What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries.
Identifieur interne : 000517 ( PubMed/Checkpoint ); précédent : 000516; suivant : 000518What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries.
Auteurs : Suzanne Cross [Royaume-Uni] ; Jacqueline S. Bell ; Wendy J. GrahamSource :
- Bulletin of the World Health Organization [ 1564-0604 ] ; 2010.
Descripteurs français
- KwdFr :
- MESH :
English descriptors
- KwdEn :
- MESH :
- methods : Data Collection.
- statistics & numerical data : Developing Countries.
- trends : Maternal Mortality.
- Cause of Death, Female, Global Health, Humans, Pregnancy, Women's Health.
Abstract
The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.
DOI: 10.2471/BLT.09.063537
PubMed: 20428372
Affiliations:
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This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">20428372</PMID><DateCreated><Year>2010</Year><Month>04</Month><Day>29</Day></DateCreated><DateCompleted><Year>2010</Year><Month>07</Month><Day>15</Day></DateCompleted><DateRevised><Year>2017</Year><Month>02</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1564-0604</ISSN><JournalIssue CitedMedium="Internet"><Volume>88</Volume><Issue>2</Issue><PubDate><Year>2010</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Bulletin of the World Health Organization</Title><ISOAbbreviation>Bull. World Health Organ.</ISOAbbreviation></Journal><ArticleTitle>What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries.</ArticleTitle><Pagination><MedlinePgn>147-53</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2471/BLT.09.063537</ELocationID><Abstract><AbstractText>The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75% between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from England and Wales and contemporary data from Ghana, Rwanda and South Africa. The principal aim of the paper is to highlight the need to differentiate deaths in this way when evaluating maternal mortality, particularly when judging progress towards the fifth Millennium Development Goal. It is recommended that the potential effect of maternity services failing to take indirect maternal deaths into account should be modelled.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cross</LastName><ForeName>Suzanne</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Immpact, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland. suzanne_cross18@hotmail.com</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bell</LastName><ForeName>Jacqueline S</ForeName><Initials>JS</Initials></Author><Author ValidYN="Y"><LastName>Graham</LastName><ForeName>Wendy J</ForeName><Initials>WJ</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType><PublicationType UI="D013486">Research Support, U.S. Gov't, 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Version="1">15155982</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Glob Health Action. 2009 Mar 05;2:null</RefSource><PMID Version="1">20027272</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lancet. 2008 Jan 19;371(9608):203-4</RefSource><PMID Version="1">18207013</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Int J Gynaecol Obstet. 2007 Mar;96(3):226-32</RefSource><PMID Version="1">17306270</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS Patient Care STDS. 2005 Apr;19(4):239-46</RefSource><PMID Version="1">15857195</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Am J Trop Med Hyg. 2003 Apr;68(4):503-4</RefSource><PMID Version="1">12875305</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Ghana Med J. 2007 Sep;41(3):100-9</RefSource><PMID Version="1">18470327</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Trop Doct. 2007 Apr;37(2):96-8</RefSource><PMID Version="1">17540091</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lancet. 2006 Apr 1;367(9516):1066-74</RefSource><PMID Version="1">16581405</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Popul Health Metr. 2007 Feb 08;5:1</RefSource><PMID Version="1">17288607</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Trop Med Int Health. 2002 Jul;7(7):573-6</RefSource><PMID Version="1">12100439</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>BMC Med. 2008;6:12</RefSource><PMID Version="1">18503716</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Ghana Med J. 2007 Sep;41(3):118-24</RefSource><PMID Version="1">18470329</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lancet. 2007 Oct 13;370(9595):1311-9</RefSource><PMID Version="1">17933645</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Best Pract Res Clin Obstet Gynaecol. 2008 Jun;22(3):425-45</RefSource><PMID Version="1">18308640</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Br Med Bull. 2003;67:1-11</RefSource><PMID Version="1">14711750</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D002423" MajorTopicYN="Y">Cause of Death</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003625" MajorTopicYN="N">Data Collection</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003906" MajorTopicYN="N">Developing Countries</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" 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