Trends and causes of maternal mortality in Ethiopia during 1990–2013: findings from the Global Burden of Diseases study 2013

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Abstract

Background

Maternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. Continuous nationwide systematic evaluation and assessment of the problem helps to design appropriate policy and strategy in Ethiopia. This study aimed to investigate the trends and causes of maternal mortality in Ethiopia between 1990 and 2013.

Methods

We used the Global Burden of Diseases and Risk factors (GBD) Study 2013 data that was collected from multiple sources at national and subnational levels. Spatio-temporal Gaussian Process Regression (ST-GPR) was applied to generate best estimates of maternal mortality with 95% Uncertainty Intervals (UI). Causes of death were measured using Cause of Death Ensemble modelling (CODEm). The modified UNAIDS EPP/SPECTRUM suite model was used to estimate HIV related maternal deaths.

Results

In Ethiopia, a total of 16,740 (95% UI: 14,197, 19,271) maternal deaths occurred in 1990 whereas there were 15,234 (95% UI: 11,378, 19,871) maternal deaths occurred in 2013. This finding shows that Maternal Mortality Ratio (MMR) in Ethiopia was still high in the study period. There was a minimal but insignificant change of MMR over the last 23 years. The results revealed Ethiopia is below the target of Millennium Development Goals (MGDs) related to MMR. The top five causes of maternal mortality in 2013 were other direct maternal causes such as complications of anaesthesia, embolism (air, amniotic fluid, and blood clot), and the condition of peripartum cardiomyopathy (25.7%), complications of abortions (19.6%), maternal haemorrhage (12.2%), hypertensive disorders (10.3%), and maternal sepsis and other maternal infections such as influenza, malaria, tuberculosis, and hepatitis (9.6%). Most of the maternal mortality happened during the postpartum period and majority of the deaths occurred at the age group of 20–29 years. Overall trend showed that there was a decline from 708 per 100,000 live births in 1990 to 497 per 100,000 in 2013. The annual rate of change over these years was -1.6 (95% UI: -2.8 to -0.3).

Conclusion

The findings of the study highlight the need for comprehensive efforts using multisectoral collaborations from stakeholders for reducing maternal mortality in Ethiopia. It is worthwhile for policies to focus on postpartum period.

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Most cited references 31

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Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Nicholas J. Kassebaum, Amelia Bertozzi-Villa, Megan S Coggeshall … (2014)

The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Why Do Women Deliver at Home? Multilevel Modeling of Ethiopian National Demographic and Health Survey Data

Henock Yebyo, Mussie Alemayehu, Alemayehu Kahsay (2015)

Background Despite of the existing intensive efforts to improve maternal health in Ethiopia, the proportion of birth delivered at home remains high and is still the top priority among the national health threats. Objective The study aimed to examine effects of individual women and community-level factors of women’s decision on place of delivery in Ethiopia. Methods Data were obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design with rural-urban and regions as strata. The EDHS collected data from a big sample size but our study focused on a sample of 7,908 women whose most recent birth was within five years preceding 2011 and 576 communities in which the women were living in. The data were analyzed using a two-level mixed-effects logistic regression to determine fixed-effects of individual- and community-level factors and random-intercept of between-cluster characteristics. Results In the current study, 6980 out of 7908 deliveries (88.3%) took place at home. Lower educational levels (OR=2.74, 95%CI:1.84,4.70; p<0.0001), making no or only a limited number of ANC visits (OR=3.72,95%CI:2.85, 4.83; p<0.0001), non-exposure to media (OR=1.51, 95%CI 1.13, 2.01; p=0.004), higher parity (OR=2.68, 95%CI:1.96,3.68; p<0.0001), and perceived distance problem to reach health facilities (OR=1.29, 95%CI:1.03,1.62; p=0.022) were positively associated with home delivery. About 75% of the total variance in the odds of giving birth at home was accounted for the between-community differences of characteristics (ICC=0.75, p<0.0001). With regard to community-level characteristics, rural communities (OR=4.67, 95%CI:3.06,7.11; p<0.0001), pastoralist communities (OR=4.53, 95%CI:2.81,7.28; p<0.0001), communities with higher poverty levels (OR=1.49 95%CI:1.08,2.22; p=0.048), with lower levels of ANC utilization (OR=2.01, 95%CI:1.42,2.85; p<0.0001) and problem of distance to a health facility (OR=1.29, 95%CI:1.03,1.62; p=0.004) had a positive influence on women to give birth at home. Conclusions Not only individual characteristics of women, but also community-level factors determine women’s decision to deliver at home.

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Effect of parent's death on child survival in rural Bangladesh: a cohort study.

Carine Ronsmans, Mahbub Chowdhury, Sushil K DasGupta … (2010)

The effect of a parent's death on the survival of the children has been assessed in only a few studies. We therefore investigated the effect of the death of the mother or father on the survival of the child up to age 10 years in rural Bangladesh. We used data from population surveillance during 1982-2005 in Matlab, Bangladesh. We used Kaplan-Meier and Poisson regression analyses to compute the cumulative probabilities of survival and rates of age-specific death up to age 10 years, according to the survival status of the mother or father during that period. There were 144 861 livebirths, and 14 868 children died by 10 years of age. The cumulative probability of survival to age 10 years was 24% in children whose mothers died (n=1385) before their tenth birthday, compared with 89% in those whose mothers remained alive (n=143 473). The greatest effect was noted in children aged 2-5 months whose mothers had died (rate ratio 25.05, 95% CI 18.57-33.81). The effect of the father's death (n=2691) on cumulative probability of survival of the child up to 10 years of age was negligible. Age-specific death rates did not differ in children whose fathers died compared with children whose fathers were alive. The devastating effects of the mother's death on the survival of the child were most probably due to the abrupt cessation of breastfeeding, but the persistence of the effects up to 10 years of age suggest that the absence of maternal care might be a crucial factor. US Agency for International Development, UK Department for International Development, Research Program Consortium, and National Institutes of Health Fogarty International Center. Copyright 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Gizachew Assefa Tessema: agizachew@gmail.com

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 2 February 2017

Publication date PMC-release: 2 February 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 160

Affiliations

[1 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, Institute of Public Health, , University of Gondar, ; Gondar, Ethiopia

[2 ]ISNI 0000 0004 1936 7304, GRID grid.1010.0, , School of Public Health, The University of Adelaide, ; Adelaide, Australia

[3 ]ISNI 0000 0004 1936 7304, GRID grid.1010.0, , Population Research and Outcome Studies, School of Medicine, The University of Adelaide, ; Adelaide, Australia

[4 ]ISNI 0000 0001 1539 8988, GRID grid.30820.39, , School of Public Health, Mekelle University, ; Mekelle, Ethiopia

[5 ]ISNI 0000000122986657, GRID grid.34477.33, , Institute of Health Metrics and Evaluation, University of Washington, ; Seattle, USA

[6 ]GRID grid.414835.f, , Maternal and Child Health Directorate, Federal Ministry of Health, ; Addis Ababa, Ethiopia

[7 ]ISNI 0000 0004 1936 7304, GRID grid.1010.0, , School of Medicine, The University of Adelaide, ; Adelaide, Australia

[8 ]ISNI 0000 0004 0439 5951, GRID grid.442845.b, , College of Medicine and Health Sciences, Bahir Dar University, ; Bahir Dar, Ethiopia

[9 ]ISNI 0000 0004 0407 1981, GRID grid.4830.f, Department of Epidemiology, , University of Groningen, ; Groningen, The Netherlands

[10 ]GRID grid.428935.1, , Ethiopian Public Health Association, ; Addis Ababa, Ethiopia

[11 ]Population KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya

[12 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Nuffield Department of Clinical Medicine, , University of Oxford, ; Oxford, UK

[13 ]St. Paul Millennium Medical College, Addis Ababa, Ethiopia

Article

Publisher ID: 4071

DOI: 10.1186/s12889-017-4071-8

PMC ID: 5290608

PubMed ID: 28152987

SO-VID: b6670bde-f438-416a-a533-25983cb9ab0e

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 September 2016

Date accepted : 24 January 2017

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ScienceOpen disciplines: Public health

Keywords: maternal mortality,trends,global burden of diseases,ethiopia

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ScienceOpen disciplines: Public health

Keywords: maternal mortality, trends, global burden of diseases, ethiopia

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Trends and causes of maternal mortality in Ethiopia during 1990–2013: findings from the Global Burden of Diseases study 2013

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SDG 3: Good Health and Well-Being

Most cited references 31

Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Why Do Women Deliver at Home? Multilevel Modeling of Ethiopian National Demographic and Health Survey Data

Effect of parent's death on child survival in rural Bangladesh: a cohort study.

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