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Ye F.,China Japan Friendship Hospital | Ye F.,Peking University | Ao D.,Peking University | Feng Y.,Peking University | And 38 more authors.
PLoS ONE | Year: 2015

Objectives: The present study aimed to explore the inter-relationships among maternal death, household economic status after the event, and potential influencing factors. Methods: We conducted a prospective cohort study of households that had experienced maternal death (n = 195) and those that experienced childbirth without maternal death (n = 384) in rural China. All the households were interviewed after the event occurred and were followed up 12 months later. Structural equation modeling was used to test the relationship model, utilizing income and expenditure per capita in the following year after the event as the main outcome variables, maternal death as the predictor, and direct costs, the amount of money offset by positive and negative coping strategies, whether the husband remarried, and whether the newborn was alive as the mediators. Results: In the following year after the event, the path analysis revealed a direct effect from maternal death to lower income per capita (standardized coefficient = -0.43, p = 0.041) and to lower expenditure per capita (standardized coefficient = -0.51, p<0.001). A significant indirect effect was found from maternal death to lower income and expenditure per capita mediated by the influencing factors of higher direct costs, less money from positive coping methods, more money from negative coping, and the survival of the newborn. Conclusion: This study analyzed the direct and indirect effects of maternal death on a household economy. The results provided evidence for better understanding the mechanism of how this event affects a household economy and provided a reference for social welfare policies to target the most vulnerable households that have suffered from maternal deaths. © 2015 Ye et al. Source


Wang H.,Peking University | Ye F.,Peking University | Wang Y.,Peking University | Huntington D.,World Health Organization | And 35 more authors.
PLoS ONE | Year: 2013

Objective:To assess the economic impact of maternal death on rural Chinese households during the year after maternal death.Methods:A prospective cohort study matched 183 households who had suffered a maternal death to 346 households that experienced childbirth without maternal death in rural areas of three provinces in China. Surveys were conducted at baseline (1-3 months after maternal death or childbirth) and one year after baseline using the quantitative questionnaire. We investigated household income, expenditure, accumulated debts, and self-reported household economic status. Difference-in-Difference (DID), linear regression, and logistic regression analyses were used to compare the economic status between households with and without maternal death.Findings:The households with maternal death had a higher risk of self-reported "household economy became worse" during the follow-up period (adjusted OR = 6.04, p<0.001). During the follow-up period, at the household level, DID estimator of income and expenditure showed that households with maternal death had a significant relative reduction of US$ 869 and US$ 650, compared to those households that experienced childbirth with no adverse event (p<0.001). Converted to proportions of change, an average of 32.0% reduction of annual income and 24.9% reduction of annual expenditure were observed in households with a maternal death. The mean increase of accumulated debts in households with a maternal death was 3.2 times as high as that in households without maternal death (p = 0.024). Expenditure pattern of households with maternal death changed, with lower consumption on food (p = 0.037), clothes and commodity (p = 0.003), traffic and communication (p = 0.022) and higher consumption on cigarette or alcohol (p = 0.014).Conclusion:Compared with childbirth, maternal death had adverse impact on household economy, including higher risk of self-reported "household economy became worse", decreased income and expenditure, increased debts and changed expenditure pattern. © 2013 Wang et al. Source


Ye F.,Peking University | Wang H.,Peking University | Huntington D.,World Health Organization | Zhou H.,Peking University | And 44 more authors.
PLoS ONE | Year: 2012

Objective: To identify the immediate economic impact of maternal death on rural Chinese households. Methods: Results are reported from a study that matched 195 households who had suffered a maternal death to 384 households that experienced a childbirth without maternal death in rural areas of three provinces in China, using quantitative questionnaire to compare differences of direct and indirect costs between two groups. Findings: The direct costs of a maternal death were significantly higher than the costs of a childbirth without a maternal death (US$4,119 vs. $370, p<0.001). More than 40% of the direct costs were attributed to funeral expenses. Hospitalization and emergency care expenses were the largest proportion of non-funeral direct costs and were higher in households with maternal death than the comparison group (US$2,248 vs. $305, p<0.001). To cover most of the high direct costs, 44.1% of affected households utilized compensation from hospitals, and the rest affected households (55.9%) utilized borrowing money or taking loans as major source of money to offset direct costs. The median economic burden of the direct (and non-reimbursed) costs of a maternal death was quite high - 37.0% of the household's annual income, which was approximately 4 times as high as the threshold for an expense being considered catastrophic. Conclusion: The immediate direct costs of maternal deaths are extremely catastrophic for the rural Chinese households in three provinces studied. © 2012 Ye et al. Source

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