Trends and causes of maternal mortality in Ethiopia during 1990–2013: findings from the Global Burden of Diseases study 2013

Abstract

BackgroundMaternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. Continuous nationwide systematic evaluation and assessment of the problem helps to design appropriate policy and strategy in Ethiopia. This study aimed to investigate the trends and causes of maternal mortality in Ethiopia between 1990 and 2013.MethodsWe used the Global Burden of Diseases and Risk factors (GBD) Study 2013 data that was collected from multiple sources at national and subnational levels. Spatio-temporal Gaussian Process Regression (ST-GPR) was applied to generate best estimates of maternal mortality with 95% Uncertainty Intervals (UI). Causes of death were measured using Cause of Death Ensemble modelling (CODEm). The modified UNAIDS EPP/SPECTRUM suite model was used to estimate HIV related maternal deaths.ResultsIn Ethiopia, a total of 16,740 (95% UI: 14,197, 19,271) maternal deaths occurred in 1990 whereas there were 15,234 (95% UI: 11,378, 19,871) maternal deaths occurred in 2013. This finding shows that Maternal Mortality Ratio (MMR) in Ethiopia was still high in the study period. There was a minimal but insignificant change of MMR over the last 23 years. The results revealed Ethiopia is below the target of Millennium Development Goals (MGDs) related to MMR. The top five causes of maternal mortality in 2013 were other direct maternal causes such as complications of anaesthesia, embolism (air, amniotic fluid, and blood clot), and the condition of peripartum cardiomyopathy (25.7%), complications of abortions (19.6%), maternal haemorrhage (12.2%), hypertensive disorders (10.3%), and maternal sepsis and other maternal infections such as influenza, malaria, tuberculosis, and hepatitis (9.6%). Most of the maternal mortality happened during the postpartum period and majority of the deaths occurred at the age group of 20–29 years. Overall trend showed that there was a decline from 708 per 100,000 live births in 1990 to 497 per 100,000 in 2013. The annual rate of change over these years was -1.6 (95% UI: -2.8 to -0.3).ConclusionThe findings of the study highlight the need for comprehensive efforts using multisectoral collaborations from stakeholders for reducing maternal mortality in Ethiopia. It is worthwhile for policies to focus on postpartum period.

Trends and causes of maternal mortality in Eastern province of Turkey

“…Other causes were complications of abortus (%19.6), maternal hemorrhage (%12.2), hypertensive diseases (%10.3), maternal sepsis and infections (%9.6), HIV/AIDS (%0.5). In the same study, when the maternal mortality due to bleeding was examined according to years, early postpartum hemorrhages were found to be the main mortality cause, although antepartum, intrapartum, early postpartum and late postpartum bleeding rates decreased over the years (12). When the causes of mortality in our study were examined, it was found that the most frequent death was direct death (58%), as stated in the literature.…”

“…53.6% (37) had a cesarean delivery, 27.5% (19) had vaginal delivery, 1.4% (1) had abortion and 17.4% (12) had died before the end of pregnancy.…”

The implementation of safe abortion services in Ethiopia

“…The high maternal mortality rate due to complications of unsafe abortion framed the conversation of legal reform. In 2005, Ethiopia's maternal mortality ratio, although declining, was 687 deaths per 100 000 live births, with estimates at the time attributing 32% of maternal mortality to complications of unsafe abortion; later estimates would range between 19.6% and 31% . In this context, a movement developed across the medical, political, and women's rights communities to reduce maternal mortality and fulfil the rights enumerated by the new Constitution.…”

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey

“…Obstetric hemorrhage, hypertension, abortion, sepsis, HIV, preexisting medical disorders, and other indirect causes like anemia are the main causes of maternal mortality both globally and in Ethiopia [2,[4][5][6][7][8][9][10][11]. These causes of death are preventable with proven cost-effective interventions.…”