Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Abstract

Summary Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum r...

The burden of mental disorders in the Eastern Mediterranean region, 1990–2015: findings from the global burden of disease 2015 study

“…The first category represented the low-income countries (LICs) with an average GNI per capita of $523 (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators 2016; GBD 2015 Maternal Mortality Collaborators 2016; GBD 2015 Mortality and Causes of Death Collaborators 2016; GBD 2015 Risk Factors Collaborators 2016; Kassebaum et al 2016; Wang et al 2016). On the opposite end of the spectrum were some oil-rich, high-income countries (HICs) with an average GNI per capita of $39,688.…”

Long-Term Health Impact of Early Nutrition: The Power of Programming

“…The project objectives are focussed on exploring the early origins of obesity, adiposity and associated non-communicable diseases (NCDs), underlying mechanisms and opportunities for preventive interventions. This focus has been prioritized because of the strong evidence of developmental programming of NCDs as well as their very high and further increasing disease burden [2,3,4,5,6], including high losses of life years and particularly of healthylife years (Figure 1). The World Health Organisation (WHO) concluded that currently, obesity is the 5th leading cause of global deaths and responsible for 44% of the burden or diabetes mellitus, 23% of ischaemic heart disease, and 7-41% of certain cancers [7].…”

Lay beliefs about hypertension among HIV-infected adults in Kenya

“…2 The scale-up of HIV treatment in sub-Saharan Africa has prolonged survival of people living with HIV (PLWH) who are increasingly at high risk for the CVD prevalent in their communities. 1 PLWH in the developed countries are twice as likely to develop a stroke or myocardial infraction compared with their HIV-uninfected counterparts. [4][5][6] There are ongoing efforts to understand the pathophysiology of HIV-associated CVD, and current theories suggest a multifactorial aetiology consisting of chronic inflammation, antiretroviral therapy (ART) and traditional CVDRFs.…”