Maternal Mortality Estimates, Methods and Processes


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  • Estimates review in continuation…
  • Los dos Plateaus se refieren a encuestas, luegosiguendatos del sistemarutinario
  • Maternal Mortality Estimates, Methods and Processes

    1. 1. Maternal Mortality Estimates,Methods and Consultation Process Fatima Marinho MD, MPH, PhD Coordinator, Health Analysis and Information Project, PAHO/HSD/HA Regional Advisory Committee on Health Statistics Meeting Havana, Cuba, 26-28 March 2012
    2. 2. Introduction• UN Maternal Mortality Estimates Interagency Group (MMEIG)• Joint effort of WHO, UNICEF, UNFPA and the World Bank,• Technical Advisory Group• 1990, 1995, 2000, 2005, 2008 maternal mortality estimates• Upcoming: 2010 Estimates
    3. 3. 2010 estimates• PAHO did not take part in estimation process• WHO conducted country consultation: 3-4 weeks to review/respond• Most countries reviewed estimates• PAHO collaborated in consultation process• Critics of consultation procedures received PAHO
    4. 4. Methodology• Available nationally-representative mortality data• Countries divided into 3 categories based on available data: - civil registration data - other types of data - no national data• Uncertainty of estimates
    5. 5. Civil Registration (CR) Data• Data adjusted for incompleteness and misclassification• In lieu of country-specific information, an adjustment factor of 1.5 was applied• Data on maternal deaths and live births were pooled for 5-year periods (1990, 1995, 2000, 2005, 2008)
    6. 6. Without Complete CR• Multilevel regression based on national level data surveys, census, other sources• PMDF (proportion maternal among deaths of females of reproductive age): GDP, GFR, skilled attendant at birth (%)• Adjusting maternal deaths for misclassification (different correction factors applied)• Multilevel (or hierarchical) model
    7. 7. Indirect Aids maternal deaths• Direct maternal deaths are counted with the direct maternal deaths• Separate treatment of indirect death as aggravated by interaction between HIV and pregnancy
    8. 8. Methodology Critics• Includes late maternal deaths• Constant correction factor over time• Use of UN estimates with under- or overestimation of live births• Omission of discussion of international and national comparable concepts• Most recent data not included• Missing transparency of methods, sources used (improved for 2010 estimates)
    9. 9. Data Review• Preliminary WHO Results• PAHO Basic Indicators: annual data request to countries (reported), December 2011 Update• IHME: Institute of Health Metrics and Evaluation, Maternal Mortality Estimates and MDG 5 Attainment by Country 1990-2011; Sept 2011. (estimates)•
    10. 10. ComparingMMEIGestimates anddata as reportedto PAHOlatest availableyear
    11. 11. Argentina
    12. 12. Brazil
    13. 13. Chile
    14. 14. Cuba
    15. 15. Jamaica
    16. 16. Mexico
    17. 17. Suriname
    18. 18. Venezuela
    19. 19. El Salvador
    20. 20. Nicaragua
    21. 21. Honduras
    22. 22. Discussion• What should PAHO’s rol be in the estimation, consultation and dissemination of WHO (or other) estimates• How to better support countries’ responses to international agency estimates?