Background: Since 1976, Bicol Region had higher maternal mortality ratio (MMR) than the Philippine average and became the fourth region with the highest MMR in 2012. Looking at trends of maternal health outcomes and determining risk factors among mothers who died may guide interventions to reduce MMR. Objectives: To determine the changes in maternal mortality ratio (MMR) in the Bicol region from 2004 to 2017 and determine the sociodemographic profile of pregnant women who died from 2015 to 2018. Materials and Methods: A records review of Bicol?s Regional Field Health Services Information System from 2004 to 2017 and maternal death review reports from 2015 to 2018 was done. Changes in MMR was determined using Poisson regression. The sociodemographic characteristics and causes of maternal deaths were analyzed using frequencies and proportion. Results: From 2004 to 2017, MMR of 100.9 remained higher than the regional target of 31.6. Significant reductions in MMR were achieved in 2007 to 2008 and in 2011 to 2012 wherein MMR ranged between 75.3 to 89.3. However, by the end of 2012, maternal deaths again increased which reached 122.5 in 2017. From the maternal death reviews, it was observed that 29.5% of maternal deaths were aged 35 years and above and 7.5% were less than 20 years old. Mothers who had more than five pregnancies were 30.1% of total deaths. In terms of place of death, 15.7% died at home or in-transit to referral facilities. Hemorrhage or hypertension-related causes were the leading reasons for maternal deaths. Conclusion Significant reduction in MMR was not sustained after 2012 and higher deaths were reported in the succeeding years. Maternal deaths can be further reduced by using a systems approach, by promoting family planning, and by strengthening service delivery networks to effectively manage hemorrhage and hypertension-related emergencies.
Maternal Mortality ; Maternal Health

Background Background. Establishing and integrating Basic Emergency Obstetrics and Newborn Care (BEmONC)-capable facilities into the healthcare delivery system is one of the strategies employed by the Philippine government to address high maternal mortality. Objectives. This study aimed to determine the functionality of BEmONC-capable rural health units (RHUs) in Luzon, the largest island in the country. Methods. The study utilized a researcher-administered facility survey and facility observation using a checklist designed to measure BEmONC functionality. Facilities were selected through a two-stage sampling method. A BEmONC Score Card was used to determine the overall functionality of a facility based on three categories — institutional capacity, service capacity, and personnel capacity. The total scores from the three categories provided the overall functionality score.Results. Of the 245 BEmONC-provider RHUs included in the study, 85 (35%) were adequately functional. The mean functionality score for Luzon (60±25.27) corresponded to adequate functionality. The mean institutional and service capacities were consistently high across all regions on the island. Still, the personnel capacity did not reach the minimum average, pulling down the overall score and leading to low overall functionality. Conclusion. The BEmONC facilities continue to function despite being hampered by factors that can be easily remedied. The provision of BEmONC services remains relevant across all regions in Luzon as they fill in the gaps and serve the needs of mothers and pregnant women. This study should be replicated in the Visayas and Mindanao to obtain a complete representation of the BEmONC program.
Maternal Mortality

A survey was conducted in 7 provinces representative for 7 ecological zones of the country. The aim was to determine mother’s mortality, direct and indirect causes of the death and factors related to mother’s mortality of 61.341 women who gave birth living infants. The estimative of mother’s mortality was 165/100.000 living born children. The risk of mother mortality accounted for 1/334. Direct fatal causes included hemorrhage, pre-eclampsy, infection, complication of artificial abortion, uterin breakage, ectopic pregnancy… Indirect causes included heart disease, hepatitis or liver diseases, cerebrovascular accidents, tuberculosis and malaria. In addition, family factors, economic and culture factors, customs and behaviors were also the factors to ban the accessibility of women to reproductive health.
Maternal Mortality ; Epidemiology ; Mortality

Introduction: Implementation of Basic Emergency Obstetric and Newborn Care (BEmONC) aims to curb maternal mortality. However, the Philippines failed to significantly reduce the maternal mortality rate (MMR) targeted in the Millennium Development Goals (MDGs). Currently, the country is still far from the targeted Sustainable Development Goals (SDGs). This review describes the historical development of BEmONC in the Philippines over the past 13 years and provides insights on its role in decreasing MMR. Methods: We searched online for journal articles, publications, reports, policies, and other issuances related to BEmONC and maternal health in the Philippines. We accessed updates and data via correspondence with the Department of Health (DOH). Statistics were compiled from public databases. The identified citations were screened, appraised, synthesized, and analyzed in a historical approach. Results: A direct result of the Emergency Obstetric Care Approach, BEmONC was developed to respond to the high MMR in the Philippines, in line with global efforts to improve maternal health. However, BEmONC functionality generally remained inadequate. Conclusions Although the provision of BEmONC services increased facility-based deliveries and skilled birth attendance during childbirth, this failed to decrease MMR and achieve targeted goals substantially. Further capacity-building is needed, especially in rural and resource-poor areas. Government issuances at the national and local levels should be aligned to complement each other. There should be a health systems approach that considers the building blocks of an efficient health care system and the social determinants that impact them.
Maternal Health Services ; Maternal Mortality

Background: Teaching clinics provide low-cost health programs while offering valuable learning opportunities for student clinicians, which then contributes to increasing health care accessibility. To date, there is a paucity of literature exploring the satisfaction of patient seen in rehabilitation teaching clinics in developing countries. The Service Quality (ServQual) Scale is a valid and reliable tool that has been used to measure client satisfaction in different work settings and industries.

Objectives: The aim of this study was to demonstrate the usefulness of ServQual
in measuring the satisfaction of clients in a rehabilitation teaching clinic in a developing country.

Methodology: A cross-sectional survey was conducted for three months among CTS-AA (Clinic for Therapy Services- Adult and Adolescent Section) clients who are at least 18 years old; have attended at least three sessions; and can read. Prior to
administration in CTS-AA, the ServQual scale was translated to Filipino, validated
and pilot tested for reliability.

Results: Thirty-two respondents were included in the analysis. there was no
statistically significant difference between the expectation and the perceptions
of the clients for the domains of reliability (z=1.799, p=0.0721),responsiveness (z=0.839, p=0.4013), assurance (z=1.914, p=0.0556) and empathy (z=1.772, p=0.0764). However, there was a statistically significant difference between the clients' perception and expectation for tangibles (z=4.117, p<0.0001) and between the overall client perception and expectation (z=4.086, p<0.0001).The overall ServQual score for CTS-AA is -0.3782.

Conclusion: The ServQual has been shown to be useful in assessing the satisfaction of clients in rehabilitation clinics and the specific areas that needs improvement. The tool can still be further improved by including items on cost, relationship of students with supervisors and outcomes of treatment.

No abstract available.
Critical Care* ; Maternal Mortality*

The research was performed on 2,822 birth-related deaths in women aged 15-49 at 3 provinces Quang Ngai, Song Be and Vinh Phó during 1994-1995. Bleeding was the leading cause of death (55.1%), followed by gestational toxicity and eclampsia (13.04%), uterine rupture (12.3%), umbilical infection and tetanus (10.9%) that occurred only in remote areas and induced abortion (1.89%). Source of this situation related to awareness of pregnant women, specialist level and antenatal care has not met the requirements in fact. Training approaches and favorable treatment policies for primary health workers are needed
Maternal Mortality ; death

Maternal Mortality ; Malaysia

Introduction: There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates. Materials and Methods: A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management. Results: There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births. Conclusion Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes.
Maternal Mortality ; Fetus ; Morbidity

Female ; Humans ; Maternal Health Services ; Maternal Mortality ; Pregnancy