Scientists at the Research Center on Population’s Health of the National Institute of Public Health (INSP) conducted a study to determine the day and time when there is an increased risk of maternal death, considered by the World Health organization (WHO) as the leading cause of death in women of reproductive age.

Maternal mortality, defined by the WHO, occurs when a woman is pregnant or within 42 days after termination of pregnancy, from any cause related or aggravated by the pregnancy or its care.

According to estimates by the United Nations Population Fund (UNFPA), more than 500 thousand women and girls die every day from complications related to pregnancy and childbirth; by receiveing timely care, 95 percent of these deaths could be prevented, estimates the Pan American Health Organization (PAHO).

The research, led by Hector Lamadrid Figueroa, head of the INSP Department of Health and Gender, was to determine the risk of maternal death per day of the week and time of the day in health institutions, through a multiple statistical analysis using data from information systems of the Directorate General of Health Information.

Lamadrid Figueroa, Doctor in Science with emphasis on epidemiology, said that even though risk factors are known (such as maternal age, socioeconomic aspects, lack of prenatal care), there are others still unknown, occurring within hospitals and clinics.

In Mexico, he said, nearly 99 percent of deliveries both vaginal or through C. section are cared in health institutions, where quality of care changes during the day. From the statistical analysis, the researchers found that the risk of hospital maternal death is highest during the night, almost double compared to the morning shift. At night there is a steady, gradual increase and reaches a peak roughly at five or six o’clock in the morning.

On the other hand, the scientists detected risk peaks at key times, for example during shift changes: During the shift change in the morning, and between 14:00 and 15:00, when there is another shift change, during this time increases risk of maternal death.

The researchers also found a higher risk in weekends and public holidays in comparison with working days (Monday to Friday). During public holidays and weekends there is a slightly different pattern to that seen during the days of the week: there is not a marked increased risk during shift changes, but there is a particularly high risk during nights compared with mornings.

These results are very important because they make us think how the institutions function. On the one hand, there is evidence that was never documented before. There are certain harmful practices that should be avoided; for example, the staff is more focused on the morning shift, and at night there are fewer personnel, Lamadrid Figueroa said.

He explained that unlike Mexico, in other countries like the United Kingdom, there are hospitals that have the same number of staff 24 hours a day throughout the year. Dr. Lamadrid Figueroa said that the reason for these studies is to influence health policies to benefit women mothers.

With this research the researchers seek to let health authorities know the importance of improving the quality of care in hospitals and clinics in Mexico. First, stricter policies for obstetric care 24 hours a day should be stablished: improve the care given at night and in the afternoon to reach the standards reached in the morning, the researchers said.  They estimate that achieving that goal would reduce maternal deaths by approximately 20 percent.

Dr. Lamadrid Figueroa said that although maternal mortality has declined in Mexico in recent years, it still represents a challenge for the health system, where it has managed not meet one of the Millennium Development Goals, which consisted three – quarters in decreasing maternal mortality from 1990 to 2015.

The project is part of a broader research led by Dr. Rafael Lozano, a researcher at the Institute for Metrics and Evaluation in Health, located in Seattle, United States.

 

Source: Agencia Informativa CONACYT