reported WHO mortality estimates. Postpartum hemorrhage was found to be the leading cause of maternal death during the study period, accounting for 19.2% of maternal mortality [43]
South Africa
Women in South Africa have a lifetime risk of maternal death of 1 in 330; this risk is lower than the estimated global average. In 2017, the number of maternal deaths in South Africa was estimated to be approximately 1,400. During this year South Africa was estimated to have an MMR point of 119 deaths per 100,000 live births (UI 96 to 153), and an ARR point estimate of 1.7% (UI 0.1 to 3), indicating that the annual rate of reduction fell at a lower rate than the global average between the years 2000 and 2017 [40]
The most recent Saving Mothers triennial report, by the National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD) in South Africa, gave obstetric hemorrhage as the cause of 624 or 16.9% of the total deaths between the years 2014 and 2017, making obstetric hemorrhage the third most common cause of maternal death during this period, with 89.5% assessed to have been preventable by better care [44]
Kenya
Kenyan women have a 1 in 76 risk of maternal death during their lifetime, higher than the global average risk. In the year 2017, it was estimated that 5,000 maternal deaths occurred in Kenya, with an MMR point of 342 deaths per 100,000 live births (UI 253 to 476) during this period. Between the years 2000 and 2017 the WHO estimated that Kenya had an ARR point of 4.3% (UI 2.4 to 5.9), indicating a lower rate of reduction in maternal deaths than the global average during the same time period [40]. In 2017, the Kenyan Ministry of Heath produced their first Saving Mothers Lives report, an enquiry into maternal deaths in Kenyan country and national referral hospitals during the year 2014. Obstetric hemorrhage was found to be the underlying cause of 192, or 40% of the 945 maternal deaths during this period [45]
Sri Lanka
Sri Lankan women have a lifetime risk of maternal death of 1 in 1,300, and are at lower risk of death than the global average. In 2017, 120 maternal deaths were reported in Sri Lanka. Figures estimate that in 2017, Sri Lanka had an MMR of 36 deaths per 100,000 live births (UI 31 to 41), as well as an ARR point estimate of 2.2% (UI 1.7 to 3.5) between 2000 and 2017 [40]. This indicates that the annual rate of reduction in Sri Lanka dropped at a lower rate than the global average over this 17-year period. Data from the most recent National Maternal Mortality Review from the Family Health Bureau, Ministry of Health Care and Nutrition of Sri Lanka reported that, in 2016 obstetric hemorrhage was the cause of 13.4% of maternal deaths in Sri Lanka, and was the leading cause of maternal death during this period. More specifically, PPH was reported as the cause of death in 8 out of 112 (7.1%) maternal deaths reported in Sri Lanka during this year (46)