padua SIS 2010
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Transcript of padua SIS 2010
Are we there yet? Challenges in measuring
MDG5 achievements
Tiziana LeoneLSE Health
MDG 5Target 5.A.
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
5.1 Maternal mortality ratio5.2 Proportion of births attended by skilled health personnel
Target 5.B.
Achieve, by 2015, universal access to reproductive health
5.3: Contraceptive prevalence rate5.4: Adolescent birth rate5.5: Antenatal care coverage5.6: Unmet need for family planning
Target 5.b
Progress so far
0
1
2
3
4
5
6
MDG 5
Lancet 1990-2008
UN 1990-2005
Poor data
• If we look at the top 30 countries for Maternal deaths only South Africa, India and Chian have some vital registration system in place
• Latest publication relies on very few observations for the countries with the highest mortality with massive confidence intervals as a result
Not just maternal deaths
• 40 million babies die unregistered each year
• 40 million people die unregistered each year
• 85 countries with 66% of the world’s population do not have reliable cause of death statistics
Contraceptive use
Some facts
Sample selection
Methods
• Inclusion of data quality ratings • This would need to take into account the type of data (eg; survey vs vital statistics) as well as the
reliability of the data (e.g.: level of coverage of VT or adjustment factor of census data)• Integration of datasources• Use of multilevel modelling to account of national policies variations• Weighting to account of data quality ratings• Revision of the concept of unmet need• More emphasis needs to be given to:• Differential analysis• Variations in geographic access • Quality of care • More stress on post-partum care and abortion
DeterminantsDemographic Socio-
economicCommunity/network
Age Residence Talked about FP
Parity Ethnicity Visited Health centre
Marital status Religion Visited by FP worker
Number of unions
Wealth quintile Watch TV
Age at first birth Listens to radio
Whether heard of FP from TV radio or newspapers
Median level of education within cluster
Percentage sterilised women within cluster
Bivariate results
Discussing FP issues negatively significant Wealth not significant (wealthier women
slightly less likely) Hearing about FP from radio and newspaper
negatively significant Not significant when parity considered
Way forwards
Make every maternal death count Through civil registration,
confidential enquiries and use of IT
Conclusions
• There is some evidence of a decline in MM and increase of other MDG5 indicators but that’s a global level
• Progress of intervention is slow especially in SSA
• Need for better statistics and statisticians…• Statistics have managed to engage policy
makers