Abstract
Maternal mortality rate (MMR) is one of the main worldwide public health challenges. Presently, the high levels of MMR are a common problem in the world public health and especially, in developing countries. Half of these maternal deaths occur in Sub-Saharan Africa where little or nothing progress has been made. South Sudan is one of the developing countries which has the highest MMR. Thus, this paper deploys statistical analysis to identify the significant physiological causes of MMR in South Sudan. Prediction models based on Poisson Regression are then developed to predict MMR in terms of the significant physiological causes. Coefficients of determination and variance inflation factor are deployed to assess the influence of the individual causes on MMR. Efficacy of the models is assessed by analyzing their prediction errors. The paper for the first time has used optimization procedures to develop yearly lower and upper profile limits for MMR. Hemorrhaging and unsafe abortion are used to achieve UN 2030 lower and upper MMR targets. The statistical analysis indicates that reducing haemorrhaging by 1.91% per year would reduce MMR by 1.91% (95% CI (42.85–52.53)), reducing unsafe abortion by 0.49% per year would reduce MMR by 0.49% (95% CI (11.06–13.56)). The results indicate that the most influential predictors of MMR are; hemorrhaging (38%), sepsis (11.5%), obstructed labour (11.5%), unsafe abortion (10%), and indirect causes such as anaemia, malaria, and HIV/AIDs virus (29%). The results also show that to obtain the UN recommended MMR levels of minimum 21 and maximum 42 by 2030, the Government and other stakeholders should simultaneously, reduce haemorrhaging from the current value of 62 to 33.38 and 16.69, reduce unsafe abortion from the current value of 16 to 8.62 and 4.31. Thirty years of data is used to develop the optimal reduced Poisson Model based on hemorrhaging and unsafe abortion. The model with R2 of 92.68% can predict MMR with mean error of −0.42329 and SE-mean of 0.02268. The yearly optimal level of hemorrhage, unsafe abortion, and MMR can aid the government and other stakeholders on resources allocation to reduce the risk of maternal death.
Highlights
Maternal mortality is one of the main health problems in South Sudan [1,2,3]. ere are several contributing factors for the high maternal mortality rate Maternal mortality rate (MMR) [1]; these include socioeconomic factors, macroeconomic factors and physiological causes. e impact of the Gross Domestic Product (GDP), the General Fertility Rate (GFR), and the Skilled Attended at Births (SAB) on MMR in South Sudan has been investigated Makuei et al [2]. ey showed that the most significant predictor influencing MMR is SAB followed by GFR and GDP
Is paper investigates the most influential physiological characteristics associated with MMR in South Sudan. e physiological factors have been studied using a review of Journal of Pregnancy relevant literature and quantitative modelling
In general the direct causes related to obstetric complications of pregnancy, labour, and delivery management and the postpartum periods in developing countries account for 80% of maternal death [1, 6, 7]
Summary
Maternal mortality is one of the main health problems in South Sudan [1,2,3]. ere are several contributing factors for the high maternal mortality rate MMR [1]; these include socioeconomic factors, macroeconomic factors and physiological causes. e impact of the Gross Domestic Product (GDP), the General Fertility Rate (GFR), and the Skilled Attended at Births (SAB) on MMR in South Sudan has been investigated Makuei et al [2]. ey showed that the most significant predictor influencing MMR is SAB followed by GFR and GDP.According to the World Health Organization (WHO) in ICD-10 [4, 5], maternal mortality is defined as “the death of a woman while pregnant or within 42 days (six weeks) of termination of pregnancy irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”. is is subclassified as direct obstetric death (deaths resulting from obstetric complications of the pregnancy, labour and the puerperium, from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above). e death resulting from previous existing disease or disease that developed during pregnancy and was aggravated by physiologic effects of pregnancy is sub classified as indirect obstetric death. ese definitions are adopted in this study.is paper investigates the most influential physiological characteristics associated with MMR in South Sudan. e physiological factors have been studied using a review of Journal of Pregnancy relevant literature and quantitative modelling. E impact of the Gross Domestic Product (GDP), the General Fertility Rate (GFR), and the Skilled Attended at Births (SAB) on MMR in South Sudan has been investigated Makuei et al [2]. In general the direct causes related to obstetric complications of pregnancy, labour, and delivery management and the postpartum periods in developing countries account for 80% of maternal death [1, 6, 7]. While indirect causes related to preexisting medical conditions that may be aggravated by the physiologic demands of pregnancy account for 20% of maternal deaths. According to Minino ea: Causes of Maternal Mortality (2014), [8], in the United States, “only 0.06% of women with direct obstetric complications died in health facilities”. According to Minino ea: Causes of Maternal Mortality (2014), [8], in the United States, “only 0.06% of women with direct obstetric complications died in health facilities”. is is well below the maximum acceptable case fatality rate of 1% as per UN guidelines. e most frequent cause of death was complications predominantly in the puerperium (28%) followed by preeclampsia, and eclampsia (21%)
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