Methods used to measure maternal mortality in Sub‐Saharan Africa from 1980 to 2020: A systematic literature review

Musarandega, Reuben; Machekano, Rhoderick; Munjanja, Stephen; Pattinson, Robert Clive

doi:10.1002/ijgo.13695

Cited by 13 publications

(11 citation statements)

References 56 publications

(60 reference statements)

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“…One contributing factor was limited access to antibiotics [ 125 ]. Community health centers and referral hospitals must have trained and motivated healthcare providers [ 126 ], access to equipment, essential drugs, and blood transfusions delivered by experienced staff at all hours [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several methods are used in Africa to estimate maternal mortality: demographic surveillance studies; health record review studies; confidential inquiries into maternal deaths and maternal death surveillance and response systems; prospective cohort studies; reproductive-age mortality surveys (RAMOS); direct or indirect sisterhood methods; mixed methods; and mathematical modeling. Maternal mortality ratios produced by sisterhood method studies and RAMOS studies that combined institutional records and community data are more compatible with the estimations of international organizations [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Maternal Mortality in Africa: Regional Trends (2000–2017)

Onambele

Ortega-Leon

Guillen-Aguinaga

et al. 2022

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Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa’s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children’s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of −3.0% (95% CI −2.9; −3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations’ sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations’ target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maternal Mortality in Africa: Regional Trends (2000–2017)

Onambele

Ortega-Leon

Guillen-Aguinaga

et al. 2022

IJERPH

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“…The 2018–2019 MMR estimate of 217 (95% CI: 164 to 269) is considerably lower than MICS’ 462 (95% CI: 288 to 538) and MMEIG’s 458 (95% CI: 360 to 577) estimates which used different methods. MICS used the sisterhood method (asking all adult respondents about the deaths of their sisters) to identify pregnancy-related deaths in a household survey that sampled enumeration areas (survey clusters) from the country’s provinces and estimated a 7-year (2013 to 2019) MMR 69 70 70–72 72. MMEIG used country data from different sources (CRVS, population-based sisterhood surveys, confidential enquiries into maternal deaths, RAMOS and any other sources that have clear data collection methods), along with robust statistical modelling 6 7 69 73…”

Section: Discussionmentioning

confidence: 99%

Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data

et al. 2022

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BackgroundSustainable Development Goal (SDG) 3.1 target is to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100 000 live births by 2030. In the Ending Preventable Maternal Mortality strategy, a supplementary target was added, that no country has an MMR above 140 by 2030. We conducted two cross-sectional reproductive age mortality surveys to analyse changes in Zimbabwe’s MMR between 2007–2008 and 2018–2019 towards the SDG target.MethodsWe collected data from civil registration, vital statistics and medical records on deaths of women of reproductive ages (WRAs), including maternal deaths from 11 districts, randomly selected from each province (n=10) using cluster sampling. We calculated weighted mortality rates and MMRs using negative binomial models, with 95% CIs, performed a one-way analysis of variance of the MMRs and calculated the annual average reduction rate (ARR) for the MMR.ResultsIn 2007–2008 we identified 6188 deaths of WRAs, 325 pregnancy-related deaths and 296 maternal deaths, and in 2018–2019, 1856, 137 and 130, respectively. The reproductive age mortality rate, weighted by district, declined from 11 to 3 deaths per 1000 women. The MMR (95% CI) declined from 657 (485 to 829) to 217 (164 to 269) deaths per 100 000 live births at an annual ARR of 10.1%.ConclusionsZimbabwe’s MMR declined by an annual ARR of 10.1%, against a target of 10.2%, alongside declining reproductive age mortality. Zimbabwe should continue scaling up interventions against direct maternal mortality causes to achieve the SDG 3.1 target by 2030.

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“…Our literature review indicated that few countries had estimated MMR using RAMOS methods and CRVS data in SSA [ 46 ]. Adomako in Ghana and Mgawadere in Malawi used the RAMOS method to estimate MMR for a district [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study

et al. 2021

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Background Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe—an SSA country. Methods In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007–2008 and 2018–2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. Discussion This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007–2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.

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Methods used to measure maternal mortality in Sub‐Saharan Africa from 1980 to 2020: A systematic literature review

Cited by 13 publications

References 56 publications

Maternal Mortality in Africa: Regional Trends (2000–2017)

Maternal Mortality in Africa: Regional Trends (2000–2017)

Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data

Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study

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