WUNRN
GLOBAL
CAUSES OF MATERNAL DEATH: A WHO SYSTEMATIC ANALYSIS
The
Lancet Global Health, Volume
2, Issue 6, Pages e323 - e333, June 2014
Copyright
© 2014 World Health Organization Published by Elsevier Ltd.
Data
for the causes of maternal deaths are needed to inform policies to improve
maternal health. We developed and analysed global, regional, and subregional
estimates of the causes of maternal death during 2003—09, with a novel method,
updating the previous WHO systematic review.
We
searched specialised and general bibliographic databases for articles published
between between Jan 1, 2003, and Dec 31, 2012, for research data, with no
language restrictions, and the WHO mortality database for vital registration
data. On the basis of prespecified inclusion criteria, we analysed causes of
maternal death from datasets. We aggregated country level estimates to report
estimates of causes of death by Millennium Development Goal regions and
worldwide, for main and subcauses of death categories with a Bayesian
hierarchical model.
We
identified 23 eligible studies (published 2003—12). We included 417 datasets
from 115 countries comprising 60 799 deaths in the analysis. About 73%
(1 771 000 of 2 443 000) of all maternal deaths between
2003 and 2009 were due to direct obstetric causes and deaths due to indirect
causes accounted for 27·5% (672 000, 95% UI 19·7—37·5) of all deaths.
Haemorrhage accounted for 27·1% (661 000, 19·9—36·2), hypertensive
disorders 14·0% (343 000, 11·1—17·4), and sepsis (severe blook infections) 10·7%
(261 000, 5·9—18·6) of maternal deaths. The rest of deaths were due to
abortion (7·9% [193 000], 4·7—13·2), embolism (3·2% [78 000],
1·8—5·5), and all other direct causes of death (9·6% [235 000], 6·5—14·3).
Regional estimates varied substantially.
Between
2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible
for more than half of maternal deaths worldwide. More than a quarter of deaths
were attributable to indirect causes. These analyses should inform the
prioritisation of health policies, programmes, and funding to reduce maternal
deaths at regional and global levels. Further efforts are needed to improve the
availability and quality of data related to maternal mortality.
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