Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5
Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5
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DOI：
10.1016/s0140-6736(10)60518-1
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发表时间：
2010-05-08
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Hogan, Margaret C.;Foreman, Kyle J.;Murray, Christopher J. L.
孕产妇死亡率仍然是世界卫生系统面临的一个重大挑战。关于孕产妇死亡率和趋势的可靠信息对于调动资源以及规划和评估实现千年发展目标5（千年发展目标5）的进展情况至关重要，千年发展目标5的具体目标是从1990年到2015年将孕产妇死亡率降低75%。我们评估了孕产妇死亡率的水平和趋势为181 countries.Methods我们构建了一个数据库，2651观察孕产妇死亡率为181个国家，1980-2008年，从重要的登记数据，人口普查，调查，和死因推断研究。我们使用了强大的分析方法来生成1980年至2008年期间每年的孕产妇死亡和孕产妇死亡率的估计值。我们探讨了我们的数据模型规格的敏感性，并显示出我们的methods.Findings的样本预测效度我们估计，有342 900（不确定区间302 100-394 300）孕产妇死亡的全球范围内，在2008年，从526 300（446 400-629 600）在1980年。全球孕产妇死亡率从1980年的422例（358-505例）下降到1990年的320例（272-388例），2008年为每10万例活产251例（221-289例）。自1990年以来，全球产妇死亡率的年下降率为1.3%（1.0-1.5）。1990-2008年期间，孕产妇死亡率的年下降率因国家而异，从马尔代夫的8.8%（8.7-14.1）到津巴布韦的5.5%（5.2-5.6）。2008年，超过50%的孕产妇死亡发生在6个国家（印度、尼日利亚、巴基斯坦、阿富汗、埃塞俄比亚和刚果民主共和国）。如果没有艾滋病毒，2008年全世界将有281 500例孕产妇死亡（243 900-327 900）。虽然只有23个国家有望在2015年前实现孕产妇死亡率下降75%的目标，但埃及、中国、厄瓜多尔和玻利维亚等国一直在加速取得进展。
Background Maternal mortality remains a major challenge to health systems worldwide. Reliable information about the rates and trends in maternal mortality is essential for resource mobilisation, and for planning and assessment of progress towards Millennium Development Goal 5 (MDG 5), the target for which is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. We assessed levels and trends in maternal mortality for 181 countries.Methods We constructed a database of 2651 observations of maternal mortality for 181 countries for 1980-2008, from vital registration data, censuses, surveys, and verbal autopsy studies. We used robust analytical methods to generate estimates of maternal deaths and the MMR for each year between 1980 and 2008. We explored the sensitivity of our data to model specification and show the out-of-sample predictive validity of our methods.Findings We estimated that there were 342 900 (uncertainty interval 302 100-394 300) maternal deaths worldwide in 2008, down from 526 300 (446 400-629 600) in 1980. The global MMR decreased from 422 (358-505) in 1980 to 320 (272-388) in 1990, and was 251 (221-289) per 100 000 livebirths in 2008. The yearly rate of decline of the global MMR since 1990 was 1.3% (1.0-1.5). During 1990-2008, rates of yearly decline in the MMR varied between countries, from 8.8% (8.7-14.1) in the Maldives to an increase of 5.5% (5.2-5.6) in Zimbabwe. More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo). In the absence of HIV, there would have been 281 500 (243 900-327 900) maternal deaths worldwide in 2008.Interpretation Substantial, albeit varied, progress has been made towards MDG 5. Although only 23 countries are on track to achieve a 75% decrease in MMR by 2015, countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress.