Volume 122, Issue 2 p. 228-236
Original Article

Surgically avertable burden of obstetric conditions in low- and middle-income regions: a modelled analysis

H Higashi

Corresponding Author

H Higashi

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

School of Population Health, University of Queensland, Brisbane, Qld, Australia

Correspondence: H Higashi, PhD, Institute for Health Metrics and Evaluation, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA. Email [email protected]Search for more papers by this author
JJ Barendregt

JJ Barendregt

School of Population Health, University of Queensland, Brisbane, Qld, Australia

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NJ Kassebaum

NJ Kassebaum

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

Division of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA

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TG Weiser

TG Weiser

Department of Surgery, School of Medicine, Stanford University, Stanford, CA, USA

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SW Bickler

SW Bickler

Department of Surgery, School of Medicine, University of California, San Diego, CA, USA

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T Vos

T Vos

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

School of Population Health, University of Queensland, Brisbane, Qld, Australia

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First published: 26 December 2014
Citations: 25
Linked article: This article is commented on by A McCaw-Binns, p. 237 in this issue. To view this mini commentary visit http://dx.doi.org/10.1111/1471-0528.13215.

Abstract

Objective

To quantify the burden of maternal and neonatal conditions in low- and middle-income countries (LMICs) that could be averted by full access to quality first-level obstetric surgical procedures.

Design

Burden of disease and epidemiological modelling.

Setting

LMICs from all global regions.

Population

The entire population in 2010.

Methods

We included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion1; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability-adjusted life years (DALYs) of these conditions into surgically ‘avertable’ and ‘non-avertable’ burdens. We applied the lowest age-specific fatality rates from all global regions to each LMIC region to estimate the avertable deaths, assuming that the differences of death rates between each region and the lowest rates reflect the gap in surgical care.

Main outcome measures

Deaths and DALYs avertable.

Results

Of the estimated 56.6 million DALYs (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million DALYs (37%) are avertable by full coverage of quality obstetric surgery in LMICs. The avertable burden in absolute term is substantial given the size of burden of these conditions in LMICs. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million DALYs) among the five conditions, followed by abortion (2.1 million DALYs).

Conclusions

Improving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs.