First study to uncover significant burden of ill-health for women during and after pregnancy in India, Pakistan, Kenya and Malawi

News article 9 May 2018
© 2013 Ismail Ferdous, Bangladesh, Courtesy of Photoshare

Non-life threatening maternal morbidity (ill-health) is a relatively new concept internationally. Researchers from the Centre for Maternal and Newborn Health (CMNH) have just published the first study to comprehensively measure the burden of non-acute maternal morbidity during and after pregnancy in four low- and middle-income countries: India, Pakistan, Malawi and Kenya. They used a standardised approach to assess the physical, psychological, and social components of ill-health, in combination with objective clinical and laboratory measurements. The study is published in BMJ Global Health:

Key findings
Of 11,454 women included in the study:

  • Almost 3 out of 4 women had one or more symptom (73.5%), abnormalities on clinical examination (71.3%) or laboratory investigation (73.5%).
  • In total, 9.0% of women had an identified infectious disease (HIV, malaria, syphilis, chest infection or tuberculosis); and 32.5% had signs of early infection.
  • Overall, 47.9% of women were anaemic, 11.5% were diagnosed with other medical or obstetric morbidity, 25.1% of women reported psychological morbidity and 36.6% reported social morbidity (domestic violence and/or substance misuse).
  • Maternal morbidity was not limited to a core ‘at risk’ group; only 1.2% of women had a combination of all four morbidities.

How might this affect practice?
For the first time, this study highlights a significant burden of ill-health during and after pregnancy that has largely been ‘hidden’ and/or underestimated. Currently, when women attend for antenatal and postnatal care in low- and middle-income settings, their heath needs are not assessed; and point-of-care tests and screening for psychological and social morbidity are not routinely available at primary and secondary level. It is important to use the data from this study to improve the content and quality of antenatal and postnatal care packages so that women’s health needs during and after pregnancy are assessed and that individualised care which meets the identified health needs of each woman is provided.

Dr Mary McCauley, Senior Clinical Research Associate at the Centre for Maternal and Newborn Health:
“The team at the Centre for Maternal and Newborn Health at LSTM are delighted that the BMJ Global Health has published our study, and that for the first time, maternal ill-health has been measured in a comprehensive and holistic approach in women in India, Pakistan, Kenya and Malawi. The results of this study will be used to improve the care women receive during and after pregnancy in low resource settings.”