Maternal mortality estimates: global progress on levels and trends

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IHME's Dr. Lozano presents the results of IHME's research on maternal mortality, which shows that global maternal deaths are declining.

For more information visit www.healthmetricsandevaluation.org

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  • This graph shows maternal deaths by 21 Global Burden of Disease regions. The global total was 526,300 in 1980, dropping to 342,900 in 2008, a yearly rate of decline of about 1.5% in the number of deaths. You can see here the enormous but shrinking contribution of South Asia, which includes India, Pakistan, Afghanistan and Bangladesh. You can also see that the relative contribution of maternal deaths in Sub-Saharan Africa has been increasing, from about 23% in 1980 to more than half (52%) in 2008.
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  • Maternal mortality estimates: global progress on levels and trends

    1. 1. Maternal Mortality Estimates: Global Progress on Levels and Trends August 30, 2010 Rafael Lozano, MD MSc Professor of Global Health
    2. 2. Outline <ul><li>Background </li></ul><ul><li>Data sources and methods </li></ul><ul><li>Results </li></ul><ul><li>Lessons learned and next steps </li></ul>
    3. 3. Broader context <ul><li>Important momentum for new estimates </li></ul><ul><ul><li>Need to assess progress given international commitment to Millennium Development Goal 5. </li></ul></ul><ul><li>Opportunities for robust reassessment </li></ul><ul><ul><li>WHO sponsored development of country estimates for 1990, 1995, 2000, 2005. </li></ul></ul><ul><ul><li>Most recent assessment (Hill et al, 2007) reported 576,300 maternal deaths in 1990 and 535,900 in 2007; 0.48% annual rate of decline in the global maternal mortality ratio. </li></ul></ul><ul><li>Methodological advances </li></ul><ul><li>More data than ever before </li></ul>
    4. 4. Outline <ul><li>Background </li></ul><ul><li>Data sources and methods </li></ul><ul><li>Results </li></ul><ul><li>Lessons learned and next steps </li></ul>
    5. 5. Definitions <ul><li>Maternal death : “death of a woman while pregnant or within 42 days of termination of pregnancy…from any cause related to the pregnancy or its management, but not from accidental or incidental causes” (ICD-10) </li></ul><ul><li>For inter-temporal and international comparisons, ICD and MDG manual recommend A+B+C excluding D+E+F </li></ul><ul><li>Maternal mortality ratio: number of maternal deaths per 100,000 live births </li></ul>  Direct Indirect HIV Incidental Early maternal (<42 days) A B C D Late maternal (> 42 days & < 1 year) E F    
    6. 6. Density of site-years of observation, 1980-2008
    7. 7. Systematic identification of data <ul><li>Vital registration data </li></ul><ul><ul><li>Naghavi et al.* have undertaken a correction of the registration data, increasing maternal deaths in vital registration countries by 40% on average. </li></ul></ul><ul><li>Sibling history data </li></ul><ul><ul><li>Survey respondents report on survival of siblings and whether deaths of sisters 15-49 occurred during pregnancy, childbirth, or period after birth. </li></ul></ul><ul><ul><li>Apply the Gakidou-King correction for survival bias. </li></ul></ul><ul><li>Deaths in the household </li></ul><ul><li>National and sub-national verbal autopsy </li></ul><ul><ul><li>Literature review to identify published estimates from national and sub-national population-based studies of maternal mortality. </li></ul></ul>* Naghavi M, et al. Algorithms for enhancing public health utility of cause s of death data, Population Health Metrics, 2010. No data for 21 countries, representing 2.2% of births Source of Data Site-Years of Observation Vital registration 2,186 Sibling Histories 204 Surveillance Systems 20 Census/Survey Deaths in Household 26 National VA 35 Subnational VA 180 Total 2,651
    8. 8. Analytical approach <ul><li>Extract the proportion of all female deaths due to maternal causes for five-year age groups (15-49). </li></ul><ul><li>Apply proportion to new adult female mortality time series (Rajaratnam et al, 2010) to arrive at maternal mortality rates by country, year, and age groups. </li></ul><ul><li>Two-stage analysis, modeling the age-specific maternal mortality rate: </li></ul><ul><ul><li>Stage 1: Linear model </li></ul></ul><ul><ul><li>Stage 2: Spatial-temporal model </li></ul></ul><ul><li>HIV counterfactual analysis </li></ul><ul><li>Model validation </li></ul>
    9. 9. Criteria for better and consistent estimates <ul><li>Continued increase in quantity and quality of data </li></ul><ul><li>Use of models with improved predictive validity </li></ul><ul><li>Quantify uncertainty using statistical methods </li></ul><ul><li>Transparency of data sources and methods </li></ul>
    10. 10. Outline <ul><li>Background </li></ul><ul><li>Data sources and methods </li></ul><ul><li>Results </li></ul><ul><li>Lessons learned and next steps </li></ul>
    11. 11. Maternal deaths by region, 1980-2008
    12. 12. Regional trends in the MMR
    13. 13. MMR with and without HIV
    14. 14. India: Predicted MMR per 100,000 live births with uncertainty
    15. 15. MMR per 100,000 live births, 2008
    16. 16. Annualized rate of decline in MMR, 1990 to 2008
    17. 17. Outline <ul><li>Background </li></ul><ul><li>Data sources and methods </li></ul><ul><li>Results </li></ul><ul><li>Lessons learned and next steps </li></ul>
    18. 18. Lessons learned <ul><li>Gaining ground </li></ul><ul><ul><li>Global maternal deaths down to 342,900 in 2008 </li></ul></ul><ul><ul><li>Global trend is a 1.4% decline per year since 1990 </li></ul></ul><ul><ul><li>23 countries are on track to meet MDG 5, achieving an annual rate of decline of 5.5% </li></ul></ul><ul><li>Progress undocumented but not unexpected </li></ul><ul><ul><li>Global total fertility rate has dropped from 3.70 in 1980 to 2.56 in 2008 </li></ul></ul><ul><ul><li>Income per capita has been rising over the period, particularly in Asia and Latin America </li></ul></ul><ul><ul><li>Maternal education has been increasing as well; in Sub-Saharan Africa, the average years of schooling for women aged 25-44 rose from 1.5 years in 1980 to 4.4 years in 2008 </li></ul></ul>
    19. 19. Lessons learned <ul><li>Adverse Impact of HIV </li></ul><ul><ul><li>Progress on reducing maternal mortality would have been much greater in the absence of HIV, especially in sub-Saharan Africa </li></ul></ul><ul><ul><li>Important implications for intervention policy </li></ul></ul><ul><li>Communication with countries and local researchers </li></ul><ul><ul><li>Letters to the editor: Argentina. Jamaica, Iran, Burkina Faso, Peru, Philippines, Indonesia </li></ul></ul><ul><ul><li>Letters to correspondence author: Turkey, Jamaica, Centro America, Cambodia </li></ul></ul>
    20. 20. Next steps <ul><li>Research </li></ul><ul><ul><li>Continue updates </li></ul></ul><ul><ul><li>Evaluation </li></ul></ul><ul><li>Data dissemination </li></ul><ul><ul><li>Reports </li></ul></ul><ul><ul><li>Web page http://www.healthmetricsandevaluation.org </li></ul></ul><ul><li>Organization of regional workshops </li></ul>
    21. 21. KNOWING IS NOT ENOUGH; WE MUST APPLY. WILLING IS NOT ENOUGH; WE MUST DO. JOHANN W. VON GOETHE ( 1749-1832)

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