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Understanding maternal mortality from top-down and bottom-up perspectives: Case of Tigray Region, Ethiopia.

Godefay H, Byass P, Kinsman J, Mulugeta A - J Glob Health (2015)

Bottom Line: This simple but well-designed survey approach enabled estimation of maternal mortality in Tigray Region on a local, contemporary basis.It also provided insights into possible local variations in MMR and their determinants.Consequently, this approach could be implemented at regional level in other large sub-Saharan African countries, or at national level in smaller ones to monitor and evaluate maternal health service interventions.

View Article: PubMed Central - PubMed

Affiliation: Tigray Regional Health Bureau, Mekelle, Ethiopia.

ABSTRACT

Background: Unacceptably high levels of preventable maternal mortality persist as a problem across sub-Saharan Africa and much of south Asia. Currently, local assessments of the magnitude of maternal mortality are not often made, so the best available information for health planning may come from global estimates and not reflect local circumstances.

Methods: A community-based cross-sectional survey was designed to identify all live births together with all deaths among women aged 15-49 years retrospectively over a one-year period in six randomly selected districts of Tigray Region, northern Ethiopia. After birth and death identification, Health Extension Workers trained to use the WHO 2012 verbal autopsy (VA) tool visited households to carry out VAs on all deaths among women aged 15-49 years. All pregnancy-related deaths were identified after processing the VA material using the InterVA-4 model, which corresponds to the WHO 2012 VA. A maternal mortality ratio (MMR) was calculated for each District and expressed with a 95% confidence interval (CI).

Results: The MMRs across the six sampled Districts ranged from 37 deaths per 100 000 live births (95% CI 1 to 207) to 482 deaths per 100 000 live births (95% CI 309 to 718). The overall MMR for Tigray Region was calculated at 266 deaths per 100 000 live births (95% CI 198 to 350). Direct obstetric causes accounted for 61% of all pregnancy-related deaths. Haemorrhage was the major cause of pregnancy-related death (34%). District-level MMRs were strongly inversely correlated with population density (r(2) = 0.86).

Conclusion: This simple but well-designed survey approach enabled estimation of maternal mortality in Tigray Region on a local, contemporary basis. It also provided insights into possible local variations in MMR and their determinants. Consequently, this approach could be implemented at regional level in other large sub-Saharan African countries, or at national level in smaller ones to monitor and evaluate maternal health service interventions.

No MeSH data available.


Related in: MedlinePlus

Percentage distribution of 51 pregnancy–related deaths among women aged 15–49 years from March 2012 to April 2013, Tigray Region, Ethiopia, by WHO verbal autopsy cause categories and District.
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Figure 3: Percentage distribution of 51 pregnancy–related deaths among women aged 15–49 years from March 2012 to April 2013, Tigray Region, Ethiopia, by WHO verbal autopsy cause categories and District.

Mentions: Figure 3 shows causes of death in WHO 2012 VA cause of death categories (16) for the 51 pregnancy–related deaths, by District, as determined by the InterVA–4 model. In addition, the commonest causes of indirect causes of maternal death identified were anemia (12%) followed by pulmonary tuberculosis (10%), with both HIV/AIDS and malaria causing 2% of maternal deaths. Out of the 51 pregnancy–related deaths recorded, 61.3% were ascribed to direct obstetric causes. The most common obstetric causes were obstetric haemorrhage (34.4%), followed by anaemia of pregnancy (9.3%) and pregnancy–induced hypertension (8.1%). Post–abortion deaths accounted for 5.9% of pregnancy–related mortality.


Understanding maternal mortality from top-down and bottom-up perspectives: Case of Tigray Region, Ethiopia.

Godefay H, Byass P, Kinsman J, Mulugeta A - J Glob Health (2015)

Percentage distribution of 51 pregnancy–related deaths among women aged 15–49 years from March 2012 to April 2013, Tigray Region, Ethiopia, by WHO verbal autopsy cause categories and District.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306295&req=5

Figure 3: Percentage distribution of 51 pregnancy–related deaths among women aged 15–49 years from March 2012 to April 2013, Tigray Region, Ethiopia, by WHO verbal autopsy cause categories and District.
Mentions: Figure 3 shows causes of death in WHO 2012 VA cause of death categories (16) for the 51 pregnancy–related deaths, by District, as determined by the InterVA–4 model. In addition, the commonest causes of indirect causes of maternal death identified were anemia (12%) followed by pulmonary tuberculosis (10%), with both HIV/AIDS and malaria causing 2% of maternal deaths. Out of the 51 pregnancy–related deaths recorded, 61.3% were ascribed to direct obstetric causes. The most common obstetric causes were obstetric haemorrhage (34.4%), followed by anaemia of pregnancy (9.3%) and pregnancy–induced hypertension (8.1%). Post–abortion deaths accounted for 5.9% of pregnancy–related mortality.

Bottom Line: This simple but well-designed survey approach enabled estimation of maternal mortality in Tigray Region on a local, contemporary basis.It also provided insights into possible local variations in MMR and their determinants.Consequently, this approach could be implemented at regional level in other large sub-Saharan African countries, or at national level in smaller ones to monitor and evaluate maternal health service interventions.

View Article: PubMed Central - PubMed

Affiliation: Tigray Regional Health Bureau, Mekelle, Ethiopia.

ABSTRACT

Background: Unacceptably high levels of preventable maternal mortality persist as a problem across sub-Saharan Africa and much of south Asia. Currently, local assessments of the magnitude of maternal mortality are not often made, so the best available information for health planning may come from global estimates and not reflect local circumstances.

Methods: A community-based cross-sectional survey was designed to identify all live births together with all deaths among women aged 15-49 years retrospectively over a one-year period in six randomly selected districts of Tigray Region, northern Ethiopia. After birth and death identification, Health Extension Workers trained to use the WHO 2012 verbal autopsy (VA) tool visited households to carry out VAs on all deaths among women aged 15-49 years. All pregnancy-related deaths were identified after processing the VA material using the InterVA-4 model, which corresponds to the WHO 2012 VA. A maternal mortality ratio (MMR) was calculated for each District and expressed with a 95% confidence interval (CI).

Results: The MMRs across the six sampled Districts ranged from 37 deaths per 100 000 live births (95% CI 1 to 207) to 482 deaths per 100 000 live births (95% CI 309 to 718). The overall MMR for Tigray Region was calculated at 266 deaths per 100 000 live births (95% CI 198 to 350). Direct obstetric causes accounted for 61% of all pregnancy-related deaths. Haemorrhage was the major cause of pregnancy-related death (34%). District-level MMRs were strongly inversely correlated with population density (r(2) = 0.86).

Conclusion: This simple but well-designed survey approach enabled estimation of maternal mortality in Tigray Region on a local, contemporary basis. It also provided insights into possible local variations in MMR and their determinants. Consequently, this approach could be implemented at regional level in other large sub-Saharan African countries, or at national level in smaller ones to monitor and evaluate maternal health service interventions.

No MeSH data available.


Related in: MedlinePlus