Trends and causes of maternal mortality in Ethiopia during 1990\u20132013: findings from the Global Burden of Diseases study 2013

Gizachew Assefa Tessema,Amare Deribew,Abiye Hiruye,Yohannes Adama Melaku,Caroline O Laurence,Berihun M Zeleke,Azmeraw T Amare,Yihunie Lakew,Sintayehu A Woldie,Awoke Misganaw

doi:10.1186/s12889-017-4071-8

Abstract

BackgroundMaternal 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.MethodsWe 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.ResultsIn 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).ConclusionThe 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.

Highlights

Maternal mortality is noticeably high in sub-Saharan African countries including Ethiopia
This study found that maternal mortality in Ethiopia over the period 1990–2013 was considerably high and remained above the Millennium Development target goal set in 2000
This study found that the major causes of maternal mortality were other direct maternal causes such as anaesthesia, embolism, and the condition of peripartum cardiomyopathy followed by complications of abortion

Summary

Introduction

Maternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. While some progress has been made, according to WHO estimate in 2015, the Maternal Mortality Ratio (MMR) dropping by 44% worldwide between 1990 and 2015 [3], it remains unacceptably high in developing countries in sub-Sahara African countries [4, 5]. In one of these countries, Ethiopia, the MMR remains high, ranging from 266–1667 per 100,000 Live Births (LB) [3, 5,6,7,8,9,10]. The infant and under-five survival is highly correlated with child nutrition and other important child health care practices demanding maternal involvement [12]

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