Evaluation of Strategies to Reduce Maternal Mortality from COVID-19 Infection in Regional Health 12, Thailand

Abstract

Case fatality rate among mothers with COVID-19 infection in Regional Health 12 was very high in
the initial period. Strategies to reduce maternal mortality have been urgently implemented. The objective
of this study was to evaluate the efficacy of these interventions in reducing maternal mortality within
the region. A descriptive study was conducted, using secondary data from a database developed by the
collaborative team from the Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of
Songkla University, Regional Health Promotion Center 12 Yala, Regional Health Office 12, and National
Health Security Office Region 12 Songkhla, from April 2021 to March 2022. Strategies were
implemented on September 8, 2021, following consensus from the Maternal Child Health Board of
Regional Health 12. These strategies included (1) maximizing COVID-19 vaccination coverage for
pregnant women; (2) implementing rapid diagnosis and treatment systems at community entry points
and facilitating swift referrals for treatment; and (3) establishing a database of mothers infected with
COVID-19 to generate information for surveillance and action plan adjustments. An action plan was
executed and outcomes were continuously assessed. Of the 1,818 mothers infected with COVID-19, 20
resulted in fatalities. Maternal deaths showed a steady declined, notably by the conclusion of the postimplementation
period (October 2021 to March 2022), with no reports of maternal deaths in the last
two months. A comparative analysis between the pre-implementation (April to September 2021) and the
post-implementation (October 2021 to March 2022) periods using Chi-square test revealed significant
improvements: vaccination coverage increased from 24.7% to 48.8% (p<0.001), remdesivir administration
rates rose from 14.7% to 19.8% (p=0.047), case fatality rates notably decreased from 2.2% to
0.5% (p<0.001), and pneumonia rates continuously decreased from 7.3% to 3.7% (p<0.001). The
implemented strategies effectively reduced case fatality rate from COVID-19 infection within Regional
Health 12, demonstrating their potential applicability to future emerging diseases.