{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T01:36:54Z","timestamp":1772933814018,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,12,26]],"date-time":"2014-12-26T00:00:00Z","timestamp":1419552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To quantify the burden of maternal and neonatal conditions in low\u2010 and middle\u2010income countries (<jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content>s) that could be averted by full access to quality first\u2010level obstetric surgical procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Burden of disease and epidemiological modelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content>s from all global regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>The entire population in 2010.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion<jats:sup>1<\/jats:sup>; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability\u2010adjusted life years (<jats:styled-content style=\"fixed-case\">DALY<\/jats:styled-content>s) of these conditions into surgically \u2018avertable\u2019 and \u2018non\u2010avertable\u2019 burdens. We applied the lowest age\u2010specific fatality rates from all global regions to each <jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content> region to estimate the avertable deaths, assuming that the differences of death rates between each region and the lowest rates reflect the gap in surgical care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Deaths and <jats:styled-content style=\"fixed-case\">DALY<\/jats:styled-content>s avertable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the estimated 56.6 million <jats:styled-content style=\"fixed-case\">DALY<\/jats:styled-content>s (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million <jats:styled-content style=\"fixed-case\">DALY<\/jats:styled-content>s (37%) are avertable by full coverage of quality obstetric surgery in <jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content>s. The avertable burden in absolute term is substantial given the size of burden of these conditions in <jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content>s. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million <jats:styled-content style=\"fixed-case\">DALY<\/jats:styled-content>s) among the five conditions, followed by abortion (2.1 million <jats:styled-content style=\"fixed-case\">DALY<\/jats:styled-content>s).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Improving access to quality surgical care at first\u2010level hospitals could reduce a tremendous burden of maternal and neonatal conditions in <jats:styled-content style=\"fixed-case\">LMIC<\/jats:styled-content>s.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13198","type":"journal-article","created":{"date-parts":[[2014,12,26]],"date-time":"2014-12-26T06:46:52Z","timestamp":1419576412000},"page":"228-236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Surgically avertable burden of obstetric conditions in low\u2010 and middle\u2010income regions: a modelled analysis"],"prefix":"10.1111","volume":"122","author":[{"given":"H","family":"Higashi","sequence":"first","affiliation":[{"name":"Institute for Health Metrics and Evaluation University of Washington Seattle WA USA"},{"name":"School of Population Health University of Queensland Brisbane Qld Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JJ","family":"Barendregt","sequence":"additional","affiliation":[{"name":"School of Population Health University of Queensland Brisbane Qld Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"NJ","family":"Kassebaum","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation University of Washington Seattle WA USA"},{"name":"Division of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"TG","family":"Weiser","sequence":"additional","affiliation":[{"name":"Department of Surgery School of Medicine Stanford University Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SW","family":"Bickler","sequence":"additional","affiliation":[{"name":"Department of Surgery School of Medicine University of California San Diego CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Vos","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation University of Washington Seattle WA USA"},{"name":"School of Population Health University of Queensland Brisbane Qld Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,12,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61689-4"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61899-6"},{"key":"e_1_2_6_4_1","volume-title":"Surgical Care at the District Hospital","author":"WHO","year":"2002"},{"key":"e_1_2_6_5_1","volume-title":"Disease Control Priorities in Developing Countries","author":"Jamison DT","year":"2006"},{"key":"e_1_2_6_6_1","first-page":"1245","volume-title":"Disease Control Priorities in Developing Countries","author":"Debas H","year":"2006"},{"key":"e_1_2_6_7_1","volume-title":"WHO Planning Tool for Emergency and Essential Surgical Services at the First Referral Level","author":"WHO","year":"2011"},{"key":"e_1_2_6_8_1","first-page":"137","article-title":"Essential surgery: integral to the right to health","volume":"12","author":"McQueen KA","year":"2010","journal-title":"Health Hum Rights"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61729-2"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61680-8"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.1997.tb07987.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.032037"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.331.7525.1107"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71088-6"},{"key":"e_1_2_6_16_1","first-page":"1399","article-title":"World Health Organization maternal health and safe motherhood programme. 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