Improving maternal health and reducing related mortality have been key concerns of the international community as one of the eight Millennium Development Goals (MDG 5) [1]. However, maternal mortality accounts for only a small fraction of the overall burden of poor maternal health. Maternal morbidity – the health problems borne by women during pregnancy, childbirth and the postpartum period contribute to this burden. Yet, the true extent of maternal morbidity is unknown. It has been suggested that for each maternal death, 20 or 30 women suffer from morbidity; however, these calculations are not based on standard, well documented, and transparent methodologies [2, 3]. Overall, three major issues have limited valid, routine, and comparable measurements of maternal morbidity, the lack of a common definition and identification criteria, standardized assessment tools especially at primary health care level, and common indicators to measure morbidity [2]. Developing measurement criteria for the burden of pregnancy and post-partum related morbidity is crucial to the on-going elaboration of the post-2015 Sustainable Development Goals (SDGs) in light of required attention to morbidity as maternal deaths have dropped significantly over the past two decades [4].
In 2011, the World Health Organization (WHO) developed a common definition and identification criteria for very severe cases of maternal morbidity (maternal near-miss) allowing its routine measurement and monitoring, especially as a tool for assessment of the quality of care women with severe morbidity receive [5]. Such definition and criteria do not exist for less-severe cases along the continuum of maternal ill health. It is necessary to arrive at a common definition and to establish clear criteria for accurate and routine measurement of maternal morbidity in order to inform policy decisions, resource allocation and ultimately to launch an appropriate programmatic response that will also help in reducing maternal deaths, and long-term suffering and disability. This is particularly essential at the community and primary care levels, where most of the burden of maternal morbidity is believed to be reported [6, 7], yet instruments to quantify and measure it are currently lacking [2].
To fulfill the need to measure and respond to the full burden of maternal morbidity, WHO initiated a project, funded by the Bill and Melinda Gates Foundation, to improve the scientific basis for defining, measuring and monitoring maternal morbidity. This project aims to construct a definition and develop identification criteria for maternal morbidity, estimate the burden of individual causes or determining factors of maternal morbidity based on existing evidence, develop and test an assessment tool for measuring maternal morbidity in low- and middle-income countries, and develop indicators for maternal morbidity.
The project is led and carried out by a technical working group, the Maternal Morbidity Working Group (MMWG), composed of obstetricians, physicians, midwives, epidemiologists, medical anthropologists, public health professionals and patient advocates from high-, middle- and low-income countries [2]. The WHO MMWG was initially convened in April 2012. Participants were invited to join the working group based upon their known technical expertise in quantitative and qualitative maternal health research, maternal health programs, contributions to other related research initiatives or membership on WHO technical advisory groups or with potential links to this work, consumer perspective, and to ensure regional and gender balance. Where this paper reports decisions by the MMWG, these were made by consensus discussions during five WG meetings (April and August 2012, February 2013, February and October 2014) as well as interim electronic communication.
Since 2012, the MMWG has elaborated on maternal morbidity from different perspectives, and on the basis of existing evidence has agreed on a common framework for maternal morbidity. This body of work is intended to complement the maternal near-miss morbidity concept, whereby together they specify the full continuum of maternal morbidity [2]. This work will be incorporated in the 11th revision of the key standards for health conditions - the International Statistical Classification of Diseases and related health problems (ICD), further enhancing the sustainability of the outputs [8]. While doing so, publishing the development process to ensure transparency and encouraging further collaboration from researchers, clinicians, and other stakeholders have been key to the work of the MMWG.
The objective of this paper is to describe this concept, and the framework, for identifying and measuring “non-severe” maternal morbidity, and the maternal morbidity matrix (see Figs. 1 2, 3 and 4) which informed the development of a “morbidity” tool, which will be pilot tested for usability, feasibility, and fit for purpose (Please see Table 1 for an outline of the tool’s components). The "morbidity" tool is conceptualized to measure maternal morbidity in primary health care settings which have high levels of service demand [9]. Nonetheless, improved access is not enough, health services must also be of good quality [10]. Measuring morbidity can serve as an indicator of the quality of obstetric care [11, 12]. Ideally the long-term outputs of this project are to establish routine data collection on maternal morbidity to inform service provision at facility-level.
Read the full paper - http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0789-4
Извор: BioMed Central - 20.04.2016
