Pregnancy-related mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

Abstract

Background

Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps.

Objective

To describe patterns of pregnancy-related mortality at INDEPTH Network Health and Demographic Surveillance System sites in sub-Saharan Africa and southeast Asia in terms of maternal mortality ratio (MMR) and cause-specific mortality rates.

Design

Data on individual deaths among women of reproductive age (WRA) (15–49) resident in INDEPTH sites were collated into a standardised database using the INDEPTH 2013 population standard, the WHO 2012 verbal autopsy (VA) standard, and the InterVA model for assigning cause of death.

Results

These analyses are based on reports from 14 INDEPTH sites, covering 14,198 deaths among WRA over 2,595,605 person-years observed. MMRs varied between 128 and 461 per 100,000 live births, while maternal mortality rates ranged from 0.11 to 0.74 per 1,000 person-years. Detailed rates per cause are tabulated, including analyses of direct maternal, indirect maternal, and incidental pregnancy-related deaths across the 14 sites.

Conclusions

As expected, these findings confirmed unacceptably high continuing levels of maternal mortality. However, they also demonstrate the effectiveness of INDEPTH sites and of the VA methods applied to arrive at measurements of maternal mortality that are essential for planning effective solutions and monitoring programmatic impacts.

• maternal mortality
• cause of death
• Africa
• Asia
• verbal autopsy
• INDEPTH Network

This paper is part of the Special Issue: INDEPTH Network Cause-Specific Mortality. More papers from this issue can be found at http://www.globalhealthaction.net

This paper is part of the Special Issue: INDEPTH Network Cause-Specific Mortality. More papers from this issue can be found at http://www.globalhealthaction.net

Acknowledgements

We are grateful to all the residents of INDEPTH HDSS sites who have contributed personal information to this mortality dataset, to the field staff who undertook so many VA interviews, and the data management staff who handled the data at every participating site. INDEPTH thanks all the site scientists who have participated in bringing this work together, and who variously participated in analysis workshops in Ghana, Belgium, Thailand, and the United Kingdom. The INDEPTH Network is grateful for core funding from Sida, the Wellcome Trust, and the William & Flora Hewlett Foundation. The Umeå Centre for Global Health Research is core funded by Forte, the Swedish Research Council for Health, Working Life and Welfare (grant 2006-1512). PB's residency at the University of the Witwatersrand Rural Knowledge Hub to analyse and draft these results was supported by the European Community Marie Curie Actions IPHTRE project (no. 295168). icddr,b is thankful to the Governments of Australia, Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. The Ouagadougou site is thankful to the Wellcome Trust for its financial support to the Ouagadougou HDSS (grant number WT081993MA). The Farafenni site is supported by the UK Medical Research Council. The Kilifi HDSS is supported through core support to the KEMRI-Wellcome Trust Major Overseas Programme from the Wellcome Trust. TNW is supported by a Senior Fellowship (091758) and CN through a Strategic Award (084538) from the Wellcome Trust. This paper is published with permission from the Director of KEMRI. The Kisumu site wishes to acknowledge the contribution of the late Dr. Kubaje Adazu to the development of KEMRI/CDC HDSS, which was implemented and continues to be supported through a cooperative agreement between KEMRI and CDC. The Nairobi Urban Health and Demographic Surveillance System (NUHDSS), Kenya, since its inception has received support from the Rockefeller Foundation (USA), the Wellcome Trust (UK), the William and Flora Hewlett Foundation (USA), Comic Relief (UK), the Swedish International Development Cooperation Agency (SIDA) and the Bill and Melinda Gates Foundation (USA). The Agincourt site notes that the School of Public Health and Faculty of Health Sciences, University of the Witwatersrand, and the Medical Research Council, South Africa, have provided vital support since inception of the Agincourt HDSS. Core funding has been provided by The Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z) with contributions from the National Institute on Aging (NIA) of the NIH, William and Flora Hewlett Foundation, and Andrew W Mellon Foundation, USA.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

Notes

This paper is part of the Special Issue: INDEPTH Network Cause-Specific Mortality. More papers from this issue can be found at http://www.globalhealthaction.net

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