{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:28:12Z","timestamp":1786688892389,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate a nine\u2010component regional program for maternal mortality reduction in Health Region 1 (HR1), Northern Thailand, examining cause\u2010specific mortality outcomes and implementation fidelity across 103 hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The present study involved before\u2010and\u2010after service evaluation of routinely collected surveillance data (CE\u201062 system) for 2016\u20132018 against a historical baseline (2009\u20132015) across 103 hospitals in eight provinces (population of approximately six\u00a0million). Components included the labor strategy (postpartum hemorrhage [PPH]), pregnancy\u2010induced hypertension (PIH) strategy (hypertensive disorders), cascade simulation training (Advanced Life Support in Obstetrics Program [ALSOP]), and the One Province, One Labor Room (OPOL) mobile coordination platform. Rate ratio with 95% confidence interval (CI; Poisson Wald method) and \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test for linear trend (Cochran\u2013Armitage) were applied; 14 process indicators assessed implementation fidelity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The maternal mortality ratio declined from 39.2\/100\u2009000 live births in 2016 (22 deaths) to 15.9 in 2018 (six deaths), a 59% reduction meeting the national target (rate ratio 0.41, 95% CI 0.16\u20131.00;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.050; \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      trend\u2009=\u20094.05;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.044). PPH deaths declined by 87.5%; PIH\/eclampsia deaths were eliminated; and indirect deaths fell 67%. All 14 process indicators improved overall between 2016 and 2018.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A nine\u2010component program was associated with substantial maternal mortality reduction across 103 hospitals without new capital expenditure. The OPOL platform represents a scalable, low\u2010cost model for regional obstetric coordination applicable to middle\u2010income country settings pursuing Sustainable Development Goal Target 3.1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71308","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:42:41Z","timestamp":1786686161000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A comprehensive program to reduce maternal mortality in Health Region 1, Northern Thailand: A regional service evaluation with policy implications for Southeast Asia"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2088-5830","authenticated-orcid":false,"given":"Suthit","family":"Khunpradit","sequence":"first","affiliation":[{"name":"Faculty of Medicine Nation University  Chiang Mai Thailand"},{"name":"Department of Obstetrics and Gynecology Lamphun Hospital  Lamphun Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krissana","family":"Kapheak","sequence":"additional","affiliation":[{"name":"Health Promotion Center Region 1 Ministry of Public Health  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thongrien","family":"Mooncheep","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Lamphun Hospital  Lamphun Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirisopa","family":"Kamkrea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Lamphun Hospital  Lamphun Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","author":"World Health Organization","year":"2023"},{"key":"e_1_2_12_3_1","volume-title":"Strategies toward Ending Preventable Maternal Mortality (EPMM)","author":"World Health Organization","year":"2015"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_12_5_1","volume-title":"Resolution Adopted by the General Assembly on 25 September 2015. 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