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Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

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

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

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Maternal 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.

Methods

We 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.

Results

In 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).

Conclusion

The 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.
Literature
1.
2.
Kassebaum NJ, Steiner C, Murray CJL, et al. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1775–812.CrossRef
3.
United Nations. The Millennium Development Goals Report 2015. New York: United Nations; 2015.
4.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.CrossRefPubMed
5.
Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez-Medina D, Barber R, Huynh C, Dicker D, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):980–1004.CrossRefPubMedPubMedCentral
6.
Yaya Y, Eide KT, Norheim OF, Lindtjorn B. Maternal and neonatal mortality in south-west Ethiopia: estimates and socio-economic inequality. PLoS One. 2014;9(4):e96294.CrossRefPubMedPubMedCentral
7.
Godefay H, Byass P, Kinsman J, Mulugeta A. Understanding maternal mortality from top-down and bottom-up perspectives: Case of Tigray Region. Ethiopia J Glob Health. 2015;5(1):010404.PubMed
8.
Yaya Y, Lindtjorn B. High maternal mortality in rural south-west Ethiopia: estimate by using the sisterhood method. BMC Pregnancy Childbirth. 2012;12:136.CrossRefPubMedPubMedCentral
9.
10.
CSA [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey 2016: Key Indicators Report. Addis Ababa and Rockville; CSA [Ethiopia] and ICF International; 2016.
11.
Molla M, Mitiku I, Worku A, Yamin A. Impacts of maternal mortality on living children and families: A qualitative study from Butajira, Ethiopia. Reprod Health. 2015;12 Suppl 1:S6.CrossRefPubMedPubMedCentral
12.
Ronsmans C, Chowdhury ME, Dasgupta SK, Ahmed A, Koblinsky M. Effect of parent's death on child survival in rural Bangladesh: a cohort study. Lancet (London, England). 2010;375(9730):2024–31.CrossRef
13.
Anderson FW, Morton SU, Naik S, Gebrian B. Maternal mortality and the consequences on infant and child survival in rural Haiti. Matern Child Health J. 2007;11(4):395–401.CrossRefPubMed
14.
Katz J, West Jr KP, Khatry SK, Christian P, LeClerq SC, Pradhan EK, Shrestha SR. Risk factors for early infant mortality in Sarlahi district, Nepal. Bull World Health Organ. 2003;81(10):717–25.PubMedPubMedCentral
15.
16.
UNFPA. Trends in Maternal Healthin Ethiopia: Challenges in achieving the MDG for maternal mortalityIndepth Analysisof the EDHS 2000-2011. Addis Ababa: UNFPA; 2012.
17.
Austin A, Gulema H, Belizan M, Colaci DS, Kendall T, Tebeka M, Hailemariam M, Bekele D, Tadesse L, Berhane Y, et al. Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers’ perspectives on training, referrals and supervision, a mixed methods study. BMC Pregnancy Childbirth. 2015;15:74.CrossRefPubMedPubMedCentral
18.
Admasu K, Haile-Mariam A, Bailey P. Indicators for availability, utilization, and quality of emergency obstetric care in Ethiopia, 2008. Int J Gynaecol Obstet. 2011;115(1):101–5.CrossRefPubMed
19.
Gaym A. Maternal mortality studies in Ethiopia--magnitude, causes and trends. Ethiop Med J. 2009;47(2):95–108.PubMed
20.
Mirkuzie AH, Sisay MM, Reta AT, Bedane MM. Current evidence on basic emergency obstetric and newborn care services in Addis Ababa, Ethiopia; a cross sectional study. BMC Pregnancy Childbirth. 2014;14:354.CrossRefPubMedPubMedCentral
21.
Melaku YA, Weldearegawi B, Tesfay FH, Abera SF, Abraham L, Aregay A, Ashebir Y, Eshetu F, Haile A, Lakew Y, et al. Poor linkages in maternal health care services-evidence on antenatal care and institutional delivery from a community-based longitudinal study in Tigray region, Ethiopia. BMC Pregnancy Childbirth. 2014;14:418.CrossRefPubMedPubMedCentral
22.
Wilunda C, Putoto G, Dalla Riva D, Manenti F, Atzori A, Calia F, Assefa T, Turri B, Emmanuel O, Straneo M, et al. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach. PLoS One. 2015;10(5):e0127827.CrossRefPubMedPubMedCentral
23.
Tsegay Y, Gebrehiwot T, Goicolea I, Edin K, Lemma H, Sebastian MS. Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study. Int J Equity Health. 2013;12:30.CrossRefPubMedPubMedCentral
24.
Tarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy Childbirth. 2014;14:161.CrossRefPubMedPubMedCentral
25.
Roro MA, Hassen EM, Lemma AM, Gebreyesus SH, Afework MF. Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia? BMC Res Notes. 2014;7:556.CrossRefPubMedPubMedCentral
26.
Worku AG, Yalew AW, Afework MF. Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC Int Health Hum Rights. 2013;13(1):1–11.CrossRef
27.
Bedford J, Gandhi M, Admassu M, Girma A. 'A normal delivery takes place at home': a qualitative study of the location of childbirth in rural Ethiopia. Matern Child Health J. 2013;17(2):230–9.CrossRefPubMed
28.
Yebyo H, Alemayehu M, Kahsay A. Why do women deliver at home? Multilevel modeling of Ethiopian National Demographic and Health Survey data. PLoS One. 2015;10(4):e0124718.CrossRefPubMedPubMedCentral
29.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRefPubMed
30.
31.
Godefay H, Kinsman J, Admasu K, Byass P. Can innovative ambulance transport avert pregnancy-related deaths? One-year operational assessment in Ethiopia. J Glob Health. 2016;6(1):010410.CrossRefPubMedPubMedCentral
32.
33.
34.
35.
Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. Measuring maternal mortality: an overview of opportunities and options for developing countries. BMC Med. 2008;6:12.CrossRefPubMedPubMedCentral
36.
Alam N, Townend J. The neighbourhood method for measuring differences in maternal mortality, infant mortality and other rare demographic events. PLoS One. 2014;9(1):e83590.CrossRefPubMedPubMedCentral
37.
El Arifeen S, Jamil K, Al-Sabir A, Raggers H, Hill K, Koenig M. How should we measure maternal mortality in the developing world?: a comparison of household deaths and sibling history approaches. 2006.
38.
CSA [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa and Calverton; CSA [Ethiopia] and ICF International; 2012.
39.
40.
CSA [Ethiopia]. Ethiopia Mini Demographic and Health Survey 2014. Addis Ababa; CSA [Ethiopia]; 2014.
41.
Global Buden of Disease Study 2013: Global Burden of Disease Study 2013 (GBD 2013) Results by Location, Cause, and Risk Factor. Seattle Institute for Health Metrics and Evaluation (IHME) http://​www.​healthdata.​org/​gbd. Accessed 11 June 2016.
42.
Naghavi MWH, Vos T, et al. Global, regional, and national age&sex specific all-cause and cause-specific mortality for 240 causes of death, 1990&2013;2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;385(9963):117–71.
43.
44.
Murray CJ, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, Dansereau EA, Graetz N, Barber RM, Brown JC, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2014;384(9947):1005–70.CrossRef
45.
46.
47.
Kassebaum NJ, Lopez AD, Murray CJL, Lozano R. A comparison of maternal mortality estimates from GBD 2013 and WHO. Lancet. 2014;384(9961):2209–10.CrossRefPubMed
48.
CSA [Ethiopia] and ORC Macro. Ethiopia Demographic and Health Survey 2005. Addis Ababa and Calverton: CSA [Ethiopia] and ORC Macro; 2006.
49.
CSA [Ethiopia] and ORC Macro. Ethiopia Demographic and Health Survey 2000. Addis Ababa and Calverton: Central Statistical Authority [CSA] and ORC Macro; 2001.
50.
Berhan Y, Berhan A. Causes of maternal mortality in Ethiopia: a significant decline in abortion related death. Ethiop J Health Sci. 2014;24(Suppl):15–28.CrossRefPubMedPubMedCentral
51.
Federal HIV/AIDS Prevention and Control Office. Prevention of Mother to Child Transmission of HIV. Addis Ababa; Federal HAPCO; 2001.
52.
Nigatu T, Woldegebriel Y. Analysis of the prevention of mother-to-child transmission (PMTCT) service utilization in Ethiopia: 2006-2010. Reprod Health. 2011;8:6.CrossRefPubMedPubMedCentral
53.
Cherinet Y, Berihu A, Bekele A, Biadgilign S, Taye B, Tsegaye A. Trend of HIV prevalence among pregnant women attending Antenatal Care Unit of Bishoftu Hospital, Ethiopia. Ethiop Med J. 2013;51(3):169–76.PubMed
54.
Yaya Y, Data T, Lindtjorn B. Maternal mortality in rural south Ethiopia: outcomes of community-based birth registration by health extension workers. PLoS One. 2015;10(3):e0119321.CrossRefPubMedPubMedCentral
55.
Getachew A, Ricca J, Cantor D, Rawlins B, Rosen H, Tekleberhan A, Bartlett L, Gibson H. Quality of care for prevention and management of common maternal and newborn complications: a study of Ethiopia’s hospitals. Baltimore: Jhpiego; 2011.
56.
Mirkuzie AH, Sisay MM, Reta AT, Bedane MM. Current evidence on basic emergency obstetric and newborn care services in Addis Ababa, Ethiopia; a cross sectional study. BMC Pregnancy Childbirth. 2014;14(1):1.CrossRef
57.
Worku AG, Yalew AW, Afework MF. Availability and components of maternity services according to providers and users perspectives in North Gondar, northwest Ethiopia. Reproductive Health. 2013;10:43.CrossRefPubMedPubMedCentral
58.
Tsegaye A, Somigliana E, Alemayehu T, Calia F, Maroli M, Barban P, Manenti F, Putoto G, Accorsi S. Ambulance referral for emergency obstetric care in remote settings. Int J Gynaecol Obstet. 2016;133(3):316–9.CrossRefPubMed
59.
Jackson R, Tesfay FH, Godefay H, Gebrehiwot TG. Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia. PLoS ONE. 2016;11(3):e0150747.CrossRefPubMedPubMedCentral
Metadata
Title
Trends and causes of maternal mortality in Ethiopia during 1990–2013: findings from the Global Burden of Diseases study 2013
Authors
Gizachew Assefa Tessema
Caroline O. Laurence
Yohannes Adama Melaku
Awoke Misganaw
Sintayehu A. Woldie
Abiye Hiruye
Azmeraw T. Amare
Yihunie Lakew
Berihun M. Zeleke
Amare Deribew
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4071-8

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