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 Proux & 3 others Pratap 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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Maternal Mortality
Thailand
malaria
Malaria
Screening
Falciparum Malaria
death
Developing countries
Maternal Death
Refugees
sepsis (infection)
Sepsis
Puerperal Infection
Therapeutics
Myanmar
Pregnancy
pregnancy
Death Certificates
Prenatal Care
prenatal care

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McGready, Rose ; Boel, Machteld ; Rijken, Marcus ; Ashley, Elizabeth ; Cho, Thein ; Moo, Oh ; Paw, Moo Koh ; Pimanpanarak, Mupawjay ; Hkirijareon, Lily ; Carrara, Verena ; Lwin, Khin Manug ; Pyae Phyo, Aung ; Turner, Claudia ; Chu, Cindy ; van Vugt, Michele ; Price, Ric ; Luxemburger, Christine ; Teo Kuile, Feiko.O ; Tan, Saw Oo ; Proux, Stephane ; Singhasivanon, Pratap ; White, Nicholas J ; Nosten, François. / Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986-2010. In: PLoS One. 2012 ; Vol. 7, No. 7. pp. 1-10.
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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",
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author = "Rose McGready and Machteld Boel and Marcus Rijken and Elizabeth Ashley and Thein Cho and Oh Moo and Paw, {Moo Koh} and Mupawjay Pimanpanarak and Lily Hkirijareon and Verena Carrara and Lwin, {Khin Manug} and {Pyae Phyo}, Aung and Claudia Turner and Cindy Chu and {van Vugt}, Michele and Ric Price and Christine Luxemburger and {Teo Kuile}, Feiko.O and Tan, {Saw Oo} and Stephane Proux and Pratap Singhasivanon and White, {Nicholas J} and Fran{\~A}§ois Nosten",
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McGready, R, Boel, M, Rijken, M, Ashley, E, Cho, T, Moo, O, Paw, MK, Pimanpanarak, M, Hkirijareon, L, Carrara, V, Lwin, KM, Pyae Phyo, A, Turner, C, Chu, C, van Vugt, M, Price, R, Luxemburger, C, Teo Kuile, FO, Tan, SO, Proux, S, Singhasivanon, P, White, NJ & 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, vol. 7, no. 7, e40244, pp. 1-10. https://doi.org/10.1371/journal.pone.0040244

Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986-2010. / McGready, Rose; Boel, Machteld; Rijken, Marcus; Ashley, Elizabeth; Cho, Thein; Moo, Oh; Paw, Moo Koh; Pimanpanarak, Mupawjay; Hkirijareon, Lily; Carrara, Verena; Lwin, Khin Manug; Pyae Phyo, Aung; Turner, Claudia; Chu, Cindy; van Vugt, Michele; Price, Ric; Luxemburger, Christine; Teo Kuile, Feiko.O; Tan, Saw Oo; Proux, Stephane; Singhasivanon, Pratap; White, Nicholas J; Nosten, François.

In: PLoS One, Vol. 7, No. 7, e40244, 2012, p. 1-10.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986-2010

AU - McGready, Rose

AU - Boel, Machteld

AU - Rijken, Marcus

AU - Ashley, Elizabeth

AU - Cho, Thein

AU - Moo, Oh

AU - Paw, Moo Koh

AU - Pimanpanarak, Mupawjay

AU - Hkirijareon, Lily

AU - Carrara, Verena

AU - Lwin, Khin Manug

AU - Pyae Phyo, Aung

AU - Turner, Claudia

AU - Chu, Cindy

AU - van Vugt, Michele

AU - Price, Ric

AU - Luxemburger, Christine

AU - Teo Kuile, Feiko.O

AU - Tan, Saw Oo

AU - Proux, Stephane

AU - Singhasivanon, Pratap

AU - White, Nicholas J

AU - Nosten, François

PY - 2012

Y1 - 2012

N2 - 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

AB - 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

KW - adult

KW - article

KW - bleeding

KW - controlled study

KW - early diagnosis

KW - early intervention

KW - eclampsia

KW - female

KW - human

KW - immigrant

KW - incidence

KW - major clinical study

KW - malaria

KW - malaria falciparum

KW - maternal mortality

KW - medical record review

KW - Myanmar

KW - newborn

KW - Plasmodium vivax

KW - pregnancy

KW - prenatal care

KW - retrospective study

KW - screening test

KW - sepsis

KW - stroke

KW - Thailand

KW - thrombosis

KW - Early Diagnosis

KW - Female

KW - Hemorrhage

KW - Humans

KW - Infant, Newborn

KW - Malaria

KW - Maternal Death

KW - Pregnancy

KW - Pregnancy Outcome

KW - Refugees

KW - Sepsis

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DO - 10.1371/journal.pone.0040244

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JO - PLoS One

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