Impact of Pregnancy-Related Deaths on Female Life Expectancy in Zambia: Application of Life Table Techniques to Census Data

Abstract

IntroductionSince 2000, the world has been coalesced around efforts to reduce maternal mortality. However, few studies have estimated the significance of eliminating maternal deaths on female life expectancy. We estimated, based on census data, the potential gains in female life expectancy assuming complete elimination of pregnancy-related mortality in Zambia.MethodsWe used data on all-cause and pregnancy-related deaths of females aged 15–49 reported in the Zambia 2010 census, and evaluated, adjusted and smoothed them using existing and verified techniques. We used associated single decrement life tables, assuming complete elimination of pregnancy-related deaths to estimate the potential gains in female life expectancy at birth, at age 15, and over the ages 15–49. We compared these gains with the gains from eliminating deaths from accidents, injury, violence and suicide.ResultsComplete elimination of pregnancy-related deaths would extend life expectancy at birth among Zambian women by 1.35 years and life expectancy at age 15 by 1.65 years. In rural areas, this would be 1.69 years and 2.19 years, respectively, and in urban areas, 0.78 years and 0.85 years. An additional 0.72 years would be spent in the reproductive age group 15–49; 1.00 years in rural areas and 0.35 years in urban areas. Eliminating deaths from accidents, injury, suicide and violence among women aged 15–49 would cumulatively contribute 0.55 years to female life expectancy at birth.ConclusionEliminating pregnancy-related mortality would extend female life expectancy in Zambia substantially, with more gains among adolescents and females in rural areas. The application of life table techniques to census data proved very valuable, although rigorous evaluation and adjustment of reported deaths and age was necessary to attain plausible estimates. The collection of detailed high quality cause-specific mortality data in future censuses is indispensable.

Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis

“…The eighteen included studies were primarily hospital or health clinic based patient record reviews, except for two studies which were based on household surveys [ 16 , 17 ], one which was based on public death notification forms [ 18 ], and one which used various data sources [ 19 ]. Two of the studies, both by Mombo-Ngoma et al, reported on some of the same data [ 20 , 21 ], and to avoid adding the same data twice, only one of the studies was included in the meta-analysis.…”

“…Three studies had data on adolescents aged less than 15 years [ 16 , 18 , 19 ], four studies had an adolescent group aged 15 years or less [ 22 – 25 ], five studies included adolescents aged 16 years or less [ 20 , 21 , 26 – 28 ], while six included adolescents up to 17 years old [ 17 , 29 – 34 ]. There were three studies from Cameroon [ 23 , 27 , 28 ], two each from Nigeria[ 25 , 29 ], Tanzania [ 24 , 32 ], South Africa [ 18 , 34 ] and Zambia [ 16 , 17 ], one study each from Namibia [ 31 ], Gabon [ 20 ], Ghana [ 33 ], Ethiopia [ 19 ] and Sudan [ 26 ], and two multi-country studies: Ganchimeg et al with data from Algeria, Angola, Democratic Republic of Congo, Niger, Nigeria, Kenya and Uganda [ 22 ], and Mombo-Ngoma et al which included data from Benin, Gabon and Mozambique [ 21 ]. See Table 2 for study characteristics, and Tables 3 and 4 for results for the individual studies.…”

“…They reported pregnancy-related deaths, defined as deaths occurring while pregnant, during childbirth, or in a 6 week period after giving birth. Based on their findings, the pregnancy-related mortality ratio was 9338/100.000 live births for girls aged 12–14 year old, compared to 557/100.000 live births for 20–24 year olds [ 16 ].…”

“…They reported a high number of missing cases, up to 32.44% [ 18 ]. Three other studies with data on these outcomes, found that adolescents had a higher risk of pregnancy-related and maternal mortality [ 16 , 22 , 25 ]. Tessema et al found a MMR for 10–14 year olds that was lower than the 20–24 year olds for recent years, while it was higher than the MMR for 25–29 year olds [ 19 ].…”

“…Another limitation with these studies is the small sample sizes of some of the studies, which is associated with a risk of random variations in the number of cases with complications, possibly influencing the overall associations. In addition, all except for three [ 16 – 18 ] are hospital-based or health clinic-based studies. This means that the samples may not be representative of the general population, as births outside of health facilities are common in Sub-Saharan Africa, particularly in rural areas [ 42 , 43 ].…”