Maternal Mortality Estimates, Methods and Processes
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Maternal Mortality Estimates, Methods and Consultation Process
Fatima Marinho MD, MPH, PhDCoordinator, Health Analysis and Information Project, PAHO/HSD/HA
Regional Advisory Committee on Health Statistics MeetingHavana, Cuba, 26-28 March 2012
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Introduction• UN Maternal Mortality Estimates Interagency
Group (MMEIG)• Joint effort of WHO, UNICEF, UNFPA and the
World Bank, • Technical Advisory Group• 1990, 1995, 2000, 2005, 2008 maternal
mortality estimates• Upcoming: 2010 Estimates
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2010 estimates• PAHO did not take part in estimation process• WHO conducted country consultation:
3-4 weeks to review/respond • Most countries reviewed estimates• PAHO collaborated in consultation process• Critics of consultation procedures received
PAHO
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Methodology• Available nationally-representative mortality
data • Countries divided into 3 categories based on
available data:- civil registration data- other types of data- no national data
• Uncertainty of estimates
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Civil Registration (CR) Data • Data adjusted for incompleteness and
misclassification• In lieu of country-specific information, an
adjustment factor of 1.5 was applied• Data on maternal deaths and live births were
pooled for 5-year periods (1990, 1995, 2000, 2005, 2008)
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Without Complete CR• Multilevel regression based on national level
data surveys, census, other sources• PMDF (proportion maternal among deaths of
females of reproductive age): GDP, GFR, skilled attendant at birth (%)
• Adjusting maternal deaths for misclassification (different correction factors applied)
• Multilevel (or hierarchical) model
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Indirect Aids maternal deaths• Direct maternal deaths are counted with the
direct maternal deaths
• Separate treatment of indirect death as aggravated by interaction between HIV and pregnancy
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Methodology Critics• Includes late maternal deaths • Constant correction factor over time• Use of UN estimates with under- or
overestimation of live births• Omission of discussion of international and
national comparable concepts• Most recent data not included• Missing transparency of methods, sources
used (improved for 2010 estimates)
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Data Review• Preliminary WHO Results• PAHO Basic Indicators: annual data request to
countries (reported), December 2011 Update• IHME: Institute of Health Metrics and Evaluation,
Maternal Mortality Estimates and MDG 5 Attainment by Country 1990-2011; Sept 2011. (estimates)
• http://craes.drupalgardens.com/visualizaciones
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Comparing MMEIG estimates and data as reported to PAHO
latest available year
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Argentina
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Brazil
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Chile
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Cuba
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Jamaica
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Mexico
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Suriname
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Venezuela
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El Salvador
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Nicaragua
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Honduras
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Discussion
• What should PAHO’s rol be in the estimation, consultation and dissemination of WHO (or other) estimates
• How to better support countries’ responses to international agency estimates?