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Table 2 Input parameters for direct complications of pregnancy and childbirth

From: Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria

Direct complications

Estimates

Range

Postpartum hemorrhage (PPH)

  

Incidence and mortality

  

−PPH, probability of event (range) [24, 25]

0.114

(0.051-0.228) g

−PPH, probability of morbidity (range) b[26–29]

0.008

(0.006-0.010)

−PPH, case fatality rate (CFR) [30–32]

0.010

 

−PPH, adjusted CFR (range) a

0.023

(0.007-0.030) g

Impact of interventions

  

−PPH, decrease in incidence (range) [33, 34]c, d

50%, 75% g

(25%-91%)

−PPH, decrease in case fatality rate (range) d, e[30, 35–41]

75%

(60% - 90%) g

Obstructed labor (OL)

  

Incidence and mortality

  

−OL, probability of event (range) [24, 25]

0.047

(0.030-0.074) g

−OL, probability of morbidity (range) b[26–29]

0.022

(0.018-0.026)

−OL, case fatality rate (CFR) [30–32]

0.007

 

−OL, adjusted CFR (range) a

0.019

(0.005-0.025) g

Impact of interventions

  

−OL, decrease in incidence (range) [33, 34]d

-

 

−OL, decrease in case fatality rate (range) d, e[30, 35–41]

95%

(76% - 100%) g

Hypertensive disorders of pregnancy (HD)

  

Incidence and mortality

  

−HD, probability of event (range) [24, 25]

0.035

(0.025-0.05) g

−HD, probability of morbidity (range) b[26–29]

0.001

(0.001-0.001)

−HD, case fatality rate (CFR) [30–32]

0.017

 

−HD, adjusted CFR (range) a

0.021

(0.012-0.027) g

Impact of interventions

  

−HD, decrease in incidence (range) [33, 34]d

NA

(25%-50%)

−HD, decrease in case fatality rate (range) d, e[30, 35–41]

59%

(45% - 95%) g

Sepsis

  

Incidence and mortality

  

−Probability of event (range) [24, 25]

0.050

(0.043-0.060) g

−Probability of morbidity (range) b[26–29]

0.400

(0.320-0.480)

−Case fatality rate (CFR) [30–32]

0.013

 

−Adjusted CFR (range) a

0.028

(0.009-0.036) g

Impact of interventions

  

−Decrease in incidence (range) [33, 34]c, d

25%, 50%

(0%-60%)

−Decrease in case fatality rate (range) d, e[30, 35–41]

90%

(63% - 93%) g

Unsafe abortion (UA)

  

Incidence and mortality

  

−UA, probability of event (range) f[24, 25]

0.128

(0.050-0.250)

−UA, probability of morbidity (range) b[26–29]

0.120

(0.096-0.144)

−UA, case fatality rate (CFR) [30–32]

0.003

 

−UA, adjusted CFR (range) a

0.009

(0.002-0.012)

Impact of interventions

  

−UA, decrease in incidence (range) [33, 34]d

NA

(0%-100%)

−UA, decrease in case fatality rate (range) d, e[30, 35–41]

98% c

(50% - 100%)

  1. a CFRs were adjusted based on complication severity (e.g., life threatening complications requiring cEmOC) and underlying severity of anemia [42].
  2. b Examples of nonfatal complications include Sheehan’s syndrome from obstetric hemorrhage, fistula from obstructed labor, neurologic sequelae from eclampsia, pelvic inflammatory disease (PID).Not shown but included are the risk of infertility from PID (0.086), and the risk of severe anemia following obstetric hemorrhage (0.09) [27, 43].
  3. c The incidence of sepsis reduced by 50% with SBA and clean delivery in birthing center, bEmOC, and cEmOC; and reduced by 25% with SBA and clean delivery at home [34]. Incidence of maternal hemorrhage reduced by 50%–75% depending on expectant versus active management of labor; we assume for the status quo, all cEmOC facilities provide active management, 50% of bEmOC facilities provide active management, and birthing centers/health centers provide expectant management only [33].
  4. d For each baseline estimate, sensitivity analysis was conducted across a plausible range based on literature review; references and assumptions are documented in the Additional file 1.
  5. e Estimates shown represent average reduction in case fatality rate provided complications necessitating surgery (e.g., cesarean section), blood transfusion, intensive hemodynamic support are treated in cEmOC. Obstructed labor is managed using assisted vaginal delivery with forceps or vacuum and, if necessary, cesarean section; severe pre-eclampsia and eclampsia treated with intravenous hydralazine and magnesium sulfate, in addition to induction of labor or emergency cesarean section when required; sepsis treated with ampicillin, gentamycin, and metronidazole or equivalent regimen followed by an 8-d course of intramuscular gentamycin and oral metronidazole (see Additional file 1 for details) [30, 44].
  6. f Incidence of elective abortion is 0.170, all of which are assumed to be unsafe in the base case. Case fatality rate (CFR) of safe abortion is 0.000006; representing a 98% reduction in mortality (see Text S1). Incidence of miscarriage (not shown) is 0.150 [25].
  7. g These ranges were used to assess parameter uncertainty on the incidence and CFR of direct maternal complications, and effectiveness of interventions (see Table 6).
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BMC Public Health

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