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Delivery as Trauma: A Prospective Time-Cohort Study of Maternal and Perinatal Mortality in Rural Cambodia

Published online by Cambridge University Press:  26 January 2017

Chandy Houy ,
Sam Ol Ha ,
Margit Steinholt ,
Eystein Skjerve  and
Hans Husum
Chandy Houy
Affiliation:
Trauma Care Foundation Cambodia, Battambang, Cambodia
Sam Ol Ha
Affiliation:
Trauma Care Foundation Cambodia, Battambang, Cambodia
Margit Steinholt
Affiliation:
Tromso Mine Victim Resource Centre, University Hospital Northern Norway, Department of Community Medicine, University of Tromso, Tromso, Norway
Eystein Skjerve
Affiliation:
Department of Food Safety and Infection Biology, Norwegian University of Life Sciences, Oslo, Norway
Hans Husum*
Affiliation:
Department of Community Medicine, University of Tromso, Tromso, Norway
*
Correspondence: Hans Husum, MD, PhD N-9690 Havoysund, Norway E-mail: husumhans@gmail.com
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Abstract

Objective

The majority of maternal and perinatal deaths are preventable, but still women and newborns die due to insufficient Basic Life Support in low-resource communities. Drawing on experiences from successful wartime trauma systems, a three-tier chain-of-survival model was introduced as a means to reduce rural maternal and perinatal mortality.

Methods

A study area of 266 villages in landmine-infested Northwestern Cambodia were selected based on remoteness and poverty. The five-year intervention from 2005 through 2009 was carried out as a prospective study. The years of formation in 2005 and 2006 were used as a baseline cohort for comparisons with later annual cohorts. Non-professional and professional birth attendants at village level, rural health centers (HCs), and three hospitals were merged with an operational prehospital trauma system. Staff at all levels were trained in life support and emergency obstetrics.

Findings

The maternal mortality rate was reduced from a baseline level of 0.73% to 0.12% in the year 2009 (95% CI Diff, 0.27-0.98; P<.01). The main reduction was observed in deliveries at village level assisted by traditional birth attendants (TBAs). There was a significant reduction in perinatal mortality rate by year from a baseline level at 3.5% to 1.0% in the year 2009 (95% CI Diff, 0.02-0.03; P<.01). Adjusting maternal and perinatal mortality rates for risk factors, the changes by time cohort remained a significant explanatory variable in the regression model.

Conclusion

The results correspond to experiences from modern prehospital trauma systems: Basic Life Support reduces maternal and perinatal death if provided early. Trained TBAs are effective if well-integrated in maternal health programs.

HouyC, HaSO, SteinholtM, SkjerveE, HusumH. Delivery as Trauma: A Prospective Time-Cohort Study of Maternal and Perinatal Mortality in Rural Cambodia. Prehosp Disaster Med. 2017;32(2):180–186.

Keywords

Cambodiamaternal mortalityprehospitaltraditional birth attendanttrauma system
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 2 , April 2017 , pp. 180 - 186
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest: All authors confirm that there are no conflicts of interest, copyright constraints, or industry funding to report for any of the authors. The views expressed in this article are those of the authors and do not reflect the policy or position of any institution.

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