Direct maternal morbidity and the risk of pregnancy-related deaths,stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries

BackgroundMaternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa.Methods and findingsThis is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes.Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes.ConclusionsOur findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths.Trial registrationThe study is not a clinical trial.     

The vegetation of seacliffs and headlands in New South Wales,Australia

A phytosociological survey of seacliff and headland vegetation on the central and south coast of New South Wales was carried out. Analysis of the quadrat data led to the recognition of 15 communities; the occurrence of a number of other vegetation types is briefly discussed. The vegetation types fall into three major groupings: grasslands, scrub and heathland, although the coincidence between structural and floristic boundaries is poor. Ordination of the communities indicates that the major factors varying between communities are exposure and soil fertility, the grasslands and scrubs occurring on more fertile soils than the heathlands. Amongst the woody communities it is suggested that the two major groups recognized fall into different phytosociological alliances, although lack of studies of Australian vegetation limits the applicability of a conventional hierarchical classification. The true heathlands correspond closely with the alliance Leptospermion, previously recognized in Victoria. The scrub communities are assigned to a new alliance, the Westringio-Banksion integrifoliae.     

The conservation status of athalassic lakes in New South Wales,Australia

To provide an overview for the State Pollution Control Commission of NSW, 102 lakes were visited throughout the state during the 1988–9 summer to ascertain their ecological condition. The sites chosen covered a spectrum of geomorphic types in approximate proportion to their perceived relative abundance. Field work concentrated on some physicochemical parameters and on zooplankton and littoral invertebrates. A summary of these features of the lakes of NSW is given.The most widespread problem is eutrophication, though for many lakes changes in trophic status could be part of wider changes in lakes since European settlement. A significant number of lakes suffer eroded shorelines and sedimentation. The introduced mosquito fish, Gambusia affinis, is associated with decreased diversity mainly in coastal lakes where also alien plants may be pestiferous. A few lakes in western areas have their flooding regime altered, while a number in the east are drained. With few exceptions there are no management programs to improve the conservation status of degraded lakes in NSW.     

Lower Devonian Polyplacophora from New South Wales, Australia

Silicified polyplacophorans are common in the Lower Devonian Garra Formation in New South Wales. Four taxa occur within the lower 237 m of the formation at 14 horizons associated with an abundant and diverse fauna. Chelodes calceoloides Etheridge ranges through the section. New taxa are Chelodes cordatus sp. nov., Acutichiton depressolatus sp. nov., and Jugochiton patulus gen. and sp. nov. A single plate of an indeterminate genus occurs in the lower portion of the Camelford Limestone.     

Hypsilophodontid dinosaurs from Lightning Ridge,New South Wales,Australia

The Lower Cretaceous (Albian) Griman Creek Fm. at Lightning Ridge, New South Wales, Australia, has yielded seven partial femora of hypsilophodontid ornithopods. Six of these femora represent a member of the hypsilophodont group of the Hypsilophodontidae. Similarities of the structure of the medial condyle and popliteal region indicate reference to Fulgurotherium australe. The seventh femur appears to derive from a second, unnamed hypsilophodontid species. These specimens confirm the presence of hypsilophodontids in Australia.     

Cephalopod diversity in commercial fisheries landings of New South Wales, Australia

The development of commercial cephalopod fisheries is a relatively recent phenomenon in Australia. Multiple commercial fisheries land cephalopods in New South Wales (NSW), Australia, yet few useful data exist for the sustainable management of these resources. This paper presents results of the first study to quantitatively document cephalopod diversity in commercial fisheries landings of NSW. A total of 21 cephalopod taxa were observed in randomly selected market samples from the three major regions of landings. Few species comprised the majority of landings in each market category, but several species constituted the remaining proportions. Sepia rozella and S. hedleyi comprised the largest proportion by numbers and weight in cuttlefish samples. Octopus australis and O. tetricus were most abundant in octopus samples, while Sepioteuthis australis, Nototodarus gouldi, and Uroteuthis (Photololigo) sp. comprised the largest proportion of squid samples. The proportion each species contributes to commercial cephalopod landings reported at the Sydney Fish Market was estimated. Cephalopod diversity in the present study was generally consistent with that observed in previous years during fishery independent surveys of prawn trawl grounds. Quantifying cephalopod diversity in New South Wales commercial fisheries provides the necessary first step toward the sustainable management of these valuable resources.     

Identification of structures restricting tidal flow in New South Wales,Australia

New South Wales is the most populous state in Australia with 80% of its people living 100 km or less from the coast. One legacy of settlement has been the construction of structures that interrupt tidal flow to coastal wetlands. We initiated a four-phase operation to locate these structures. In the first phase, 148 1:25,000 scale topographic maps were examined for six types of structure with the potential to reduce tidal flow: bridges, causeways, culverts, floodgates, fords and weirs. In the second phase, anecdotal information on the presence, impact and suitability for modification of these structures was sought from commercial fishers, oyster farmers and district fisheries officers. In the third phase, field investigations were carried out to confirm the presence of the structures, gain a first-hand impression of rehabilitation potential, and gather site-specific information not available from the maps, such as the diameter of culverts. The fourth phase was a review of the anecdotal and field data by the commercial fishers and conservation managers working for NSW Fisheries. A database was constructed with catchment and sub-catchment data, type of habitat problem, rehabilitation potential and other relevant comments. Over 5,300 structures between mean sea level and the +10-m contour were located on the topographic maps; approximately 2,000 structures were not inspected (1,000 were above tidal limit and another 1,000 were inaccessible within the constraints of the project). Field inspections identified 500 structures that were incorrectly labeled. Another 1,000 structures were identified from sources other than the topographic maps, giving rise to a total of over 4,200 structures with potential for structural modification to rehabilitate estuarine habitat. Of these, 1,388, including 1,035 floodgates, 185 culverts, 91 weirs, 46 causeways, 26 bridges and 5 fords, were considered modifiable. Investigations are continuing to set up a ranking system by which to initiate rehabilitation activities. The results have relevance to habitat managers along the eastern seaboard and elsewhere in Australia, and the method by which the results were obtained may have application elsewhere.     

Saline lakes of the Paroo,inland New South Wales,Australia

Twenty-five lakes from fresh to crystallizing brine in the semi-desert of northwestern New South Wales, Australia, were studied regularly for 27 months. The lakes are small, shallow and ephemeral. Chemically waters are mainly of the NaCl type. Seventy-four species of invertebrate occur in saline waters (>3 g l^–1) with crustaceans such as Parartemia minuta, Apocyclops dengizicus, Daphniopsis queenslandensis, Diacypris spp. and Reticypris spp. dominant, particularly at higher salinities. The insects Tanytarsus barbitarsis and Berosus munitipennis are also important in meso- and hypersaline lakes. They are joined in hypo- and mesosaline waters by many others, including more beetles, odonatans, trichopterans, pyralids, notonectids, and corixids. Species richness declines with increasing salinity. There is a prominent inland faunal component mainly of crustaceans, including P. minuta, D. queenslandensis, R. walbu, Trigonocypris globulosa and Moina baylyi.     

New records of marine benthic algae from New South Wales, eastern Australia

Twenty‐four species of marine macroalgae are recorded from the mainland coast of New South Wales for the first time. One species, Laurencia platyclada Boergesen, represents a new record for Australia and the Pacific Ocean. Included in these new records is the introduced, invasive and cold‐tolerant strain of the green alga Caulerpa taxifolia, which was formerly known only as native, non‐invasive populations from Lord Howe Island. Based on published accounts, the composition of the marine benthic algae for the state of New South Wales now stands at 131 green, 140 brown and 449 red macroalgae. This baseline information adds significantly to our knowledge of the overall marine biodiversity of the state, as well as to the phycogeography of the southwestern Pacific region.     

Litterfall and decomposition in the Pilliga State Forests,New South Wales,Australia

Abstract The annual litterfall and decomposition rate of litter in three semi-arid vegetation communities (forest, mallee and broom) in the Pilliga State Forests, New South Wales, Australia, were measured over a period of 3 years. Annual litterfall was found to vary widely between the communities, ranging from 1005 to 3409 kg ha^?1 year^?1. Decomposition rates were measured and the half lives obtained ranged from 2. 5 to 5. 3 years. In many forests fire removes much of the accumulated litter at regular intervals. Two of the three study sites (the forest and mallee) had reached steady state after 36 years of litter accumulation after fire, while the broom, with only 20 years accumulation, was not in steady state. Between fires decomposition of the liner dominates. In the mallee soil fauna were most active, burying the litter under mineral soil before comminution commenced, demonstrating a cycling of litter which differs markedly from that in more humid climates.     

Occurrence and importance of mycorrhizae in aquatic trees of New South Wales,Australia

Vesicular arbuscular mycorrhizal (VAM) infection was found in KOH-cleared and lactophenolblue-stained roots of Salix babylonica, Melaleuca quinquenervia and Casuarina cunninghamiana. These are all trees growing on creeks and river banks, in stationary or slowly flowing fresh or brackish waters in swamps, creeks, drains and channels, and in seepage areas of New South Wales, Australia. Larger and older roots lacked VAM infection in the inner cortex, probably due to suberisation of cells, and the endophyte was restricted to the epidermal layers. Spores and sporocarps of the VAM fungi Glomus fasciculatus, G. mosseae, Sclerocystis rubiformis, Gigaspora margarita and an unidentified Scutellospora sp. were wet sieved and decanted from aquatic sediments and soils. The presence of similar VAM fungal spores in the aquatic sediments and terrestrial soil suggests that they probably enter the aquatic sediments through run off from the land ecosystem. All three plants formed vesicular arbuscular (VA) mycorrhizae almost exclusively in the marshy, periodically inundated soils, but the same plant species formed endo-/ ectomycorrhizae when growing in soil with higher redox potentials (E _h). Salix and Melaleuca tree roots possessed both VAmycorrhizae and ectomycorrhizae. VAM roots of Casuarina were equipped with both N-fixing Frankia nodules and proteoid roots. VAM endophytes did not invade nodular cortical tissues, suggesting the presence of an exclusion mechanism which needs further study. The highest VAM infection was found in nodulated specimens. Free-floating roots growing in water close to the banks were non-mycorrhizal but were mycorrhizal in the bottom-rooting state. VAM spore number and mycorrhizal infection seem to be associated with redox-potential, i.e. lower at sites such as swamps, water or sediments with lower E _h values than in terrestrial soils with higher E _h values. A relationship between soil moisture gradient and VAM infection pattern became apparent from the study of a C. cunninghamiana transect on a creek embankment, i.e. typical vesicles and arbuscules were found in roots from drier soils, there was a lack of arbuscules in relatively wet soils but large lipid-filled intracellular vesicles were present, and typical vesicles and arbuscules were absent in flooded creek beds where roots were associated with coenocytic intercellular hyphae with abundant lipid droplets. The importance of VA mycorrhiza, ectomycorrhizae, N-fixing root nodules and proteoid roots at the land-water interface is discussed with reference to the use of these trees as pioneering species for stabilising river and stream banks, reducing erosion, windbreaking, and as a long-term and inexpensive means of achieving biological control of aquatic weeds by shading waterways.     

Molecular diversity of soil basidiomycete communities in northern-central New South Wales, Australia

Basidiomycete communities were profiled using terminal RFLP (TRFLP) and amplified ribosomal DNA restriction analysis (ARDRA) approaches at seven field sites under differing land use in northern-central New South Wales (NSW), Australia. TRFLP data indicated greater basidiomycete species richness at sites with natural vegetation. Sixty-seven basidiomycete ARDRA-types were detected. Various putatively ectomycorrhizal fungi were detected at all sites with native vegetation. Most ectomycorrhizal taxa had affinities to the genus Tomentella, while two Pisolithus taxa and putatively ectomycorrhizal Cantharellales taxa were also detected. Although soils under woodland or grassland communities supported a range of putatively saprotrophic taxa, only members of the Ceratobasidiales were detected in soils under agricultural land use. This study is the first investigation of fungal communities in soils of northern-central NSW, Australia.     

Latitude and elevation as factors controlling occurrence of calanoid copepods in marginal lotic waters in New South Wales,Australia

Freshwater calanoid copepods develop abundant populations in lentic water bodies such as lakes, reservoirs and lagoons. In this study, we examined the potential habitat value of edges in lotic systems such as creeks and rivers where waters tend to stagnate, providing lentic-like environments. We examined a total of 353 edge samples collected from 321 sites across the state of New South Wales, Australia, with latitudes in the range 28.3–37.4°S and elevations in the range 2–1834 m above sea level. Of the total samples examined, calanoid copepods were found in 94 samples, with the frequency of occurrences of species decreasing in the order: Boeckella fluvialis Henry, B. triarticulata (Thomson), Gladioferens spinosus Henry, G. pectinatus (Brady), B. major Searle, B. minuta Sars, and Calamoecia lucasi Brady. The probability of occurrence of the calanoid copepods was related negatively to both latitude (as absolute values) and elevation, based on logistic regression models. We conclude that the edges of many lotic systems provide additional habitats for some species of freshwater calanoid copepods, with constraints on their distributions along latitudinal and elevational gradients.     

The shelled gastropods of the Solitary Islands Marine Park,northern New South Wales,Australia

ABSTRACT

Away from the major population centres, the biodiversity of Australia's shallow coastal marine waters is poorly known. The Tweed-Moreton Bioregion, covering northern New South Wales and south-east Queensland, is both a focus of marine conservation (with three marine parks), and research efforts to predict the effects of climate change through species range extensions and shifts in community composition. Here we provide the first comprehensive list of shallow-water (<30?m) shelled, gastropod macro-molluscs (>5?mm) from the Solitary Islands Marine Park, compiled from a range of sources, including field collections over a 30-year period to 2017. The Cypraeidae (50 spp.), Muricidae (47 spp.) and Conidae (32 spp.) were the most speciose families, accounting for 26% of the total inventory of 500 species from 77 families. A total of 143 species are recorded at their southern limit of distribution on Australia's east coast, most being rare, tropically affiliated taxa found at offshore island sites that receive more frequent contact with the southward-flowing East Australian Current. The inventory confirms the high biodiversity of the Solitary Islands region and the importance of ongoing conservation management.     

Genotype by environment interactions for Pinus radiata in New South Wales, Australia

Historical data from 26 progeny trials in the NSW breeding program was analyzed to determine the extent and practical importance of genotype by environment (G×E) interactions for a range of traits. Significant G×E interaction was present for diameter (DBH) with 75% of the 35 estimated between-site genetic correlations falling below the threshold value of 0.6 where regionalization should be considered. Estimated genetic correlations for stem straightness, branch quality, and outerwood density were much higher, indicating these traits are not as affected by G×E. Levels of G×E for DBH are sufficient to have serious impacts on the expression of genetic gain in deployed material. For DBH, altitude differences between sites appear to be the key factor driving the G×E with a difference of greater than 280 m in altitude leading to a breakdown in correlations. Two groups of sites were identified as having limited G×E within each group: one for sites above 900 m elevation plus a lower-altitude group. Sites included in the higher-altitude group were located across the entire north–south geographic range of NSW. Equations for prediction of site mean DBH indicate that altitude, prior land use, and underlying geology are key driving variables. A more complex model was developed for predicting the between-site genetic correlations for DBH with the model accounting for approximately 50% of the observed variation.     

Amphorothecium,a new pyrenocarpous lichen genus from New South Wales,Australia

Abstract:Amphorothecium occultum P. M. McCarthy, Kantvilas & Elix gen. et sp. nov. is described from deeply shaded, saxicolous bryophytes in south-eastern New South Wales, Australia. This genus is characterized by a trentepohlioid photobiont, distinctive thallus chemistry, pale, simple perithecia, largely unbranched paraphyses and periphyses, thin-walled, non-amyloid asci and very large, multiseptate ascospores. Its systematic position is uncertain.     

Geographic Variation of Failure-to-Rescue in Public Acute Hospitals in New South Wales,Australia

Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002–2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state''s centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.     

Silurian radiolarians from the Jenolan Caves region,New South Wales,Australia

Moderately-preserved Silurian radiolarians have been recovered from the Jenolan Caves region, eastern NSW, Australia. Radiolarians were first reported from this area in the late 19th Century by T.W. Edgeworth David, but were not described in detail, neither were they illustrated. Nearly 120 years later, the first images of these fossils are presented. The radiolarians reported include: ?Futobari cf. solidus Furutani, ?Zadrappolus sp., Haplentactiniid gen. and sp. indet, Borisella sp., ?Palaeoephippium sp., ?Insolitignum vivanima MacDonald and ?Helenifore speciosus (Furutani). The fauna is similar to others described from Upper Silurian strata in Japan.     

Dissolved and particulate organic carbon in two wetlands in southwestern New South Wales,Australia

Concentrations of dissolved (DOC) and particulate organic carbon (POC) in two billabong wetlands (Murrumbidgil Swamp and Lake Merrimajeel) in inland temperate Australia were positively correlated with leaf fall from river red gums Eucalyptus camaldulensis (DOC and POC in Murrumbidgil Swamp), phytoplankton productivity (DOC in Murrumbidgil Swamp, DOC and POC in Lake Merrimajeel), and with biomass of aquatic macrophytes (DOC in the two wetlands). DOC correlated with water level at both sites. Mean concentrations of DOC (Murrumbidgil Swamp, 36.0 gm^-3; Lake Merrinmajeel, 27.5 g m^-3) and POC (15.0 g m^-3; 15.5 g m^-3) were high compared with other water bodies worldwide, although average for wetlands. The relatively high concentrations of DOC and POC in the study wetlands appear to be the result of their high rates of plant production, and input of leaves from river red gums.