Maternal and Child Health Journal最新文献

{"title":"Determinants of Delays in Receiving Labor and Delivery Care at Health Facilities: An Analysis of the 2021 Nepal Health Facility Survey.","authors":"Rabina Dhakal, Sara Riese","doi":"10.1007/s10995-026-04290-z","DOIUrl":"10.1007/s10995-026-04290-z","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality remains a significant challenge worldwide. In Nepal, although remarkable achievements have been made, maternal mortality remains high. The three-delays framework is widely acknowledged as a framework for identifying the factors contributing to maternal mortality. This study aims to assess the extent of the third delay (delay in receiving care after arriving at a health facility) in Nepal and identify client and facility characteristics associated with this delay.</p><p><strong>Methods: </strong>This cross-sectional study utilized data from the 2021 Nepal Health Facility Survey. A total of 307 interviewed postpartum women who gave birth at a health facility were included in the study. Descriptive analysis, cross-tabulation, and multivariate regression models were used to identify variables associated with the third delay.</p><p><strong>Results: </strong>In total, 5.8% women experienced the third delay. A woman's education level was significantly associated with receiving timely care at a health facility. Women at hospitals had higher odds of experiencing a delay compared to women at local level health facilities. However, women at facilities with higher levels of technical quality of care had lower odds of experiencing a delay compared to women at facilities with lower levels of technical quality of care.</p><p><strong>Conclusions: </strong>This study found that approximately 5 in 100 women experienced a delay in receiving care after arriving at the health facility. Woman's education level, the level of health facility and quality of care contributed to the experience of the third delay. The government should consider prioritizing quality improvement of maternal health care, to reduce maternal mortality and improve maternal health.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"942-951"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Study of Internal Engagement Factors in Home Visiting Programs.","authors":"Gayane A Baziyants, Nicole Barton, David Bard, Helen Milojevich","doi":"10.1007/s10995-026-04296-7","DOIUrl":"10.1007/s10995-026-04296-7","url":null,"abstract":"<p><strong>Background: </strong>Home visiting (HV) services promote child and family well-being, with most services targeting families at risk of experiencing health disparities. Yet, services remain underutilized by eligible populations. Moreover, those who do enroll in services often drop out before receiving the full dosage of home visits.</p><p><strong>Objectives: </strong>The present study utilized the family engagement framework developed by the Cross-Model Collaboration and Data Sharing project (MODS) to examine internal constructs of engagement. Specifically, the primary study aim was to understand internal factors that may influence caregivers' decision-making when offered evidenced-based home visiting services.</p><p><strong>Methods: </strong>Participants included 19 parents ages 21 through 43 years, all identifying as female. Semi-structured qualitative interviews were conducted on Zoom and then transcribed. Thematic analysis was conducted to draw out themes and subthemes using NVivo 14.</p><p><strong>Results: </strong>Parents perceived the in-home service model and HV provision of support as appealing aspects of HV. Most parents were satisfied with their current areas of parenting but expressed interest in learning new parenting strategies. Parents needed more information about HV providers to aid their decision to enroll and simplified enrollment processes.</p><p><strong>Conclusions for practice: </strong>Results suggest enhancing the enrollment process by providing more information about provider qualifications and minimizing administrative burdens, which in turn may increase family engagement with HV.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"934-941"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant Mortality Rates of Non-Hispanic White and African-American Term Births: The Effect of Acknowledged Fathers' Education.","authors":"Abigail Whitney, Kristin M Rankin, James W Collins","doi":"10.1007/s10995-026-04306-8","DOIUrl":"10.1007/s10995-026-04306-8","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the extent to which acknowledged fathers' education attainment is associated with the infant mortality rate of term births to African-American and non-Hispanic White women. We hypothesized that African American (compared to non-Hispanic White) term births would have a greater percentage of first-year deaths attributable to low paternal education attainment.</p><p><strong>Methods: </strong>Stratified and multivariable regression analyses were performed on the 2018-2019 National Center for Health Statistics US cohort-linked live birth-infant death data files. Only term (37-42 weeks) singleton births to non-Hispanic White (n = 2,937,995) and African-American (n = 508,374) U.S.-born women with acknowledged fathers and a non-missing value for paternal education were included.</p><p><strong>Results: </strong>Paternal low education attainment was higher among births to African-American women compared to non-Hispanic White women. In both races, infant mortality rates decreased with higher levels of paternal education attainment. When controlling for traditional maternal risk factors, the relative risk of infant mortality for births to fathers with < 12 years of education compared to a bachelor's degree or higher equaled 1.59 (1.18-2.14) and 1.55 (1.35-1.77) for African-American and non-Hispanic White births, respectively. A greater percentage of term infant mortality was attributable to low paternal education attainment (< 12 years) in births to African-American (compared to non-Hispanic White) women (6.5% vs. 5.4%).</p><p><strong>Conclusions: </strong>Acknowledged fathers' education attainment is a determinant of term infant first-year mortality.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"893-898"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracting Signs and Symptoms of Hypertensive Disorders in Pregnancy from Clinical Notes Using Natural Language Processing.","authors":"Jihye Kim Scroggins, Zhihong Zhang, Ismael I Hulchafo, Maxim Topaz, Veronica Barcelona","doi":"10.1007/s10995-026-04275-y","DOIUrl":"10.1007/s10995-026-04275-y","url":null,"abstract":"<p><strong>Purpose: </strong>Hypertensive disorders in pregnancy (HDP) affect 16% of births in the United States. In this pilot study, we conducted a preliminary evaluation of natural language processing (NLP) in extracting signs and symptoms (SS) of HDP from clinical notes within electronic health records (EHRs).</p><p><strong>Methods: </strong>This retrospective observational pilot study used EHR data from patients admitted for labor and birth (N = 83,003 clinical notes from 17,775 patients). Four SS categories were extracted: elevated blood pressure, neurological, renal, and hepatic/hematologic. Five machine learning models and ClinicalBERT were trained and tested using five-fold cross-validation. The best-performing model was applied to the full dataset. Bivariate analyses were performed to examine (1) differences in HDP diagnoses based on ICD-10 codes (gestational hypertension, preeclampsia, and eclampsia) by SS documentation and (2) differences in SS documentation by patient race and ethnicity.</p><p><strong>Results: </strong>XGBoost demonstrated the highest macro-average F1-score (0.75). Elevated blood pressure showed the highest F1-score (0.87), followed by neurological SS (0.77). In the full dataset, 24.3% of clinical notes and 42.3% of patients had documentation of at least one SS category. A higher proportion of HDP diagnoses was observed with an increased number of SS categories documented (p < .001). A higher proportion of non-Hispanic Black patients had documentation of SS across all categories.</p><p><strong>Conclusion: </strong>NLP can extract SS with moderate accuracy, supporting feasibility for larger-scale extraction. Findings also highlight differences in SS documentation by patient race and ethnicity. Future research is needed to improve NLP performance, including expanding annotated data.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"809-819"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Motherhood for Early Maternal Bonding and Engagement.","authors":"Karina M Shreffler, Kayleigh Esparza, Tara Wyatt","doi":"10.1007/s10995-026-04272-1","DOIUrl":"10.1007/s10995-026-04272-1","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal perceptions about the importance of motherhood have been found to impact a variety of maternal well-being outcomes, but the impact of the importance of motherhood for the early maternal bonding relationship and on caregiving behaviors has not been explored. Examining attitudinal factors associated with maternal-infant bonding or early caregiving behaviors is essential for the development of effective interventions.</p><p><strong>Methods: </strong>Using a clinic-based, urban sample of predominately low-income and diverse pregnant women (N = 177), we used hierarchical linear regression analysis to examine whether perceptions of the importance of motherhood measured during the first trimester predicted maternal-fetal bonding measured during the second trimester, caregiving engagement at two months postpartum, and postpartum bonding measured at six months postpartum, controlling for sociodemographic characteristics and prior outcomes.</p><p><strong>Results: </strong>Perceived importance of motherhood was positively and significantly associated with higher maternal-fetal bonding (b = 1.28, p < .01), greater daily infant engagement (b = 0.57, p < .05), and higher postpartum bonding (b = 0.94, p < .01). Adjusting for prior outcomes to model temporal pathways revealed that the impact of perceived importance of motherhood for early engagement was fully attenuated by maternal-fetal bonding but remained a significant predictor of postpartum bonding.</p><p><strong>Discussion: </strong>Perceiving motherhood as important promotes early maternal bonding and caregiving behaviors, which are critical for early infant development. Preconception or parenting education programs that strive to promote the importance of motherhood through mindfulness or maternal reflective functioning interventions should be considered.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"772-779"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Status of Low-Dose Aspirin and Calcium Supplementation to Prevent Preeclampsia in Burkina Faso, Ethiopia, Kenya, Nigeria and Pakistan.","authors":"Patricia S Coffey, Kimberly Mansen, Nesibu Agonafir, Gbenga Ishola, Basilia Coefe Nitiema, Megan E Parker, Soha Randhawa, Janet Shauri, Katharine D Shelley","doi":"10.1007/s10995-026-04270-3","DOIUrl":"10.1007/s10995-026-04270-3","url":null,"abstract":"<p><strong>Purpose: </strong>Hypertensive disorders of pregnancy are a leading cause of maternal death. Global guidance recommends use of low-dose aspirin and calcium supplementation for prevention of preeclampsia. Published literature showcasing the implementation of these guidelines in low- and middle-income countries (LMICs) is sparse.</p><p><strong>Description: </strong>The objective of this practice note is to share our findings related to implementation of low-dose aspirin and calcium supplementation for the prevention of preeclampsia in Burkina Faso, Ethiopia, Kenya, Nigeria and Pakistan. The experiences from these five countries can illustrate important aspects about the nature and scope of scale of these two evidence-based interventions in LMICs.</p><p><strong>Assessment: </strong>Between May 2023 and March 2024, we conducted policy review and key informant interviews (n = 59) at global and country level. Implementation efforts for the two interventions show variations in the policy environment and clinical practices across countries. Progress toward scale of low-dose aspirin is hampered by variable clinical practices, low provider and community awareness, late antenatal care attendance, and under resourced health systems including weak supply chains. In the case of calcium supplementation, a complicated regimen and conditional global recommendations leaves countries without actionable plans aligning with optimal counseling models for improved adherence.</p><p><strong>Conclusion: </strong>Effective implementation of low-dose aspirin and calcium supplementation for preeclampsia prevention will require strengthening antenatal care and provision of services at the primary health care level and enabling the policy environment where needed. Increased coordination around a package of interventions aimed at reducing preeclampsia will also be critical going forward. Practice recommendations on policy, demand, clinical implementation, and monitoring are summarized.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"731-741"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Determinants for Home Births in Rural Sierra Leone: A Cross-Sectional Study.","authors":"Jenny Wussow, Tatyana D Fedorova, Moses Ibrahim Conteh, Sebastian Starling, Rosa Roemers, Amadu Wurie Bah, Ishmael Abu Kalokoh, Haja Sarrah Sheriff, Abubakarr Dumbuya, Zainab Matilda Sankoh, Håkon Angell Bolkan, Josien Westendorp, Rugiatu Jalloh, Lena Skovgaard Andersen, Monica Lauridsen Kujabi","doi":"10.1007/s10995-026-04277-w","DOIUrl":"10.1007/s10995-026-04277-w","url":null,"abstract":"<p><strong>Introduction: </strong>Sub-Saharan Africa and Sierra Leone bear one of the world's highest maternal mortality rates. In rural Sierra Leone, 19% of births occur at home, contributing to high maternal mortality ratios. This study aims to identify characteristics and reasons for home births among women in the rural Mathonkara Catchment area in Sierra Leone.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 555 women of childbearing age in the Mathonkara Catchment area, Tonkolili district. Data was collected between February 25 and May 12, 2023. A structured questionnaire assessed birthplaces, demographic characteristics, maternal health indicators, care seeking behaviours, and previous experiences of care at health facilities.</p><p><strong>Results: </strong>The prevalence of home births was 26.67%. Characteristics associated with home births include the experience of feeling like health care workers did not care about your life (AOR = 19.11; 95% CI:1.57-799.61), a distance of > 1 km to the nearest health facility (AOR = 7.15; 95% CI:3.12-16.51), ≤ 3 antenatal care visits (AOR = 4.84; 95% CI:2.37-10.14), and previous homebirths (AOR = 4.17; 95% CI:2.42-7.30). Common reasons for home births were labour occurring at nighttime, transportation costs and availability, and health care service costs.</p><p><strong>Conclusions for practice: </strong>The factors influencing home births in rural Sierra Leone are multifaceted. To improve maternal outcomes, it is crucial to address the challenges that impede facility-based births, including quality of care and respectful care at health facilities, distance, economic costs of reaching facilities, and transportation challenges such as quality of roads and availability of transportation.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"864-874"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's Autonomy and Respectful Maternity Care in Zambia: A Cross-Sectional Study Using Validated Patient-Reported Measures.","authors":"Atika Khalaf, Francis Sichimba, Kalunga Cindy Nakazwe, Lena Halawi","doi":"10.1007/s10995-026-04278-9","DOIUrl":"10.1007/s10995-026-04278-9","url":null,"abstract":"<p><strong>Objective: </strong>Although women's autonomy is key to patient care, the extent to which patients exercise autonomy during clinical consultations in resource-limited contexts such as Zambia remains unknown. This study aimed to examine women's experiences of autonomy in decision-making and respectful treatment in Zambian maternal healthcare.</p><p><strong>Methods: </strong>The study was conducted in Lusaka and used a cross-sectional survey design. The sample consisted of 305 women who were conveniently recruited. Data was collected using a questionnaire consisting of sociodemographic data and two validated instruments: the 7-item Mothers Autonomy and Decision-Making Scale (MADM), and the 14-item Measure of Respect (MOR) index.</p><p><strong>Results: </strong>Higher levels of decision-making autonomy, according to MADM, are significantly associated with higher levels of perceived respect in maternal healthcare settings, according to MOR (p < .001). Furthermore, higher education was found to correlate significantly with higher autonomy and respect (p < .001). Both instruments showed an excellent (MADM) and good (MOR) internal consistency among this sample (Cronbach's alpha = 0.959 and 0.851, respectively). Overall, while there's significant variation in responses, there is a slight tendency towards positive experiences in both autonomy and respect in maternal healthcare settings.</p><p><strong>Conclusions for practice: </strong>Health authorities should promote the implementation of autonomous and respectful care for all women, regardless of socioeconomic or educational background, and provide a supportive environment that fosters user participation in decision-making.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"831-842"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Inflammatory Biomarkers at 28 Weeks of Pregnancy and Childhood Adiposity at Age 7 and 13 Years in the Seychelles Child Development Study.","authors":"M Kahwaji, E M McSorley, A J Yeates, M S Mulhern, T Spence, W Crowe, P Allsopp, E Shroff, C Shamlaye, J J Strain, E van Wijngaarden","doi":"10.1007/s10995-026-04263-2","DOIUrl":"10.1007/s10995-026-04263-2","url":null,"abstract":"<p><strong>Introduction: </strong>Dysregulated inflammation during pregnancy can result in an adverse intrauterine environment, potentially disrupting fetal growth and development and increasing the risk of childhood obesity. This study aimed to assess the association between maternal inflammation during the second trimester of pregnancy and childhood adiposity at ages 7 and 13 years.</p><p><strong>Methods: </strong>Utilizing the Seychelles Child Development Study Nutrition Cohort 2 (SCDS NC2), we measured maternal inflammatory markers (IL-1β, IL-2, IFN-γ, TNF-α, IL-4, IL-5, IL-10, IL-6, CRP, MCP-1, sFlt-1, and VEGF-D) at 28 weeks gestation and childhood body mass index (BMI)-for-age z-scores, waist-to-hip circumference ratios, and the odds of overweight and obesity at ages 7 and 13 years. The associations between maternal inflammatory markers and childhood adiposity measures were analyzed using linear regression for BMI-for-age z-scores and waist-to-hip ratios and multinomial logistic regression for weight status. Potential effect modification by child sex was explored using interaction terms.</p><p><strong>Results: </strong>Among the 1,351 mother-child pairs, 57.1% of mothers, 12.3% of children at age 7 years, and 15.0% of children at age 13 years were classified with obesity. Few associations between gestational inflammatory markers and any adiposity outcome were statistically significant, and all beta coefficients were close to the null. Several associations had statistically significant sex interaction terms (p < 0.05), however most of these associations were not statistically significant.</p><p><strong>Discussion: </strong>Overall, there was no evidence of an association between second trimester maternal inflammatory markers and childhood adiposity at age 7 or 13 years in this cohort.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"780-789"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Deaths in Suriname: A Nationwide Cohort Study on Causes of Death and Lessons Learned from Facility-Based Audits.","authors":"Zita D Prüst, Kim J C Verschueren, Safir Liesdek, Fernando Rigters, Gieta Bhika-Kori, Kitty W M Bloemenkamp, Thomas van den Akker, Lachmi R Kodan","doi":"10.1007/s10995-026-04280-1","DOIUrl":"10.1007/s10995-026-04280-1","url":null,"abstract":"<p><strong>Objectives: </strong>The WHO recommends implementing the Maternal and Perinatal Death Surveillance and Response (MPDSR) cycle to evaluate and reduce perinatal mortality. We aimed to (1) assess Suriname's national perinatal mortality rate (PMR), (2) classify perinatal death causes, (3) investigate contributing modifiable factors.</p><p><strong>Methods: </strong>A nationwide, prospective cohort study of perinatal deaths in Suriname (June - December 2022). We conducted surveillance, classified causes of death and conducted audits, as part of the MPDSR cycle. We audited a random selection of cases and used quantitative analysis to report modifiable factors.</p><p><strong>Results: </strong>We identified 83 (53%) stillbirths and 72 (47%) neonatal deaths. The PMR was 28.2 per 1000 total births. Stillbirths occurred antenatally in 80% (n = 66/83), of which 49% (n = 32/66) of unknown cause. Leading causes of antepartum stillbirth were placental insufficiency and placental abruption (combined 37.8%, n = 25), often linked to hypertensive disorders of pregnancy (HDP) (n = 19). In 23 neonatal death cases, missing files hindered cause classification. Congenital anomalies (29%, n = 14/49) and infections (22%, n = 11/49) were primary causes of neonatal deaths. We reviewed 63 cases and identified 150 modifiable factors, half of which related to quality-of-care, including suboptimal antenatal care and substandard neonatal life support. Delays in seeking care and shortages of supplies and staff also contributed significantly.</p><p><strong>Conclusions: </strong>To decrease perinatal mortality, we suggest enhancing antenatal and neonatal care, by improved ultrasound, better triage, mitigating the impact of HDP, and upgrading neonatal respiratory support. Furthermore, policymakers should prioritize improving access to care, availability of trained staff and sustainable implementation of the MPDSR cycle.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"843-854"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}