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. 2018 Jan 17;13(1):e0189416.
doi: 10.1371/journal.pone.0189416. eCollection 2018.

Timing of maternal death: Levels, trends, and ecological correlates using sibling data from 34 sub-Saharan African countries

Leena Merdad  1 , Mohamed M Ali  2
Affiliations

Timing of maternal death: Levels, trends, and ecological correlates using sibling data from 34 sub-Saharan African countries

Leena Merdad et al. PLoS One. .

Abstract

Millennium Development Goal 5 has not been universally achieved, particularly in sub-Saharan Africa. Understanding whether maternal deaths occur during pregnancy, childbirth, or puerperium is important to effectively plan maternal health programs and allocate resources. Our main research objectives are to (1) describe the proportions and rates of mortality for the antepartum, intrapartum, and postpartum periods; (2) document how these trends vary by sub-region; and (3) investigate ecological correlations between these rates and maternal care interventions. We used data from the Demographic and Health Survey program, which comprises 84 surveys from 34 sub-Saharan African countries conducted between 1990 and 2014. We calculated age-standardized maternal mortality rates and time-specific maternal mortality rates and proportions, and we assessed correlations with maternal care coverage. We found high levels of maternal mortality in all three periods. Time-specific maternal mortality rates varied by country and region, with some showing an orderly decline in all three periods and others exhibiting alarming increases in antepartum and postpartum mortality. Ecological analysis showed that antenatal care coverage was significantly associated with low antepartum mortality, whereas the presence of a skilled attendant at childbirth was significantly associated with low postpartum mortality. In sub-Saharan Africa, maternal deaths occur at high rates in all three risk periods, and vary substantially by country and region. The provision of maternal care is a predictor of time-specific maternal mortality. These results confirm the need for country-specific interventions during the continuum of care to achieve the global commitment to eliminating preventable maternal mortality.

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Conflict of interest statement

Competing Interests: MMA is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions, policy or views of the World Health Organization. The country names used do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city of area or of its authorities.

Figures

Fig 1
Fig 1. Timing of maternal death (antepartum, intrapartum and postpartum) by sub-Saharan African region.
Fig 2
Fig 2. Trends in timing of maternal death (antepartum, intrapartum and postpartum mortality rates) by sub-Saharan African region.
Fig 3
Fig 3. Antenatal and childbirth care by sub-Saharan African region.
Fig 4
Fig 4. Timing of maternal death (antepartum, intrapartum and postpartum mortality rates) versus antenatal care and childbirth.
(A) Antepartum mortality vs. number of ANC (antenatal care) visits; (B) Intrapartum vs. skilled attendant at birth; (C) Postpartum mortality vs. skilled attendant at birth.
See this image and copyright information in PMC

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