Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998-2017)

Affette McCaw-Binns; Leroy Campbell; Ardene Harris; Lesley-Ann James; Monika Asnani

doi:10.1016/j.eclinm.2021.101238

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998-2017)

EClinicalMedicine. 2021 Dec 15:43:101238. doi: 10.1016/j.eclinm.2021.101238. eCollection 2022 Jan.

Authors

Affette McCaw-Binns¹, Leroy Campbell², Ardene Harris³, Lesley-Ann James³, Monika Asnani⁴

Affiliations

¹ Department of Community Health & Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica.
² Victoria Jubilee Hospital, South-East Regional Health Authority, North Street, Kingston, Jamaica.
³ Ministry of Health & Wellness, Epidemiology Unit, 10-16 Grenada Crescent, Kingston 5, Jamaica.
⁴ Sickle Cell Unit, Caribbean Institute for Health Research, The University of the Indies, Mona Campus, Kingston 7, Jamaica.

Abstract

Background: Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998-2007 their maternal mortality ratio was 7-11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care.

Methods: Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open.

Findings: Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008-17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07-5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36-3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051).

Interpretation: MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children.

Funding: No external funding was provided.

Keywords: Direct Deaths; Jamaica; Maternal Deaths; Sickle Cell Disease; Surveillance.