Upload
pahorho
View
1.888
Download
0
Embed Size (px)
DESCRIPTION
Citation preview
Maternal Mortality Estimates, Methods and Consultation Process
Fatima Marinho MD, MPH, PhDCoordinator, Health Analysis and Information Project, PAHO/HSD/HA
Regional Advisory Committee on Health Statistics MeetingHavana, Cuba, 26-28 March 2012
Introduction• UN Maternal Mortality Estimates Interagency
Group (MMEIG)• Joint effort of WHO, UNICEF, UNFPA and the
World Bank, • Technical Advisory Group• 1990, 1995, 2000, 2005, 2008 maternal
mortality estimates• Upcoming: 2010 Estimates
2010 estimates• PAHO did not take part in estimation process• WHO conducted country consultation:
3-4 weeks to review/respond • Most countries reviewed estimates• PAHO collaborated in consultation process• Critics of consultation procedures received
PAHO
Methodology• Available nationally-representative mortality
data • Countries divided into 3 categories based on
available data:- civil registration data- other types of data- no national data
• Uncertainty of estimates
Civil Registration (CR) Data • Data adjusted for incompleteness and
misclassification• In lieu of country-specific information, an
adjustment factor of 1.5 was applied• Data on maternal deaths and live births were
pooled for 5-year periods (1990, 1995, 2000, 2005, 2008)
Without Complete CR• Multilevel regression based on national level
data surveys, census, other sources• PMDF (proportion maternal among deaths of
females of reproductive age): GDP, GFR, skilled attendant at birth (%)
• Adjusting maternal deaths for misclassification (different correction factors applied)
• Multilevel (or hierarchical) model
Indirect Aids maternal deaths• Direct maternal deaths are counted with the
direct maternal deaths
• Separate treatment of indirect death as aggravated by interaction between HIV and pregnancy
Methodology Critics• Includes late maternal deaths • Constant correction factor over time• Use of UN estimates with under- or
overestimation of live births• Omission of discussion of international and
national comparable concepts• Most recent data not included• Missing transparency of methods, sources
used (improved for 2010 estimates)
Data Review• Preliminary WHO Results• PAHO Basic Indicators: annual data request to
countries (reported), December 2011 Update• IHME: Institute of Health Metrics and Evaluation,
Maternal Mortality Estimates and MDG 5 Attainment by Country 1990-2011; Sept 2011. (estimates)
• http://craes.drupalgardens.com/visualizaciones
Comparing MMEIG estimates and data as reported to PAHO
latest available year
Argentina
Brazil
Chile
Cuba
Jamaica
Mexico
Suriname
Venezuela
El Salvador
Nicaragua
Honduras
Discussion
• What should PAHO’s rol be in the estimation, consultation and dissemination of WHO (or other) estimates
• How to better support countries’ responses to international agency estimates?