Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda
Abstract Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite in...
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2025-01-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-025-02379-5 |
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| author | Manuela Straneo Lenka Beňová Thomas van den Akker Muzdalifat S. Abeid Elizabeth Ayebare Jean-Paul Dossou Greta Handing Bianca Kandeya Andrea B. Pembe Claudia Hanson |
| author_facet | Manuela Straneo Lenka Beňová Thomas van den Akker Muzdalifat S. Abeid Elizabeth Ayebare Jean-Paul Dossou Greta Handing Bianca Kandeya Andrea B. Pembe Claudia Hanson |
| author_sort | Manuela Straneo |
| collection | DOAJ |
| description | Abstract Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite increased risk, high parity women rarely use hospitals for childbirth. We assessed whether emergency referral during childbirth was associated with adverse events in high parity women in hospitals in Benin, Malawi, Tanzania and Uganda. We used e-registry data collected in 16 hospitals included in the Action Leveraging Evidence to Reduce perinatal morbidity and morTality (ALERT) trial. Main outcomes were severe maternal outcomes and in-facility peripartum death (fresh stillbirth or very early neonatal death). Main exposure was parity; emergency (in-labour) referral was included as effect modifier with potential confounders. We used multivariable logistic regression including parity/referral interaction and post-regression margins analysis. Among 80,663 births, 4,742 (5.9%) were to high parity women. One third reached hospital following emergency referral. Severe maternal outcomes and peripartum mortality were over 2.5-fold higher in high parity women with emergency referral compared to the lowest risk group. To avert these adverse events, emergency referral must be avoided by ensuring high parity women give birth in hospitals. Trial registration Pan African Clinical Trial Registry ( www.pactr.org ): PACTR202006793783148. Registered on 17th June 2020. |
| format | Article |
| id | doaj-art-dc238ad011ab4d9eb06c2589a4133988 |
| institution | Kabale University |
| issn | 1475-9276 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-dc238ad011ab4d9eb06c2589a41339882025-01-26T12:20:43ZengBMCInternational Journal for Equity in Health1475-92762025-01-0124111010.1186/s12939-025-02379-5Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and UgandaManuela Straneo0Lenka Beňová1Thomas van den Akker2Muzdalifat S. Abeid3Elizabeth Ayebare4Jean-Paul Dossou5Greta Handing6Bianca Kandeya7Andrea B. Pembe8Claudia Hanson9Health Systems and Policy Global Public Health, Karolinska InstitutetInstitute of Tropical MedicineAthena Institute, Vrije UniversityMedical College East Africa, Aga Khan UniversityDepartment of Nursing, College of Health Sciences, Makerere UniversityCentre de Recherche en Reproduction Humaine Et en Démographie (CERRHUD)Department of Student Affairs, Baylor College of MedicineCenter for Reproductive Health, Kamuzu University of Health SciencesDepartment of Obstetrics and Gynaecology, Muhimbili University of Health and Allied SciencesHealth Systems and Policy Global Public Health, Karolinska InstitutetAbstract Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite increased risk, high parity women rarely use hospitals for childbirth. We assessed whether emergency referral during childbirth was associated with adverse events in high parity women in hospitals in Benin, Malawi, Tanzania and Uganda. We used e-registry data collected in 16 hospitals included in the Action Leveraging Evidence to Reduce perinatal morbidity and morTality (ALERT) trial. Main outcomes were severe maternal outcomes and in-facility peripartum death (fresh stillbirth or very early neonatal death). Main exposure was parity; emergency (in-labour) referral was included as effect modifier with potential confounders. We used multivariable logistic regression including parity/referral interaction and post-regression margins analysis. Among 80,663 births, 4,742 (5.9%) were to high parity women. One third reached hospital following emergency referral. Severe maternal outcomes and peripartum mortality were over 2.5-fold higher in high parity women with emergency referral compared to the lowest risk group. To avert these adverse events, emergency referral must be avoided by ensuring high parity women give birth in hospitals. Trial registration Pan African Clinical Trial Registry ( www.pactr.org ): PACTR202006793783148. Registered on 17th June 2020.https://doi.org/10.1186/s12939-025-02379-5ChildbirthVulnerabilityHospitalsHigh parityEmergency referralIntrapartum care |
| spellingShingle | Manuela Straneo Lenka Beňová Thomas van den Akker Muzdalifat S. Abeid Elizabeth Ayebare Jean-Paul Dossou Greta Handing Bianca Kandeya Andrea B. Pembe Claudia Hanson Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda International Journal for Equity in Health Childbirth Vulnerability Hospitals High parity Emergency referral Intrapartum care |
| title | Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda |
| title_full | Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda |
| title_fullStr | Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda |
| title_full_unstemmed | Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda |
| title_short | Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda |
| title_sort | mixed vulnerabilities the biological risk of high parity is aggravated by emergency referral in benin malawi tanzania and uganda |
| topic | Childbirth Vulnerability Hospitals High parity Emergency referral Intrapartum care |
| url | https://doi.org/10.1186/s12939-025-02379-5 |
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