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An appraisal of the maternal mortality decline in Nepal.

Hussein J, Bell J, Dar Iang M, Mesko N, Amery J, Graham W - PLoS ONE (2011)

Bottom Line: The sub-national changes are of similar magnitude and direction to those observed nationally, and in the terai region (plains) the differences are statistically significant with a reduction of 361 per 100,000 live births (95% CI 36,686) during the same time period.The reduction in fertility, changes in education and wealth, improvements in components of the human development index, gender empowerment and anaemia each explained more than 10% of the district variation in maternal mortality.We recommend close tracking of maternal mortality and its determinants in Nepal, attention to the communication of future estimates, and various options for bridging data gaps.

View Article: PubMed Central - PubMed

Affiliation: Immpact, University of Aberdeen, Aberdeen, Scotland. j.hussein@abdn.ac.uk

ABSTRACT

Background: A decline in the national maternal mortality ratio in Nepal has been observed from surveys conducted between 1996 and 2008. This paper aims to assess the plausibility of the decline and to identify drivers of change.

Methods: National and sub-national trends in mortality data were investigated using existing demographic and health surveys and maternal mortality and morbidity surveys. Potential drivers of the variation in maternal mortality between districts were identified by regressing district-level indicators from the Nepal demographic health surveys against maternal mortality estimates.

Results: A statistically significant decline of the maternal mortality ratio from 539 maternal deaths to 281 per 100,000 (95% CI 91,507) live births between 1993 and 2003 was demonstrated. The sub-national changes are of similar magnitude and direction to those observed nationally, and in the terai region (plains) the differences are statistically significant with a reduction of 361 per 100,000 live births (95% CI 36,686) during the same time period. The reduction in fertility, changes in education and wealth, improvements in components of the human development index, gender empowerment and anaemia each explained more than 10% of the district variation in maternal mortality. A number of limitations in each of the data sources used were identified. Of these, the most important relate to the underestimation of numbers of deaths.

Conclusion: It is likely that there has been a decline in Nepal's maternal mortality since 1993. This is good news for the country's sustained commitments in this area. Conclusions on the magnitude, pattern of the change and drivers of the decline are constrained by lack of data. We recommend close tracking of maternal mortality and its determinants in Nepal, attention to the communication of future estimates, and various options for bridging data gaps.

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Related in: MedlinePlus

Maternal mortality rate by fertility for eight districts in Nepal.
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pone-0019898-g003: Maternal mortality rate by fertility for eight districts in Nepal.

Mentions: The NDHS reported that fertility declined from 4.6 births per woman in 1994 to 3.1 in 2004. This was based on fertility three years prior to the survey (for example, the NDHS 1996 reference period was 1993–1995 so the estimate was placed at the mid-point of 1994). Figure 2 illustrates the drop of one and a half births per woman in ten years. The decline in fertility was greater in the five years between 2001 and 2006 than between 1996 and 2001. The percentage of women using modern contraceptive methods showed a corresponding steady increase. The regression analysis reported in Table 2 relevant to this question is shown in Figure 3; it illustrates the high level of correlation between GFR and MMrate.


An appraisal of the maternal mortality decline in Nepal.

Hussein J, Bell J, Dar Iang M, Mesko N, Amery J, Graham W - PLoS ONE (2011)

Maternal mortality rate by fertility for eight districts in Nepal.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3102673&req=5

pone-0019898-g003: Maternal mortality rate by fertility for eight districts in Nepal.
Mentions: The NDHS reported that fertility declined from 4.6 births per woman in 1994 to 3.1 in 2004. This was based on fertility three years prior to the survey (for example, the NDHS 1996 reference period was 1993–1995 so the estimate was placed at the mid-point of 1994). Figure 2 illustrates the drop of one and a half births per woman in ten years. The decline in fertility was greater in the five years between 2001 and 2006 than between 1996 and 2001. The percentage of women using modern contraceptive methods showed a corresponding steady increase. The regression analysis reported in Table 2 relevant to this question is shown in Figure 3; it illustrates the high level of correlation between GFR and MMrate.

Bottom Line: The sub-national changes are of similar magnitude and direction to those observed nationally, and in the terai region (plains) the differences are statistically significant with a reduction of 361 per 100,000 live births (95% CI 36,686) during the same time period.The reduction in fertility, changes in education and wealth, improvements in components of the human development index, gender empowerment and anaemia each explained more than 10% of the district variation in maternal mortality.We recommend close tracking of maternal mortality and its determinants in Nepal, attention to the communication of future estimates, and various options for bridging data gaps.

View Article: PubMed Central - PubMed

Affiliation: Immpact, University of Aberdeen, Aberdeen, Scotland. j.hussein@abdn.ac.uk

ABSTRACT

Background: A decline in the national maternal mortality ratio in Nepal has been observed from surveys conducted between 1996 and 2008. This paper aims to assess the plausibility of the decline and to identify drivers of change.

Methods: National and sub-national trends in mortality data were investigated using existing demographic and health surveys and maternal mortality and morbidity surveys. Potential drivers of the variation in maternal mortality between districts were identified by regressing district-level indicators from the Nepal demographic health surveys against maternal mortality estimates.

Results: A statistically significant decline of the maternal mortality ratio from 539 maternal deaths to 281 per 100,000 (95% CI 91,507) live births between 1993 and 2003 was demonstrated. The sub-national changes are of similar magnitude and direction to those observed nationally, and in the terai region (plains) the differences are statistically significant with a reduction of 361 per 100,000 live births (95% CI 36,686) during the same time period. The reduction in fertility, changes in education and wealth, improvements in components of the human development index, gender empowerment and anaemia each explained more than 10% of the district variation in maternal mortality. A number of limitations in each of the data sources used were identified. Of these, the most important relate to the underestimation of numbers of deaths.

Conclusion: It is likely that there has been a decline in Nepal's maternal mortality since 1993. This is good news for the country's sustained commitments in this area. Conclusions on the magnitude, pattern of the change and drivers of the decline are constrained by lack of data. We recommend close tracking of maternal mortality and its determinants in Nepal, attention to the communication of future estimates, and various options for bridging data gaps.

Show MeSH
Related in: MedlinePlus