Global causes of maternal death: a WHO systematic analysis
Global causes of maternal death: a WHO systematic analysis
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DOI：
10.1016/s2214-109x(14)70227-x
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发表时间：
2014-06-01
影响因子：
34.3
通讯作者：
Alkema, Leontine
中科院分区：
文献类型：
--
作者：
Say, Lale;Chou, Doris;Alkema, Leontine
需要关于孕产妇死亡原因的数据，以便为改善孕产妇健康的政策提供信息。我们开发并分析了2003-09年期间全球、区域和次区域孕产妇死亡原因的估计值，采用一种新的方法，更新了之前的WHO系统评价。方法我们检索了2003年1月1日至2012年12月31日期间发表的专业和一般文献数据库中的研究数据，没有语言限制，以及世卫组织死亡率数据库，以获取生命登记数据。根据预先设定的纳入标准，我们分析了数据集中的孕产妇死亡原因。我们汇总国家一级的估计报告的千年发展目标地区和世界范围内的死亡原因的估计，主要和次要原因的死亡类别与贝叶斯hierarchical model.Findings我们确定了23个合格的研究（2003-12年出版）。我们在分析中纳入了来自115个国家的417个数据集，包括60799例死亡。2003年至2009年期间，所有孕产妇死亡中约有73%（2 443 000人中的1 771 000人）是直接产科原因造成的，间接原因造成的死亡占所有死亡的27.5%（672 000人，95% UI 19.7-37.5）。出血占孕产妇死亡的27.1%（661 000，19.9-36.2），高血压疾病占14.0%（343 000，11.1-17.4），败血症占10.7%（261 000，5.9-18.6）。其余死亡是由于流产（7.9%[193 000]，4.7-13.2），栓塞（3.2% [78 000]，1.8-5.5），和所有其他直接死亡原因（9.6% [235 000]，6.5-14.3）。解释2003年至2009年，出血、高血压疾病和败血症是导致全球一半以上孕产妇死亡的原因。超过四分之一的死亡可归因于间接原因。这些分析应有助于确定卫生政策、方案和供资的优先次序，以在区域和全球各级减少孕产妇死亡。通过比尔和梅林达·盖茨基金会向生殖健康和生殖健康委员会提供赠款，向美援署、美国儿童基金会基金和开发计划署/人口基金/儿童基金会/世卫组织/世界银行人类生殖研究、发展和研究培训特别方案提供资金，生殖健康和研究部。版权所有（C）2014世界卫生组织;许可人爱思唯尔。这是一篇开放获取的文章，发表时不放弃世卫组织根据国际法、公约或协定享有的任何特权和豁免。本文不得复制用于商业产品、服务或任何法律的实体的推广。不应暗示世卫组织认可任何特定组织或产品。不允许使用世卫组织标志。此通知应与文章的原始URL一起保存沿着。
Background Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review.Methods We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model.Findings We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27.5% (672 000, 95% UI 19.7-37.5) of all deaths. Haemorrhage accounted for 27.1% (661 000, 19.9-36.2), hypertensive disorders 14.0% (343 000, 11.1-17.4), and sepsis 10.7% (261 000, 5.9-18.6) of maternal deaths. The rest of deaths were due to abortion (7.9%[193 000], 4.7-13.2), embolism (3.2% [78 000], 1.8-5.5), and all other direct causes of death (9.6% [235 000], 6.5-14.3). Regional estimates varied substantially.Interpretation Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality.Funding USAID, the US Fund for UNICEF through a grant from the Bill & Melinda Gates Foundation to CHERG, and The UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research.Copyright (C) 2014 World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO's privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.