Maternal mortality in Bangladesh: a Countdown to 2015 country case study
Maternal mortality in Bangladesh: a Countdown to 2015 country case study
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DOI：
10.1016/s0140-6736(14)60955-7
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发表时间：
2014-10-11
期刊：
影响因子：
168.9
通讯作者：
Streatfield, Peter Kim
中科院分区：
文献类型：
--
作者：
El Arifeen, Shams;Hill, Kenneth;Streatfield, Peter Kim
孟加拉国是在2015年前实现千年发展目标5主要具体目标的仅有的9个倒计时国家之一。它也是唯一一个拥有两个大型的、具有全国代表性的、高质量的家庭调查侧重于孕产妇死亡率和服务使用的测量。方法我们使用2001年和2010年孟加拉国孕产妇死亡率调查的数据来衡量孕产妇死亡率（MMR）的变化并从这些和六个孟加拉国人口和健康调查，以衡量可能与这种变化有关的因素的变化。我们估计的变化，孕产妇死亡的风险之间的两次调查使用Poisson regression.Findings的产妇死亡率从322例死亡每100 000活产（95%CI 253-391）在1998-2001年至194例死亡每100 000活产（149-238）在2007-10年，每年的下降率为5.6%。这一下降率略高于在1990年至2015年期间实现千年发展目标所需的下降率（5.5%）。这一下降的主要原因是死亡率风险下降，主要是因为获得和使用卫生设施的机会增加。此外，在这一期间还发生了一些有利的变化：生育率下降，与母亲高风险有关的分娩比例下降;人均收入大幅增加，贫困率下降;育龄妇女的教育水平大幅提高。我们估计，由于生育率和孕产妇死亡风险的降低，2010年可能发生的孕产妇死亡中有52%得以避免。解释孟加拉国孕产妇死亡率的下降似乎是卫生部门内外因素共同作用的结果。在全世界讨论和决定千年发展目标后的目标和战略之际，这一发现为其他国家提供了重要的经验教训。对孟加拉国来说，这一案例研究为追求更广泛的发展议程提供了强有力的理由，同时增加和加速投资，以改善孟加拉国提供孕产妇保健的公共和私营保健设施的可及性和质量。
Background Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.Methods We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression.Findings The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253-391) in 1998-2001 to 194 deaths per 100 000 livebirths (149-238) in 2007-10, an annual rate of decrease of 5.6%. This decrease rate is slightly higher than that required (5.5%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal death.Interpretation The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This finding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in Bangladesh.