The Evolving Contribution of Non-Communicable Diseases to Maternal Mortality in Jamaica, 1998-2015: a Population-Based Study.

Objective To describe trends in indirect cause-specific pregnancy-related mortality from 1998 to 2015. Design Secondary analysis of annual, national cross-sectional database of maternal and late maternal deaths, identified through active surveillance of deaths among women aged 10-50 years. Setting Jamaica, a middle-income Caribbean country. Population Maternal and late maternal deaths. Methods Descriptive trend analyses of demographic and cause-specific maternal and pregnancy-related mortality ratios undertaken comparing the periods 1998-2003, 2004-2009 and 2010-2015. Multivariate logistic regression was used to confirm changes in risk of indirect death. Main outcome measures Maternal, pregnancy-related, direct, indirect and cause-specific mortality ratios (deaths/100 000 live births). Results Maternal deaths from indirect conditions increased between the first two periods (P= 0.004) and stabilised in the third (P = 0.085). Associated with upward movement in cardiovascular deaths (P-[trend] = 0.003), women under 25 years were at elevated risk (odds ratio 1.44, 95% CI 1.00-2.08; P = 0.052). Haematological/immunological conditions (69% sickle cell disease) ranked second but did not vary with time. Health service utilisation was similar across age, parity, health region and major cause categories (non-communicable diseases, non-obstetric infections, direct), however women with indirect conditions spent more time in hospital (median 5 days versus 3 days) and more often died after the puerperium. Conclusions Medical conditions, especially cardiovascular disease, are increasingly associated with maternal and late maternal mortality. Middle-income countries need to simultaneously improve management of indirect conditions, while redoubling efforts to reduce direct deaths. Postpuerperal medical services should be integrated into routine infant health services to improve continuity of care during this high-risk period.