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. 2018 Jul 3;18(1):278.
doi: 10.1186/s12884-018-1892-0.

Optimal profile limits for maternal mortality rate (MMR) in South Sudan

Gabriel Makuei  1 , Mali Abdollahian  2 , Kaye Marion  2
Affiliations

Optimal profile limits for maternal mortality rate (MMR) in South Sudan

Gabriel Makuei et al. BMC Pregnancy Childbirth. .

Abstract

Background: Reducing Maternal Mortality Rate (MMR) is considered by the international community as one of the eight Millennium Development Goals. Based on previous studies, Skilled Assistant at Birth (SAB), General Fertility Rate (GFR) and Gross Domestic Product (GDP) have been identified as the most significant predictors of MMR in South Sudan. This paper aims for the first time to develop profile limits for the MMR in terms of significant predictors SAB, GFR, and GDP. The paper provides the optimal values of SAB and GFR for a given MMR level.

Methods: Logarithmic multi- regression model is used to model MMR in terms of SAB, GFR and GDP. Data from 1986 to 2015 collected from Juba Teaching Hospital was used to develop the model for predicting MMR. Optimization procedures are deployed to attain the optimal level of SAB and GFR for a given MMR level. MATLAB was used to conduct the optimization procedures. The optimized values were then used to develop lower and upper profile limits for yearly MMR, SAB and GFR.

Results: The statistical analysis shows that increasing SAB by 1.22% per year would decrease MMR by 1.4% (95% CI (0.4-5%)) decreasing GFR by 1.22% per year would decrease MMR by 1.8% (95% CI (0.5-6.26%)). The results also indicate that to achieve the UN recommended MMR levels of minimum 70 and maximum 140 by 2030, the government should simultaneously reduce GFR from the current value of 175 to 97 and 75, increase SAB from the current value of 19 to 50 and 76.

Conclusions: This study for the first time has deployed optimization procedures to develop lower and upper yearly profile limits for maternal mortality rate targeting the UN recommended lower and upper MMR levels by 2030. The MMR profile limits have been accompanied by the profile limits for optimal yearly values of SAB and GFR levels. Having the optimal level of predictors that significantly influence the maternal mortality rate can effectively aid the government and international organizations to make informed evidence-based decisions on resources allocation and intervention plans to reduce the risk of maternal death.

Keywords: Ln multi-regression; Maternal mortality rate; Optimisation; Profile limits; South Sudan.

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Conflict of interest statement

Authors’ information

G. Makuei is a PhD candidate at RMIT University, Melbourne, Australia and was a lecturer for statistics and operation research courses at DR John Garang University of Science and Technology from 2010 to 2012, Bor, South Sudan. Mali Abdollahian and Kaye Marion are both senior lecturers and lecturers at RMIT University, School of Science, Melbourne, Australia.

Ethics approval and consent to participate

To conduct this research the ethical approval was obtained from South Sudan Government through Ministry of Health (MoH), the Ethical Review Committee of the National Medical Body, Juba, South Sudan. Informed consent was obtained from the Head of Department of Health Policy, Planning, Budgeting and Research with Department Reproductive Health, Ministry of Health (MoH) S. Sudan, before the research commenced. It also has been approved and registered by the authority concern from the RMIT University, under registration number: ASEHAPP 97–16, Melbourne, Australia.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Calculation optimal max Ln (SAB) and min Ln (GFR) values for a given MMR level
Fig. 2
Fig. 2
Lower and upper profile limits for Ln (MMR), Ln (SAB) and Ln (GFR). a Profile limits for Ln (MMR), Ln (SAB) and LN (GFR). The target MMR for 2030 is 140. b Profile limits for Ln (MMR), Ln (SAB) and LN (GFR). The target MMR for 2030 is 70
Fig. 3
Fig. 3
The lower and upper profile limits for MMR, SAB and GFR. Figure 3a: Profile limits for the numerical values of MMR, SAB and GFR. The target MMR for 2030 is 140. Fig. 3b: Profile limits for the numerical values of MMR, SAB and GFR. The target MMR for 2030 is 70
Fig. 4
Fig. 4
a Three dimensional Surface Plot of MMR values vs SAB and GFR for target MMR 140. b Three dimensional Surface Plot of MMR values vs SAB and GFR for target MMR 70
See this image and copyright information in PMC

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