{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:11:06Z","timestamp":1793221866771,"version":"4.5.0"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T00:00:00Z","timestamp":1743897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV\u2010028724"],"award-info":[{"award-number":["INV\u2010028724"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Risk stratification of pregnancies informs clinical care globally. Yet recent research has cast doubt on the ability of currently used population\u2010level risk measures to accurately predict poor outcomes at the individual level. We examine the assumption that existing forms of risk stratification can successfully identify women likely to develop complications during delivery in a rural setting in Kenya.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective observational study of 19,653 pregnant women in Kakamega County in Western Kenya. Women were contacted three times during the perinatal period and surveyed about provider\u2010identified risks and self\u2010assessed concerns about pregnancy complications, delivery process outcomes, and adverse delivery outcomes. Measures of risk were derived from women's self\u2010reporting. We compared delivery process outcomes and adverse delivery outcomes between high\u2010 and low\u2010risk pregnancies, and between women with and without expressed concerns about delivery complications. Delivery process outcomes included intrapartum referral, unplanned caesarean section, blood transfusion, hysterectomy, or admission to an intensive care unit. Adverse delivery outcomes included stillbirth, neonatal mortality, and maternal mortality. We reported means and confidence intervals for each category, and tested for differences using bivariate linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010eight percent of pregnancies had at least one risk factor consistent with a high risk pregnancy; the remaining 62% were low risk by this criteria. Rates of most adverse process outcomes and delivery outcomes were higher among pregnancies with known risks. However, 64.5% of maternal deaths and 54.8% of all deaths in the sample took place among pregnancies characterised as low risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Risk stratification using existing indicators of risk during pregnancy is inadequate to identify women at risk of adverse health outcomes in this setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.14110","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T07:20:27Z","timestamp":1744010427000},"page":"531-538","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk stratification during antenatal care failed to identify most mothers who experienced adverse pregnancy outcomes: A prospective study from Kakamega County, Kenya"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2637-9050","authenticated-orcid":false,"given":"Jan E.","family":"Cooper","sequence":"first","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Kruk","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine and Geriatrics Washington University School of Medicine  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kapaon","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Boston University School of Public Health  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Opondo","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinta","family":"Nzinga","sequence":"additional","affiliation":[{"name":"Health Economics Research Unit, Kenya Medical Research Institute\u2010Wellcome Trust Research Programme, Department of International Public Health Liverpool School of Tropical Medicine  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose J.","family":"Kosgei","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Nairobi  Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Croke","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004902.pub5"},{"issue":"6","key":"e_1_2_8_3_1","first-page":"591","article-title":"Too far, too little, too late: a community\u2010based case\u2010control study of maternal mortality in rural west Maharashtra, India","volume":"76","author":"Ganatra BR","year":"1998","journal-title":"Bull World Health Organ"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2023.100253"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208563"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.03.038"},{"key":"e_1_2_8_7_1","unstructured":"KNBS ICF.Kenya Demographic and Health Survey 2022: Volume 1.2023[cited 2023 Oct 30]; Available from:https:\/\/dhsprogram.com\/publications\/publication-FR380-DHS-Final-Reports.cfm"},{"key":"e_1_2_8_8_1","unstructured":"Ministry of Public Health and Sanitation Ministry of Medical Services.National Guidelines for Quality Obstetrics and Perinatal Care [Internet].2011Available from:http:\/\/guidelines.health.go.ke:8000\/media\/National_Guidelines_for_Quality_Obstetrics_and_Perinatal_Care.pdf"},{"key":"e_1_2_8_9_1","unstructured":"Ministry of Health.National Guidelines on Quality Obstetrics and Prenatal Care [Internet].2024Available from:https:\/\/drive.google.com\/file\/d\/1En9FHigvj8Wljnq1N0Ngi3wp7tuM_jI9\/view"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13578-y"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-7-16"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-072451"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czae088"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-0975-2"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5514"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1701075"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30386-3"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-20-00684"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-071585","article-title":"Decolonisation and quality of care","volume":"380","author":"Yanful B","year":"2023","journal-title":"BMJ"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.14110","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T20:30:44Z","timestamp":1749069044000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.14110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,6]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1111\/tmi.14110"],"URL":"https:\/\/doi.org\/10.1111\/tmi.14110","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,6]]},"assertion":[{"value":"2025-04-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}