Anne CC Lee, MD1, Karen Deutsch, MPH2, Sonam Drogha, MD3, Phuntsok Dundrop, MD3, Maria Freytsis, RN, MPH3, Alan Mease, MD4, and Lee Weingrad3. (1) Department of Pediatrics, Boston University, One Boston Medical Center Place, Boston, MA 02118, 617-414-3301, email@example.com, (2) University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA 94143, (3) Surmang Foundation, Dharma Saghara Clinic, Surmang, China, (4) Department of Pediatrics, Beijing United Family Hospital, 2 Jiang Tai Lu, Beijing, China
BACKGROUND: Surmang is a rural, Tibetan region of China with limited access to maternal health services. The purpose of this study is to describe maternal health care and practices during pregnancy and childbirth. METHODS: We conducted a cross-sectional survey of women of reproductive age in Surmang, Qinghai Province, China. Due to the sparse nomadic population, we attempted to identify and survey all subjects within 3 days travel of a local clinic. Survey content included obstetrical history, child-birthing practices, and health-seeking behaviors. RESULTS: Of 470 eligible women, 409(87 %) responded. Among the respondents, 242(59%) reported a history of pregnancy. The total fertility rate was 2.6 (median 2, range 0-11). Half of subjects reported at least one pre-natal visit during their last pregnancy. The tetanus vaccination rate was 14%. Of the 242 respondents' most recent births, 207(86%) occurred in the home, 24(10%) in a tent, 9(2.7%) in an animal shed, and 2(0.8%) in a hospital. Two hundred and thirty seven births (98%) occurred without a skilled attendant. The umbilical cord was cut with a clean instrument in 14 births (3.4%). Delivery complications included: fever(41%); prolonged labor(33%); postpartum hemorrhage(15%); and retained placenta(8%). For pregnancy-related complications, 84 women (35%) sought assistance from a health care provider: 73(87%) from traditional Tibetan physicians, 6(7%) from western-trained physicians and 5(6%) from religious leaders. Traditional remedies to assist during pregnancy included: Tibetan herbs(29%), chanting(23%), butter pills(13%), and burning incense(11%). In the sample community, there were 3 maternal deaths and 97 live births in 2003 (estimated maternal mortality ratio 3,092/100,000). CONCLUSIONS: In Surmang, inadequate maternal care during pregnancy and childbirth in association with high estimates of pregnancy-related complications and maternal mortality indicate the urgent need for an intervention.
Presenting author's disclosure statement:
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA