{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T18:58:50Z","timestamp":1782500330542,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To review the quality of maternal death audits and identify factors contributing to refugee maternal deaths in the East and Horn of Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Maternal death audits submitted to The UN Refugee Agency (UNHCR) from 2017 to 2019 in 43 refugee camps in eight countries were analyzed for completeness, obstetric history, cause of death, and contributing factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 191 refugee maternal death audits were retrieved. The mean age of the deceased was 28\u2009years (range, 15\u201345\u2009years), and 13% were adolescents and 17% were of advanced maternal age. Most patients (55%) were grand multigravida (\u22655 pregnancies). The majority (86%) attended antenatal care visits, with 51% attending four or more visits. Among women who delivered (<jats:italic>n<\/jats:italic>\u00a0=\u2009140), 91% were facility\u2010based deliveries. Most (68%) deaths occurred postpartum. Obstetric hemorrhage (49%) was the leading direct cause of death (with 77 cases of postpartum hemorrhage), followed by hypertensive disorder (19%) and infection (15%). Delays in care were identified in 185 (97%) cases. Delays in receiving care were more prevalent (81%) than in seeking (61%) and reaching (26%) care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Factors contributing to delays in receiving care highlight the capacity gaps in provision of emergency obstetric care, including management of postpartum hemorrhage, requiring urgent additional investments. Audit findings also show the need for attention and action towards family planning, contraception, and adolescent sexual and reproductive health services.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14504","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T06:54:52Z","timestamp":1665471292000},"page":"483-491","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Review of maternal death audits in refugee camps in <scp>UNHCR<\/scp> East and Horn of Africa and Great Lakes Region, 2017\u20132019"],"prefix":"10.1002","volume":"160","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2169-6599","authenticated-orcid":false,"given":"Tessa A.","family":"van Boekholt","sequence":"first","affiliation":[{"name":"UNHCR Regional Bureau of East and Horn of Africa and Great Lakes  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna","family":"Moturi","sequence":"additional","affiliation":[{"name":"UNHCR Regional Bureau of East and Horn of Africa and Great Lakes  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"H\u00f6lscher","sequence":"additional","affiliation":[{"name":"UNHCR Public Health Section  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrin","family":"Schulte\u2010Hillen","sequence":"additional","affiliation":[{"name":"UNHCR Public Health Section  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Tappis","sequence":"additional","affiliation":[{"name":"John Hopkins Center for Humanitarian Health Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Burton","sequence":"additional","affiliation":[{"name":"UNHCR Public Health Section  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"United Nations High Commissioner for Refugees Regional Bureau for East and Horn of Africa and Great Lakes Region.Refugees asylum\u2010seekers refugee returnees and IDPs as of 31 December 2021. [UNHCR website].2021. Accessed April 21 2022.https:\/\/data2.unhcr.org\/en\/documents\/download\/90719"},{"key":"e_1_2_10_3_1","volume-title":"Trends in Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and The United Nations Population Division","author":"World Health Organization","year":"2019"},{"key":"e_1_2_10_4_1","volume-title":"Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health: Policy Survey, 2018\u20102019: Summary Report","author":"World Health Organization","year":"2020"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)30030-5"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0243722"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-06036-1"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1405-6"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13031-022-00440-6"},{"key":"e_1_2_10_10_1","unstructured":"United Nations.The Global Compact on Refugees [UNHCR website].2018. Accessed April 21 2022.https:\/\/www.unhcr.org\/the\u2010global\u2010compact\u2010on\u2010refugees.html"},{"key":"e_1_2_10_11_1","unstructured":"World Health Organization.Strategies toward ending preventable maternal mortality (EPMM). [WHO website].2015. Accessed May 28 2022.https:\/\/apps.who.int\/iris\/handle\/10665\/153544"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1363\/3820512"},{"key":"e_1_2_10_13_1","volume-title":"The Global Health Observatory \u2010 Maternal deaths [WHO website]","author":"World Health Organization"},{"key":"e_1_2_10_14_1","first-page":"68","volume-title":"The WHO Application of ICD\u201010 to Deaths During Pregnancy, Childbirth and The Puerperium: IDC MM","author":"World Health Organization","year":"2012"},{"issue":"7","key":"e_1_2_10_15_1","first-page":"442","article-title":"Postpartum hemorrhage: prevention and treatment","volume":"95","author":"Evensen A","year":"2017","journal-title":"Am Fam Physician"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(94)90226-7"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/disa.12052"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-007753"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1505-9-S1-S1"},{"key":"e_1_2_10_20_1","volume-title":"Maternal and Perinatal Death Surveillance and Response: Materials to Support Implementation","author":"World Health Organization","year":"2021"},{"key":"e_1_2_10_21_1","unstructured":"United Nations High Commissioner for Refugees.Maternal death review guidance (2020 revision) [UNHCR website]2020. Accessed April 13 2022.https:\/\/www.unhcr.org\/publications\/brochures\/604f75224\/unhcr\u2010maternal\u2010death\u2010review\u2010guidance\u2010data\u2010collection\u2010form\u20102020\u2010pdf.html"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.127464"},{"key":"e_1_2_10_23_1","unstructured":"Interagency Working Group on Reproductive Health in Emergencies.Adolescent sexual and reproductive health toolkit for humanitarian settings 2020 edition [IAWG website]2020. Accessed May 28 2022.https:\/\/iawg.net\/resources\/adolescent\u2010sexual\u2010and\u2010reproductive\u2010health\u2010asrhtoolkit\u2010for\u2010humanitarian\u2010settings\u20102020\u2010edition"},{"key":"e_1_2_10_24_1","unstructured":"Every Women Every Child.The Global Strategy for Women's Children's and Adolescents' Health (2016\u20132030) [Every Women Every Child website].2015. Accessed May 28 2022.http:\/\/www.everywomaneverychild.org\/wp\u2010content\/uploads\/2016\/12\/EWEC_Global_Strategy_EN_inside_LogoOK_web.pdf"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-281"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30385-1"},{"key":"e_1_2_10_27_1","unstructured":"United Nations.Goal 3: Ensure healthy lives and promote well\u2010being for all at all ages [Internet]. [UN website]. Accessed May 15 2022.https:\/\/unstats.un.org\/sdgs\/report\/2017\/goal\u201003\/"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13031-020-00334-5"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.14504","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.14504","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.14504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T07:58:31Z","timestamp":1692345511000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.14504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1002\/ijgo.14504"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.14504","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,25]]},"assertion":[{"value":"2022-05-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}