Abstract
BackgroundUnacceptably high levels of preventable maternal mortality persist as a problem across sub–Saharan Africa and much of south Asia. Currently, local assessments of the magnitude of maternal mortality are not often made, so the best available information for health planning may come from global estimates and not reflect local circumstances.MethodsA community–based cross-sectional survey was designed to identify all live births together with all deaths among women aged 15–49 years retrospectively over a one–year period in six randomly selected districts of Tigray Region, northern Ethiopia. After birth and death identification, Health Extension Workers trained to use the WHO 2012 verbal autopsy (VA) tool visited households to carry out VAs on all deaths among women aged 15–49 years. All pregnancy–related deaths were identified after processing the VA material using the InterVA–4 model, which corresponds to the WHO 2012 VA. A maternal mortality ratio (MMR) was calculated for each District and expressed with a 95% confidence interval (CI).ResultsThe MMRs across the six sampled Districts ranged from 37 deaths per 100 000 live births (95% CI 1 to 207) to 482 deaths per 100 000 live births (95% CI 309 to 718). The overall MMR for Tigray Region was calculated at 266 deaths per 100 000 live births (95% CI 198 to 350). Direct obstetric causes accounted for 61% of all pregnancy–related deaths. Haemorrhage was the major cause of pregnancy–related death (34%). District–level MMRs were strongly inversely correlated with population density (r2 = 0.86).ConclusionThis simple but well–designed survey approach enabled estimation of maternal mortality in Tigray Region on a local, contemporary basis. It also provided insights into possible local variations in MMR and their determinants. Consequently, this approach could be implemented at regional level in other large sub–Saharan African countries, or at national level in smaller ones to monitor and evaluate maternal health service interventions.
Highlights
Tred around “America First”, and health care reform to limit social medicine
Public health is a global issue; worldwide there were 57 million deaths in 2008, 63% of which were attributable to non-communicable diseases (NCDs) [1]
Despite the growing public awareness about NCDs and the consequences of related lifestyle choices, the incidence of NCDs continues to rise which creates a burden on global health care systems
Summary
Public health is a global issue; worldwide there were 57 million deaths in 2008, 63% of which were attributable to non-communicable diseases (NCDs) [1]. If individuals focus on themselves, the consideration of such community, national, and global costs are severely limited. With regards to health care reform and the debate around minimizing social medicine, it is important to emphasize that the people being targeted by - and most likely to benefit from -social medicine initiatives (eg, low socioeconomic status, the elderly) experience the greatest health disparities [5]. While limiting social medicine may result in short-term gains such as decreased health insurance premiums and tax dollar allotment, there is great potential for a longterm consequence of decreased community- and national-level overall health
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