Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis


Fuhr, DC; Calvert, C; Ronsmans, C; Chandra, PS; Sikander, S; de Silva, MJ; Patel, V; (2014) Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis. The lancet Psychiatry, 1 (3). pp. 213-225. ISSN 2215-0366 DOI: https://doi.org/10.1016/S2215-0366(14)70282-2

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Abstract

SummaryBackground Although suicide is one of the leading causes of deaths in young women in low-income and middle-income countries, the contribution of suicide and injuries to pregnancy-related mortality remains unknown. Methods We did a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide or injuries, or both, in low-income and middle-income countries. We used a random-effects meta-analysis to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in low-income and middle-income countries (burns, poisoning, falling, or drowning) as suicide. Findings We identified 36 studies from 21 countries. The pooled total prevalence across the regions was 1·00% for suicide (95% CI 0·54–1·57) and 5·06% for injuries (3·72–6·58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1·68% (1·09–2·37). Americas (3·03%, 1·20–5·49), the eastern Mediterranean region (3·55%, 0·37–9·37), and the southeast Asia region (2·19%, 1·04–3·68) had the highest prevalence for suicide, with the western Pacific (1·16%, 0·00–4·67) and Africa (0·65%, 0·45–0·88) regions having the lowest. Interpretation The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in low-income and middle-income countries with wide regional variations. However, this study might have underestimated suicide deaths because of the absence of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in low-income and middle-income countries. Funding National Institute of Mental Health.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Maternal Health Group
Centre for Global Mental Health
Population Studies Group
PubMed ID: 26360733
Web of Science ID: 343703500023
URI: http://researchonline.lshtm.ac.uk/id/eprint/2212715

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