• H Higashi, J J Barendregt, N J Kassebaum, T G Weiser, S W Bickler, and T Vos.
• Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; School of Population Health, University of Queensland, Brisbane, Qld, Australia.
• BJOG. 2015 Jan 1;122(2):228-36.

ObjectiveTo quantify the burden of maternal and neonatal conditions in low- and middle-income countries (LMICs) that could be averted by full access to quality first-level obstetric surgical procedures.DesignBurden of disease and epidemiological modelling.SettingLMICs from all global regions.PopulationThe entire population in 2010.MethodsWe included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion(1) ; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability-adjusted life years (DALYs) of these conditions into surgically 'avertable' and 'non-avertable' burdens. We applied the lowest age-specific fatality rates from all global regions to each LMIC 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.Main Outcome MeasuresDeaths and DALYs avertable.ResultsOf the estimated 56.6 million DALYs (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million DALYs (37%) are avertable by full coverage of quality obstetric surgery in LMICs. The avertable burden in absolute term is substantial given the size of burden of these conditions in LMICs. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million DALYs) among the five conditions, followed by abortion (2.1 million DALYs).ConclusionsImproving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs.© 2014 Royal College of Obstetricians and Gynaecologists.

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