Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986-2010

Rose McGready, Machteld Boel, Marcus Rijken, Elizabeth Ashley, Thein Cho, Oh Moo, Moo Koh Paw, Mupawjay Pimanpanarak, Lily Hkirijareon, Verena Carrara, Khin Manug Lwin, Aung Pyae Phyo, Claudia Turner, Cindy Chu, Michele van Vugt, Ric Price, Christine Luxemburger, Feiko.O Teo Kuile, Saw Oo Tan, Stephane ProuxPratap Singhasivanon, Nicholas J White, François Nosten

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    Abstract

    Introduction: Maternal mortality is high in developing countries, but there are few data in high-risk groups such as migrants and refugees in malaria-endemic areas. Trends in maternal mortality were followed over 25 years in antenatal clinics prospectively established in an area with low seasonal transmission on the north-western border of Thailand.

    Methods and Findings: All medical records from women who attended the Shoklo Malaria Research Unit antenatal clinics from 12th May 1986 to 31st December 2010 were reviewed, and maternal death records were analyzed for causality. There were 71 pregnancy-related deaths recorded amongst 50,981 women who attended antenatal care at least once. Three were suicide and excluded from the analysis as incidental deaths. The estimated maternal mortality ratio (MMR) overall was 184 (95%CI 150–230) per 100,000 live births. In camps for displaced persons there has been a six-fold decline in the MMR from 499 (95%CI 200–780) in 1986–90 to 79 (40–170) in 2006–10, p<0.05. In migrants from adjacent Myanmar the decline in MMR was less significant: 588 (100–3260) to 252 (150–430) from 1996–2000 to 2006–2010. Mortality from P.falciparum malaria in pregnancy dropped sharply with the introduction of systematic screening and treatment and continued to decline with the reduction in the incidence of malaria in the communities. P.vivax was not a cause of maternal death in this population. Infection (non-puerperal sepsis and P.falciparum malaria) accounted for 39.7 (27/68) % of all deaths.

    Conclusions: Frequent antenatal clinic screening allows early detection and treatment of falciparum malaria and substantially reduces maternal mortality from P.falciparum malaria. No significant decline has been observed in deaths from sepsis or other causes in refugee and migrant women on the Thai–Myanmar border
    Original languageEnglish
    Article numbere40244
    Pages (from-to)1-10
    Number of pages10
    JournalPLoS One
    Volume7
    Issue number7
    DOIs
    Publication statusPublished - 2012

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    McGready, R., Boel, M., Rijken, M., Ashley, E., Cho, T., Moo, O., Paw, M. K., Pimanpanarak, M., Hkirijareon, L., Carrara, V., Lwin, K. M., Pyae Phyo, A., Turner, C., Chu, C., van Vugt, M., Price, R., Luxemburger, C., Teo Kuile, F. O., Tan, S. O., ... Nosten, F. (2012). Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986-2010. PLoS One, 7(7), 1-10. [e40244]. https://doi.org/10.1371/journal.pone.0040244