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Maternal Mortality Estimates, Methods and Processes

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 Maternal Mortality Estimates, Methods and Processes Presentation Transcript

  • 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
  • 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
  • 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
  • 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
  • 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)
  • 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
  • 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
  • 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)
  • 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)• http://craes.drupalgardens.com/visualizaciones
  • ComparingMMEIGestimates anddata as reportedto PAHOlatest availableyear
  • Argentina
  • Brazil
  • Chile
  • Cuba
  • Jamaica
  • Mexico
  • Suriname
  • Venezuela
  • El Salvador
  • Nicaragua
  • Honduras
  • 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?