TY - JOUR
T1 - Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas
T2 - 5. Mortality assessment
AU - Perry, Henry B.
AU - Stollak, Ira
AU - Llanque, Ramiro
AU - Okari, Annah
AU - Westgate, Carey C.
AU - Shindhelm, Alexis
AU - Chou, Victoria B.
AU - Valdez, Mario
N1 - Funding Information:
This Project was supported by donors to Curamericas Global, the American people through the United States Agency for International Development (USAID)-funded Child Survival and Health Grants Program (CSHGP) [Cooperative Agreement No. AID-OAA-A-11-00041], and the Ronald McDonald House Charities. Part of Dr. Perry’s effort and the publication expenses were funded by the Bill & Melinda Gates Foundation (Investment ID OPP 1197181). Financial and in-kind support were provided by the communities themselves, particularly for the Community Birthing Centers. The implementation research activities were funded by a separate “add on” from USAID to Curamericas Global with a sub-contract to the Johns Hopkins University with Dr. Perry as principal investigator. Prior to initiation of the Project, the technical team at Curamericas Global, Curamericas/Guatemala, and the Johns Hopkins University collaborated with the technical team at the CSHGP to finalize the implementation research questions and protocol. None of the donors had any further role in the research activities. Support for part of Dr. Perry’s effort and for publication expenses was funded by the Bill & Melinda Gates Foundation (Investment ID OPP 1197181).
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/2
Y1 - 2023/2
N2 - Background: The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality. Methods: The Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST). Findings: The leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively. Conclusion: The baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond.
AB - Background: The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality. Methods: The Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST). Findings: The leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively. Conclusion: The baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond.
KW - Care Groups
KW - Census-Based, Impact-Oriented Approach
KW - Child health
KW - Child mortality
KW - Community birthing centers
KW - Community health
KW - Community-based primary health care
KW - Curamericas Global
KW - Curamericas/Guatemala
KW - Equity
KW - Guatemala
KW - Implementation research
KW - Maternal health
KW - Maternal mortality
KW - Mortality assessment
KW - Primary health care
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U2 - 10.1186/s12939-022-01757-7
DO - 10.1186/s12939-022-01757-7
M3 - Article
C2 - 36855128
AN - SCOPUS:85149153679
SN - 1475-9276
VL - 21
JO - International journal for equity in health
JF - International journal for equity in health
M1 - 198
ER -