Abstract
Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with overdispersion and clustered counts when analyzing data on maternal deaths and related risk factors within health facilities in Mozambique. This paper aims at providing additional insights over previous analyses and presents an extension of such models to account for spatial variation in a disease mapping framework of facility-based maternal mortality in Mozambique.
Highlights
Maternal mortality is still a major health problem in Mozambique, despite the country had registered significant advancements in the last 10 years with an annual reduction of approximately 4.4%, between 2005 and 2015 [1]
Results showed that using the bivariate intrinsic Conditional Autoregressive model (CAR) specification for spatial random effects into zero-inflated models that already account for correlated count data slightly improved the fit, and that this is more pronounced when using the Poisson distribution, a surprising result based on our findings from [33] where the Negative binomial distribution outperformed the Poisson distribution for any considered extension
An independence structure was imposed for the multivariate distribution of spatial and non-spatial random effects but it is difficult to imagine a situation where more complex structures were necessary, as there may not be enough information in the data to attribute to various sources of variability
Summary
Maternal mortality is still a major health problem in Mozambique, despite the country had registered significant advancements in the last 10 years with an annual reduction of approximately 4.4%, between 2005 and 2015 [1].
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