Standardizing the measurement of maternal morbidity: Pilot study results.
Maria Barreix, Kelli Barbour, Affette McCaw-Binns, Doris Chou, Max Petzold, Gathari N Gichuhi, Luis Gadama, Frank Taulo, Özge Tunçalp, Lale Say, WHO Maternal Morbidity Working Group (MMWG)
Author Information
Maria Barreix: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
Kelli Barbour: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
Affette McCaw-Binns: Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica.
Doris Chou: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
Max Petzold: Center for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden.
Gathari N Gichuhi: Maternal and Child Survival Program, Jhpiego - Kenya, Nairobi, Kenya.
Luis Gadama: Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi.
Frank Taulo: Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi.
Özge Tunçalp: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
Lale Say: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
OBJECTIVE: To field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women. METHODS: A cross-sectional study was conducted in Jamaica, Kenya, and Malawi (2015-2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD-MM. RESULTS: A total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self-reported exposure to violence. CONCLUSION: Nonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self-reporting of exposure to violence, and mental health. Further validation is needed.
