Maternal critical care in the developing world

Abstract

Introduction Global maternal mortality exceeds 287000 each year, and almost all of these deaths occur in the developing world. For every maternal death, there are many more women who have severe morbidity. Recent appraisal at the half-way stage of the United Nations’ Millennium Development Goal 5 (to improve maternal care and specifically to reduce the maternal mortality ratio by 75% by 2015) suggests that progress has been disappointingly slow and particularly poor in South Asia and sub-Saharan Africa [1]. There are 49 countries classified as least developed, 32 in Africa, 8 in Asia and 9 Island nations. The burden of disease in these countries necessitates the need for critical care, yet there is a paucity of infrastructure, transport, skilled human resources, and basic resuscitative and life-saving equipment in many regions. Riviello et al. [2] noted that critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost-effective in comparison with immunizations and care of those with HIV infection.