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National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity
Ana P Betrán, Daniel Wojdyla, Samuel F Posner, A Metin Gülmezoglu
BMC Public Health , 2005, DOI: 10.1186/1471-2458-5-131
Abstract: We followed the standard methodology for systematic reviews. This manuscript presents nationally representative estimates of maternal mortality derived from the systematic review. Using regression models, relationships between study-specific and country-specific variables with the maternal mortality estimates are explored in order to assist further modelling to predict maternal mortality.Maternal mortality estimates included 141 countries and represent 78.1% of the live births worldwide. As expected, large variability between countries, and within regions and subregions, is identified. Analysis of variability according to study characteristics did not yield useful results given the high correlation with each other, with development status and region. A regression model including selected country-specific variables was able to explain 90% of the variability of the maternal mortality estimates. Among all country-specific variables selected for the analysis, three had the strongest relationships with maternal mortality: proportion of deliveries assisted by a skilled birth attendant, infant mortality rate and health expenditure per capita.With the exception of developed countries, variability of national maternal mortality estimates is large even within subregions. It seems more appropriate to study such variation through differentials in other national and subnational characteristics. Other than region, study of country-specific variables suggests infant mortality rate, skilled birth attendant at delivery and health expenditure per capita are key variables to predict maternal mortality at national level.Since the launching of the Safe Motherhood Initiative in 1987 [1], there has been a worldwide effort to reduce maternal mortality and to identify its determinants. These efforts have been directed by the outputs of a number of international conferences over the past decade such as the International Conference on Population and Development in 1994, and the Fourth World C
Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana
Smith,Jason B.; Fortney,Judith A.; Wong,Emelita; Amatya,Ramesh; Coleman,Nii A.; Johnson,Joseph de Graft;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001000500006
Abstract: objective: to estimate the maternal mortality ratio (mmr) by the sisterhood method in two districts of the brong-ahafo region of ghana, and to determine the impact of different assumptions and analytical decisions on these estimates. methods: indirect estimates of the mmr were calculated from data collected in 1995 by family health international (fhi) on 5202 women aged 15-49 years, using a household screen of randomly selected areas in the two districts. other data from the nationally representative 1994 ghana infant, child and maternal mortality survey (icmms) and from the 1997 kassena-nankana district study were also used for comparison. findings: based on the fhi data, the mmr was estimated to be 269 maternal deaths per 100 000 live births for both districts combined, a figure higher than icmms estimates. biases during data collection may account for this difference, including the fact that biases underestimating mortality are more common than those overestimating it. biases introduced during data analysis were also considered, but only the total fertility rate used to calculate the mmr seemed to affect the estimates significantly. conclusions: the results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received attention. users of this method should be aware of limitations when interpreting results. we recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of data.
Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana  [cached]
Smith Jason B.,Fortney Judith A.,Wong Emelita,Amatya Ramesh
Bulletin of the World Health Organization , 2001,
Abstract: OBJECTIVE: To estimate the maternal mortality ratio (MMR) by the sisterhood method in two districts of the Brong-Ahafo region of Ghana, and to determine the impact of different assumptions and analytical decisions on these estimates. METHODS: Indirect estimates of the MMR were calculated from data collected in 1995 by Family Health International (FHI) on 5202 women aged 15-49 years, using a household screen of randomly selected areas in the two districts. Other data from the nationally representative 1994 Ghana Infant, Child and Maternal Mortality Survey (ICMMS) and from the 1997 Kassena-Nankana District study were also used for comparison. FINDINGS: Based on the FHI data, the MMR was estimated to be 269 maternal deaths per 100 000 live births for both districts combined, a figure higher than ICMMS estimates. Biases during data collection may account for this difference, including the fact that biases underestimating mortality are more common than those overestimating it. Biases introduced during data analysis were also considered, but only the total fertility rate used to calculate the MMR seemed to affect the estimates significantly. CONCLUSIONS: The results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received attention. Users of this method should be aware of limitations when interpreting results. We recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of data.
Maternal mortality due to arterial hypertension in S?o Paulo City (1995-1999)
Vega, Carlos Eduardo Pereira;Kahhale, Soubhi;Zugaib, Marcelo;
Clinics , 2007, DOI: 10.1590/S1807-59322007000600004
Abstract: aim: to describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. methods: the committee on maternal mortality of s?o paulo city has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2% and a maternal mortality rate of 56.7/100,000 live births. arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3%) cases. results: ninety-five (66.9%) of the deaths occurred during the puerperal period and 34 (23.9%) occurred during pregnancy. the time of death was not reported in 13 (9.2%) cases. seizures were observed in 41 cases and magnesium sulfate was used in four of them. the causes of death were ruled to be cerebrovascular accident (44.4%), acute pulmonary edema (24.6%), and coagulopathies (14.1%). cesarean section was performed in 85 (59.9%) cases and vaginal delivery in 15 (16.0%). conclusion: complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in s?o paulo city. quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.
Revised estimates of influenza-associated excess mortality, United States, 1995 through 2005
Ivo M Foppa, Md Monir Hossain
Emerging Themes in Epidemiology , 2008, DOI: 10.1186/1742-7622-5-26
Abstract: U.S. monthly all-cause mortality, 1995 through 2005, was hierarchically modeled as Poisson variable with a mean that linearly depends both on seasonal covariates and on influenza-certified mortality. It also allowed for overdispersion to account for extra variation that is not captured by the Poisson error. The coefficient associated with influenza-certified mortality was interpreted as ratio of total influenza mortality to influenza-certified mortality. Separate models were fitted for four age categories (<18, 18–49, 50–64, 65+). Bayesian parameter estimation was performed using Markov Chain Monte Carlo methods. For the eleven year study period, a total of 260,814 (95% CI: 201,011–290,556) deaths was attributed to influenza, corresponding to an annual average of 23,710, or 0.91% of all deaths.Annual estimates for influenza mortality were highly variable from year to year, but they were systematically lower than previously published estimates. The excellent fit of our model with the data suggest validity of our estimates.Influenza viruses, due to their genotypic plasticity [1], cause yearly epidemics that generally coincide with peaks in all-cause mortality (Figure 1). Incidence of these infections is difficult to quantify because of their clinical similarity with other upper respiratory infections and because laboratory confirmation is rarely done. Mortality due to seasonal influenza, which may result from exacerbation of underlying pulmonary, cardiac or other systemic conditions is, nevertheless, thought to be substantial [2-17]. Recent U.S. estimates of average annual excess mortality due to seasonal influenza exceed 30,000 [11,14].To estimate excess mortality due to influenza, two fundamental approaches have previously been used. The most popular one is based on Serfling's seasonal regression method [18] and has resulted in numerous estimates of excess mortality due influenza [3-8,12,14,15,19]. This periodical regression approach is based on parametric estimatio
Maternal and Neonatal Mortality in South-West Ethiopia: Estimates and Socio-Economic Inequality  [PDF]
Yaliso Yaya, Kristiane Tislevoll Eide, Ole Frithjof Norheim, Bernt Lindtj?rn
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0096294
Abstract: Introduction Ethiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality. Nevertheless, there are challenges in reducing maternal and neonatal mortality. The aim of this study was to estimate maternal and neonatal mortality and the socio-economic inequalities of these mortalities in rural south-west Ethiopia. Methods We visited and enumerated all households but collected data from those that reported pregnancy and birth outcomes in the last five years in 15 of the 30 rural kebeles in Bonke woreda, Gamo Gofa, south-west Ethiopia. The primary outcomes were maternal and neonatal mortality and a secondary outcome was the rate of institutional delivery. Results We found 11,762 births in 6572 households; 11,536 live and 226 stillbirths. There were 49 maternal deaths; yielding a maternal mortality ratio of 425 per 100,000 live births (95% CI:318–556). The poorest households had greater MMR compared to richest (550 vs 239 per 100,000 live births). However, the socio-economic factors examined did not have statistically significant association with maternal mortality. There were 308 neonatal deaths; resulting in a neonatal mortality ratio of 27 per 1000 live births (95% CI: 24–30). Neonatal mortality was greater in households in the poorest quartile compared to the richest; adjusted OR (AOR): 2.62 (95% CI: 1.65–4.15), headed by illiterates compared to better educated; AOR: 3.54 (95% CI: 1.11–11.30), far from road (≥6 km) compared to within 5 km; AOR: 2.40 (95% CI: 1.56–3.69), that had three or more births in five years compared to two or less; AOR: 3.22 (95% CI: 2.45–4.22). Households with maternal mortality had an increased risk of stillbirths; OR: 11.6 (95% CI: 6.00–22.7), and neonatal deaths; OR: 7.2 (95% CI: 3.6–14.3). Institutional delivery was only 3.7%. Conclusion High mortality with socio-economic inequality and low institutional delivery highlight the importance of strengthening obstetric interventions in rural south-west Ethiopia.
POPULATION BASED ESTIMATES OF MATERNAL MORTALITY IN MOJOKERTO, EAST JAVA (The application of indirect technique : Sisterhood Method)  [cached]
Soeharsono Soemantri
Bulletin of Health Research , 2012,
Abstract: Mendapatkan angka kematian maternal secara langsung merupakan kendala bagi berbagai negara ber-kembang. Oleh sebab itu mendapatkannya secara tidak langsung merupakan alternatif untuk dikembang-kan. "Sisterhood method", pendekatan tidak langsung yang dikembangkan oleh Wendy Graham dkk, adalah salah satu alternatif untuk dipertimbangkan. Penerapan metode tersebut dalam survei rumah tangga di Mojokerto memberikan hasil yang konsisten dengan penerapan di negara lain (Gambia dan Peru). Mater-nal mortality ratio (MMR) dari metode tersebut di Mojokerto (397 per 100.000) juga dapat dibandingkan dengan hasil penelitian MMR cara langsung di Indonesia setelah dipertimbangkan kekurangan cara langsung.
Maternal mortality estimates are useful  [cached]
White Franklin,Saleem Sarah
Bulletin of the World Health Organization , 2001,
Abstract:
Maternal Mortality Correlates by Nation  [PDF]
Gina Marie Piane
Open Journal of Preventive Medicine (OJPM) , 2014, DOI: 10.4236/ojpm.2014.410085
Abstract: Background: This study reports the results of a secondary analysis of data provided by the World Health Organization to determine the correlates of maternal mortality among all reporting nations worldwide. Historically, maternal mortality ratios have declined in nations that provided a system for access to skilled care for the majority of its women. Currently, maternal mortality ratios are associated with access to skilled care as well as economic indicators, literacy, education, access to contraceptives, transportation and HIV prevalence. Methods: Descriptive statistics, bi-variate correlations and multiple linear regression analyses are reported using maternal mortality ratios as the dependent variable. In addition, an examination of countries that are exceptions to the regression is also reported. Results: Strong positive Pearson two-tailed correlations were found between MMR and infant mortality rate (0.866), total fertility rate (0.854), poverty rate (0.756), and adolescent fertility rate (0.710). Strong negative correlations were found between MMR and percentage of births attended by a skilled attendant (-0.786), percentage of women using contraceptives (-0.786), and adult literacy rate (-0.710). Eighty-one percent of the variation in MMR can be explained by differences in IMR, percent of births attended by a skilled provider, percent of women using contraceptive, total fertility rate, adolescent fertility rate, adult literacy rate and poverty. Discussion: Examination of the correlates of maternal mortality gives direction to the effort to achieve the WHO’s Millennium Development Goal of reducing maternal mortality by two-thirds from 1995-2015.
MATERNAL MORTALITY
TASNIM TAHIRA REHMAN
The Professional Medical Journal , 2009,
Abstract: Objective: To find out maternal mortality ratio (MMR) and to determine major causes of maternal death. Study design: A descriptive study. Setting: Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. Study period: From 01.01.2008 to 31.12.2008. Materials and methods: All cases of maternal death during this study periods were included except accidental deaths. Results: There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births. The most common cause of maternal death was hemorrhage (34.5%) followed by hypertensive disorders/eclampsia (31%). Most of the patients (75.86%) were referred from primary & secondary care level. Conclusion: Maternal mortality is still very high in underdeveloped countries including Pakistan. We must enhance emergency obstetric care (EOC) to achieve the goal of reduction in MMR.
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