1. Health, Social and Economic Burden of Maternal Morbidity in Burkina Faso Rasmané Ganaba on behalf of: V Filippi, S Russell, P Ilboudo, S Murray, K Storeng, M Akoum, H Some, T Marshall, N Meda Towards 4 + 5 RPC dissemination conference, 25-26 May 2010 www.towards4and5.org.uk

2. Rationale High number of women survive severe obstetric complications but little is known about long term consequences We investigated how severe obstetric complications affect a range of health outcomes in the years after the end of pregnancy in hospitals in Burkina Faso

3. Prospective study 1014 women into four groups Interviews - 3 days after discharge, and at 3, 6, 12 month postpartum Medical data from medical records and exams at 6 and 12 months live births (199) perinatal deaths (74) early pregnancy loss (64) Uncomplicated delivery 337 women with severe obstetric complications live births (199) perinatal deaths (74) early pregnancy loss (64) Uncomplicated delivery Intense follow up for 12 months

4. High mortality after hospital discharge 2% of women died in the complication group (Equivalent to a MMR of 1800) 8% mortality in babies born to women with severe complications

5. Increased odds of mental health problems, disharmony and debts Increased odds of depression at 3 months Significant Differences at all points More than Three times the odds

6. Extended follow-up (funded by Hewlett/ESRC) Aims: To understand the long-term (3-4 year) impact of severe obstetric complications and the costs of treating such complications and their sequelae on the economic and social well-being of women and their households To inform policies and interventions to reduce cost burdens and mitigate economic impacts for women and their families To explore a new concept: “near-miss catastrophic costs”

7. Methods Follow up study: old cohort (recruited in hospitals) + new group (community women who delivered in 2004 identified by neighbourhood sampling approach) Qualitative and quantitative instruments Interviews in year 3+ and year 4+ post end of pregnancy Data collection ended on January 2010 1073 women included

8. Composition of the cohort Previous study New study Year 3 New study Year4 Head HH Child devlpt NM Abortion6445 41 ─ NM PND74504345 ─ NM live-birth199137129111107 All Near-miss337232217197107 Uncomplicated677531491452212 a New comparison group ─ 310284257196 Total10141073993907515 a A Sub-sample

9. Mothers’ mortality: still larger in the near-miss group

10. Children’s mortality: difference still getting larger

11. Implications Safer motherhood should consider maternal morbidity (and risk of late mortality) as well as immediate maternal mortality Resources needed to ensure that women with severe complications receive adequate care before and after discharge Near-miss women and their babies are a special group who may need targeting for interventions Similar findings from Benin