Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
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DOI：
10.1016/s0140-6736(16)31470-2
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发表时间：
2016-10-08
期刊：
影响因子：
168.9
通讯作者：
Violante, Francesco S.
中科院分区：
文献类型：
--
作者：
Kassebaum, Nicholas J.;Barber, Ryan M.;Violante, Francesco S.
背景在从千年发展目标向可持续发展目标过渡的过程中，必须全面评估降低孕产妇死亡率的进展，以确定成功领域、仍然存在的挑战，并制定政策讨论框架。我们的目标是量化1990年至2015年全球孕产妇死亡率的基本原因和年龄。方法我们估计了1990年至2015年全球，区域和国家层面的孕产妇死亡率，年龄为10-54岁，系统地汇编和处理195个国家和地区中的186个国家和地区的所有可用数据来源，其中11项在国家以下一级进行了分析。我们量化了孕产妇死亡的8个根本原因和4个时间类别，改进了自2013年GBD以来成人全因死亡率、艾滋病毒相关孕产妇死亡率和晚期孕产妇死亡率的估计方法。然后，通过二次分析，系统地研究了趋势的驱动因素，包括孕产妇死亡率与特定生殖保健服务覆盖率之间的关系，以及根据社会人口指数（SDI）评估观察到的孕产妇死亡率与预期的孕产妇死亡率之间的关系，SDI是一个从人均收入、教育程度和生育率等指标中得出的汇总指标。但195个国家中有122个已经实现了SDG 3.1。1990年至2015年期间，地理差异扩大，2015年，24个国家的孕产妇死亡率仍高于400。在SDI最低的两个五分位数中，出血是孕产妇死亡的主要原因，所有孕产妇死亡的比例从1990年的约68%增加到2015年的80%以上。从1990年到2015年，中间的SDI五分之一改善最多，但也有最复杂的因果关系。在严重残疾指数最高的五分之一人群中，孕产妇死亡主要是由于其他直接的孕产妇疾病、间接的孕产妇疾病以及流产、异位妊娠和/或流产。历史模式表明，要实现可持续发展目标3.1，一次产前检查的覆盖率需要达到91%，四次产前检查的覆盖率需要达到78%，住院分娩的覆盖率需要达到81%，熟练助产人员的覆盖率需要达到87%。各国应建立或更新收集和及时传播卫生数据的系统;扩大计划生育服务的覆盖面并提高其质量，包括提供避孕药具和安全堕胎服务，以解决青少年生育率高的问题;投资于提高卫生系统的能力，包括提供常规生殖保健和更先进的产科护理，包括产科急诊;调整卫生系统和数据收集系统，以监测和扭转孕产妇间接死亡、其他直接死亡和晚期死亡的增加，特别是在严重营养不良地区;并检查他们自己的SDI水平，利用这些信息制定战略，以提高业绩，确保人口的最佳生殖健康。
Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015.Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance.Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.