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    • The greater relative importance of indirect causes

    2019-06-24

    The greater relative importance of indirect causes could be a result of successful addressing of direct complications of pregnancy and childbirth, and of a change in risk factors and disease patterns. Indirect causes of death include the effects of pre-existing disorders, such as HIV infection, mental disease, and diabetes, when aggravated by pregnancy. Unfortunately, this Canagliflozin of range of indirect causes is yet to be fully explored. Prompt action to thoroughly understand these causes of death and develop appropriate responses is crucial to continue worldwide progress in maternal mortality reduction. Despite the importance of these indirect causes, key policy and strategy documents of leading international maternal health non-governmental organisations and UN organisations do not focus much on indirect causes of maternal mortality, except for HIV infection. Predominant attention is still given to direct causes of adverse pregnancy outcomes. In particular, poor mental health as an underlying causal factor for maternal mortality and morbidity has been ignored and remains outside the stated agenda of these organisations. This omission is despite the fact that many studies have shown that poor maternal mental health has far-reaching adverse effects on mother and infant. Furthermore, suicide, as the most severe effect of poor mental health, is a leading contributor to maternal mortality worldwide and is strongly associated with violence and abuse. The situation might be helped by the WHO guidelines on recording of maternal mortality cause: the International Classification of Disease—Maternal Mortality. These guidelines now deem suicides during pregnancy and 12 months postpartum as direct maternal deaths, even if underlying obstetric psychiatric disorders are not diagnosed. This revision provides hope for improved future data on suicide as a cause of maternal death and provides reason for organisations to add mental health to their agenda. Implementation of several internationally ratified human rights conventions that require governments to take action to address maternal mental health as part of health services could improve the situation somewhat. Maternal mental health is essential to safe motherhood. The worldwide maternal health community should update their agendas to ensure programme effectiveness by giving attention to indirect causes of maternal death, including mental health.
    A UN high-level meeting on the progress achieved in the prevention and control of non-communicable diseases (NCDs), held on July 10–11, 2014, showed that progress has been insufficient and uneven, especially in developing countries. Despite the joint call of the UN and WHO for a 25% reduction in NCDs by 2025, NCDs are inadequately prioritised on the global agenda, and quite whom we can mobilise to achieve this target remains unclear. One of the possibilities could be task shifting of prevention, diagnosis, and treatment of NCDs to community health workers (CHWs), which was not mentioned as an opportunity during the UN review meeting. Almost half the member states of WHO have fewer than one physician per 1000 population. However, the world has seen major improvements in human health over the past two decades. Some of the key actors often unrecognised for their contribution to improved global health indicators are CHWs. According to WHO, there are more than 1·3 million CHWs worldwide. Despite their limited training, education, experience, and expertise, they have shown that they can be mobilised to reduce mortality and morbidity. However, CHW contributions thus far have been largely limited to maternal and newborn health and infectious diseases. Although communicable diseases are still an important cause of preventable deaths, NCDs are now the leading cause of death in many low-income and middle-income countries. At present, 85% of NCDs occur in the poorest countries of the world. NCDs also pose the single biggest threat to women\'s health, causing 65% of all female deaths. NCDs are also a major cause of catastrophic health expenditure among the uninsured. The growing global burden of NCDs in poor countries has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Although there has been a significant increase in global aid for health in the past 10 years, investment in the field of NCDs is still negligible, accounting for less than 3%.