Abstract
Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.
| Original language | English |
|---|---|
| Pages (from-to) | 980-1004 |
| Number of pages | 25 |
| Journal | The Lancet |
| Volume | 384 |
| Issue number | 9947 |
| DOIs | |
| Publication status | Published - Sept 22 2014 |
| Externally published | Yes |
ASJC Scopus subject areas
- General Medicine
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In: The Lancet, Vol. 384, No. 9947, 22.09.2014, p. 980-1004.
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TY - JOUR
T1 - Global, regional, and national levels and causes of maternal mortality during 1990-2013
T2 - A systematic analysis for the Global Burden of Disease Study 2013
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AU - Bertozzi-Villa, Amelia
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AU - Colquhoun, Samantha M.
AU - Cooper, Leslie Trumbull
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AU - Dandona, Lalit
AU - Dandona, Rakhi
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AU - Jee, Sun Ha
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AU - Jha, Vivekanand
AU - Jiang, Guohong
AU - Jonas, Jost B.
AU - Juel, Knud
AU - Kabagambe, Edmond Kato
AU - Kan, Haidong
AU - Karam, Nadim E.
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AU - Karema, Corine Kakizi
AU - Kaul, Anil
AU - Kawakami, Norito
AU - Kazanjan, Konstantin
AU - Kazi, Dhruv S.
AU - Kemp, Andrew H.
AU - Kengne, Andre Pascal
AU - Kereselidze, Maia
AU - Khader, Yousef Saleh
AU - Khalifa, Shams Eldin Ali Hassan
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AU - Khang, Young Ho
AU - Knibbs, Luke
AU - Kokubo, Yoshihiro
AU - Kosen, Soewarta
AU - Defo, Barthelemy Kuate
AU - Kulkarni, Chanda
AU - Kulkarni, Veena S.
AU - Kumar, G. Anil
AU - Kumar, Kaushalendra
AU - Kumar, Ravi B.
AU - Kwan, Gene
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AU - Leigh, James
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AU - Leung, Ricky
AU - Li, Xiaohong
AU - Li, Yichong
AU - Li, Yongmei
AU - Liang, Juan
AU - Liang, Xiaofeng
AU - Lim, Stephen S.
AU - Lin, Hsien Ho
AU - Lipshultz, Steven E.
AU - Liu, Shiwei
AU - Liu, Yang
AU - Lloyd, Belinda K.
AU - London, Stephanie J.
AU - Lotufo, Paulo A.
AU - Ma, Jixiang
AU - Ma, Stefan
AU - Machado, Vasco Manuel Pedro
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AU - Mills, Edward J.
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AU - De La Cruz Monis, Jonathan
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AU - Moradi-Lakeh, Maziar
AU - Mori, Rintaro
AU - Mueller, Ulrich O.
AU - Mukaigawara, Mitsuru
AU - Naheed, Aliya
AU - Naidoo, Kovin S.
AU - Nand, Devina
AU - Nangia, Vinay
AU - Nash, Denis
AU - Nejjari, Chakib
AU - Nelson, Robert G.
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AU - Ng, Marie
AU - Nieuwenhuijsen, Mark J.
AU - Nisar, Muhammad Imran
AU - Nolte, Sandra
AU - Norheim, Ole F.
AU - Nyakarahuka, Luke
AU - Oh, In Hwan
AU - Ohkubo, Takayoshi
AU - Olusanya, Bolajoko O.
AU - Omer, Saad B.
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AU - Orisakwe, Orish Ebere
AU - Pandian, Jeyaraj D.
AU - Papachristou, Christina
AU - Park, Jae Hyun
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AU - Patten, Scott B.
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AU - Pavlin, Boris Igor
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AU - Petzold, Max
AU - Poenaru, Dan
AU - Polanczyk, Guilherme V.
AU - Polinder, Suzanne
AU - Pope, Dan
AU - Pourmalek, Farshad
AU - Qato, Dima
AU - Quistberg, D. Alex
AU - Rafay, Anwar
AU - Rahimi, Kazem
AU - Rahimi-Movaghar, Vafa
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AU - Raju, Murugesan
AU - Rana, Saleem M.
AU - Refaat, Amany
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AU - Pimienta, Tania Georgina Sánchez
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AU - Salomon, Joshua A.
AU - Sampson, Uchechukwu
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AU - Schneider, Ione J.C.
AU - Schumacher, Austin
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AU - Seedat, Soraya
AU - Sepanlou, Sadaf G.
AU - Servan-Mori, Edson E.
AU - Shakh-Nazarova, Marina
AU - Sheikhbahaei, Sara
AU - Shibuya, Kenji
AU - Shin, Hwashin Hyun
AU - Shiue, Ivy
AU - Sigfusdottir, Inga Dora
AU - Silberberg, Donald H.
AU - Silva, Andrea P.
AU - Singh, Jasvinder A.
AU - Skirbekk, Vegard
AU - Sliwa, Karen
AU - Soshnikov, Sergey S.
AU - Sposato, Luciano A.
AU - Sreeramareddy, Chandrashekhar T.
AU - Stroumpoulis, Konstantinos
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AU - Teixeira, Carolina Maria
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AU - Vos, Theo
AU - Waller, Stephen
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AU - Wang, Linhong
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AU - Yu, Chuanhua
AU - Jin, Kim Yun
AU - El Sayed Zaki, Maysaa
AU - Zhao, Yong
AU - Zheng, Yingfeng
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N1 - Funding Information: Cyrus Cooper has received consultancy fees, lecture fees, and honoraria from Amgen, GlaxoSmithKline, Alliance for Better Bone Health, Merck Sharp and Dohme, Eli Lilly, Pfizer, Novartis, Servier, Medtronic, and Roche. Katherine B Gibney received the National Health and Medical Research Council Gustav Nossal scholarship sponsored by CSL in 2012; this award is peer-reviewed through the standard National Health and Medical Research Countil peer-review process, and CSL does not play any part in selection of the awardee. Norito Kawakami has received fees from Meiji, Otsuka, EAP Consulting, Fujitsu Software Technologies, Japan Productivity Center, Occupational Health Foundation, Japan Housing Finance Agency, Aishin-Seiki, and the Japan Dental Association; consultancy fees from Sekisui Chemicals, Junpukai Health Care Center, and Osaka Chamber of Commerce and Industry; and royalties from Igaku-Shoin, Taisha-kan, Nanko-do, Nanzan-do, PHP Publication, and Fujitsu Software Technologies. Norito Kawakami has also received research grants from the Japanese Ministry of Education, Science, and Technology; the Japanese Ministry of Health, Labor and Welfare; Fujitsu Software Technologies; Softbank; and Japan Management Association. Guilherme V Polanczyk has received grants or research support from the National Council for Scientific and Technological Development, the São Paulo Research Foundation, and the University of São Paulo; has served as a paid consultant to Shire; has served on the speakers' bureau of Shire; and has received royalties from Editora Manole. Jasvinder A Singh has received research grants from Takeda and Savient; has received consultant fees from Savient, Takeda, Regeneron, and Allergan; is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; is a member of the American College of Rheumatology's Guidelines Subcommittee of the Quality of Care Committee; and is a member of the Veterans Affairs Rheumatology Field Advisory Committee. The other authors declare no competing interests.
PY - 2014/9/22
Y1 - 2014/9/22
N2 - Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.
AB - Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=84907272570&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907272570&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(14)60696-6
DO - 10.1016/S0140-6736(14)60696-6
M3 - Article
C2 - 24797575
AN - SCOPUS:84907272570
SN - 0140-6736
VL - 384
SP - 980
EP - 1004
JO - The Lancet
JF - The Lancet
IS - 9947
ER -