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Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Optimal profile limits for maternal mortality rate (MMR) in South Sudan

Authors: Gabriel Makuei, Mali Abdollahian, Kaye Marion

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

Reducing Maternal Mortality Rate (MMR) is considered by the international community as one of the eight Millennium Development Goals. Based on previous studies, Skilled Assistant at Birth (SAB), General Fertility Rate (GFR) and Gross Domestic Product (GDP) have been identified as the most significant predictors of MMR in South Sudan.
This paper aims for the first time to develop profile limits for the MMR in terms of significant predictors SAB, GFR, and GDP. The paper provides the optimal values of SAB and GFR for a given MMR level.

Methods

Logarithmic multi- regression model is used to model MMR in terms of SAB, GFR and GDP. Data from 1986 to 2015 collected from Juba Teaching Hospital was used to develop the model for predicting MMR. Optimization procedures are deployed to attain the optimal level of SAB and GFR for a given MMR level.
MATLAB was used to conduct the optimization procedures. The optimized values were then used to develop lower and upper profile limits for yearly MMR, SAB and GFR.

Results

The statistical analysis shows that increasing SAB by 1.22% per year would decrease MMR by 1.4% (95% CI (0.4–5%)) decreasing GFR by 1.22% per year would decrease MMR by 1.8% (95% CI (0.5–6.26%)).
The results also indicate that to achieve the UN recommended MMR levels of minimum 70 and maximum 140 by 2030, the government should simultaneously reduce GFR from the current value of 175 to 97 and 75, increase SAB from the current value of 19 to 50 and 76.

Conclusions

This study for the first time has deployed optimization procedures to develop lower and upper yearly profile limits for maternal mortality rate targeting the UN recommended lower and upper MMR levels by 2030. The MMR profile limits have been accompanied by the profile limits for optimal yearly values of SAB and GFR levels. Having the optimal level of predictors that significantly influence the maternal mortality rate can effectively aid the government and international organizations to make informed evidence-based decisions on resources allocation and intervention plans to reduce the risk of maternal death.
Literature
1.
go back to reference Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–74.CrossRefPubMed Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–74.CrossRefPubMed
2.
go back to reference Kruk ME, Rockers PC, Mbaruku G, Paczkowski MM, Galea S. Community and health system factors associated with facility delivery in rural Tanzania: a multilevel analysis. Health Policy. 2010;97(2–3):209–16.CrossRefPubMed Kruk ME, Rockers PC, Mbaruku G, Paczkowski MM, Galea S. Community and health system factors associated with facility delivery in rural Tanzania: a multilevel analysis. Health Policy. 2010;97(2–3):209–16.CrossRefPubMed
3.
go back to reference (NBS) MoHMaNBoS. The Republic of South Sudan: The Sudan Household Health Survey 2010. South Sudan: (NBS) MoHMaNBoS. Juba; 2014. (NBS) MoHMaNBoS. The Republic of South Sudan: The Sudan Household Health Survey 2010. South Sudan: (NBS) MoHMaNBoS. Juba; 2014.
4.
go back to reference Trends in Maternal Mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Division. Trends in Maternal Mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Division.
5.
go back to reference Rau A. Reducing maternity mortality rate in South Sudan. In: Borgen; 2015. Rau A. Reducing maternity mortality rate in South Sudan. In: Borgen; 2015.
6.
go back to reference South Sudan: Maternal and Child Health in South Sudan. South Sudan: Maternal and Child Health in South Sudan.
7.
go back to reference Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action Evidence for Strategic Approches. Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action Evidence for Strategic Approches.
8.
go back to reference WHO U, UNFPA, World Bank Groun and the United Nations Population Division. Meauring Maternal Mortality, key facts. In: Geneva Foundation for Medical Education and Research. vol. Fact sheet No 348, vol. 20. Geneva 27, Switzerland: World Heath Organization (WHO); 2016. WHO U, UNFPA, World Bank Groun and the United Nations Population Division. Meauring Maternal Mortality, key facts. In: Geneva Foundation for Medical Education and Research. vol. Fact sheet No 348, vol. 20. Geneva 27, Switzerland: World Heath Organization (WHO); 2016.
9.
go back to reference Risk - Lifetime Risk of Death in Childbearing. Risk - Lifetime Risk of Death in Childbearing.
10.
go back to reference Makuei G, Abdollahian M, Marion K. Modeling maternal mortality rate in South Sudan. Int’l Conf Information and Knowledge Engineering. 2016;107-112:6. Makuei G, Abdollahian M, Marion K. Modeling maternal mortality rate in South Sudan. Int’l Conf Information and Knowledge Engineering. 2016;107-112:6.
11.
go back to reference WHO. Fact Sheet. Geneva: Worl Health Organization: Worl Health Oraganization (WHO); 2008. WHO. Fact Sheet. Geneva: Worl Health Organization: Worl Health Oraganization (WHO); 2008.
12.
go back to reference (NBS) NBoS. SOUTH SUDAN STATISTICAL YEAR BOOK 2015. In: 2015 SYB. m; 2015. (NBS) NBoS. SOUTH SUDAN STATISTICAL YEAR BOOK 2015. In: 2015 SYB. m; 2015.
13.
go back to reference National Bureau of Statistics NBS. Census of Population and Housing (the NBS, 2008), Southern Sudan. Juba, South Sudan: National Bureau of Statistic Office; 2008. National Bureau of Statistics NBS. Census of Population and Housing (the NBS, 2008), Southern Sudan. Juba, South Sudan: National Bureau of Statistic Office; 2008.
14.
go back to reference National Bureau of Statistics SS. The South Sudan National Baseline Household Survey’ 2009 Report. Juba Southern Sudan: Statistics NBo. National Bureau of Statistics’ Office; 2009. National Bureau of Statistics SS. The South Sudan National Baseline Household Survey’ 2009 Report. Juba Southern Sudan: Statistics NBo. National Bureau of Statistics’ Office; 2009.
15.
go back to reference Campbell OM, Graham WJ, steering g LMSS. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.CrossRefPubMed Campbell OM, Graham WJ, steering g LMSS. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.CrossRefPubMed
17.
go back to reference Rai RK, Tulchinsky TH. Addressing the sluggish progress in reducing maternal mortality in India. Asia Pac J Public Health. 2015;27(2):NP1161–9.CrossRefPubMed Rai RK, Tulchinsky TH. Addressing the sluggish progress in reducing maternal mortality in India. Asia Pac J Public Health. 2015;27(2):NP1161–9.CrossRefPubMed
18.
go back to reference Feng XL, Zhu J, Zhang L, Song L, Hipgrave D, Guo S, Ronsmans C, Guo Y, Yang Q. Socio-economic disparities in maternal mortality in China between 1996 and 2006. BJOG. 2010;117(12):1527–36.CrossRefPubMed Feng XL, Zhu J, Zhang L, Song L, Hipgrave D, Guo S, Ronsmans C, Guo Y, Yang Q. Socio-economic disparities in maternal mortality in China between 1996 and 2006. BJOG. 2010;117(12):1527–36.CrossRefPubMed
19.
go back to reference Du Q, Lian W, Naess O, Bjertness E, Kumar BN, Shi SH. The trends in maternal mortality between 1996 and 2009 in Guizhou, China: ethnic differences and associated factors. J Huazhong Univ Sci Technolog Med Sci. 2015;35(1):140–6.CrossRefPubMed Du Q, Lian W, Naess O, Bjertness E, Kumar BN, Shi SH. The trends in maternal mortality between 1996 and 2009 in Guizhou, China: ethnic differences and associated factors. J Huazhong Univ Sci Technolog Med Sci. 2015;35(1):140–6.CrossRefPubMed
20.
go back to reference Yin H, Zhao Y, Zhang Y, Zhang H, Xu L, Zou Z, Yang W, Cheng J, Zhou Y. Genome-wide analysis of the expression profile of Saccharomyces cerevisiae in response to treatment with the plant isoflavone, wighteone, as a potential antifungal agent. Biotechnol Lett. 2006;28(2):99–105.CrossRefPubMed Yin H, Zhao Y, Zhang Y, Zhang H, Xu L, Zou Z, Yang W, Cheng J, Zhou Y. Genome-wide analysis of the expression profile of Saccharomyces cerevisiae in response to treatment with the plant isoflavone, wighteone, as a potential antifungal agent. Biotechnol Lett. 2006;28(2):99–105.CrossRefPubMed
21.
go back to reference Kang S, Ren D, Xiao G, Daris K, Buck L, Enyenihi AA, Zubarev R, Bondarenko PV, Deshpande R. Cell line profiling to improve monoclonal antibody production. Biotechnol Bioeng. 2014;111(4):748–60.CrossRefPubMed Kang S, Ren D, Xiao G, Daris K, Buck L, Enyenihi AA, Zubarev R, Bondarenko PV, Deshpande R. Cell line profiling to improve monoclonal antibody production. Biotechnol Bioeng. 2014;111(4):748–60.CrossRefPubMed
22.
go back to reference Gupta SK, Bansal D, Malhi P, Das R. Developmental profile in children with iron deficiency anemia and its changes after therapeutic iron supplementation. Indian J Pediatr. 2010;77(4):375–9.CrossRefPubMed Gupta SK, Bansal D, Malhi P, Das R. Developmental profile in children with iron deficiency anemia and its changes after therapeutic iron supplementation. Indian J Pediatr. 2010;77(4):375–9.CrossRefPubMed
23.
go back to reference Gupta S. Profile monitoring-control chart schemes for monitoring linear and low order polynomial profiles. In: A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosopy. Arizona: Arizona State University; 2010. Gupta S. Profile monitoring-control chart schemes for monitoring linear and low order polynomial profiles. In: A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosopy. Arizona: Arizona State University; 2010.
24.
go back to reference Hosseinifard SZ. Monitoring and performance analysis of regression profiles. This thesis is submitted in total fulfillment of the requirements for the degree of Doctor of Philosophy. Melbourne, Victoria, Australia: RMIT University; 2012. Hosseinifard SZ. Monitoring and performance analysis of regression profiles. This thesis is submitted in total fulfillment of the requirements for the degree of Doctor of Philosophy. Melbourne, Victoria, Australia: RMIT University; 2012.
25.
go back to reference Woodall WH. Current research on profile monitoring. SciELO Brasil. 2007;17(3):420–5. Woodall WH. Current research on profile monitoring. SciELO Brasil. 2007;17(3):420–5.
26.
go back to reference Grigg OA, Farewell VT. A risk-adjusted sets method for monitoring adverse medical outcomes. Stat Med. 2004;23(10):1593–602.CrossRefPubMed Grigg OA, Farewell VT. A risk-adjusted sets method for monitoring adverse medical outcomes. Stat Med. 2004;23(10):1593–602.CrossRefPubMed
27.
go back to reference Grigg OA, Farewell VT, Spiegelhalter DJ. Use of risk-adjusted CUSUM and RSPRT charts for monitoring in medical contexts. Stat Methods Med Res. 2003;12(2):147–70.CrossRefPubMed Grigg OA, Farewell VT, Spiegelhalter DJ. Use of risk-adjusted CUSUM and RSPRT charts for monitoring in medical contexts. Stat Methods Med Res. 2003;12(2):147–70.CrossRefPubMed
28.
go back to reference Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa’s mothers, babies, and children: can the health system deliver? Lancet. 2009;374(9692):835–46.CrossRefPubMed Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa’s mothers, babies, and children: can the health system deliver? Lancet. 2009;374(9692):835–46.CrossRefPubMed
29.
go back to reference Woodall J, Dixey R, South J. Control and choice in English prisons: developing health-promoting prisons. Health Promot Int. 2014;29(3):474–82.CrossRefPubMed Woodall J, Dixey R, South J. Control and choice in English prisons: developing health-promoting prisons. Health Promot Int. 2014;29(3):474–82.CrossRefPubMed
30.
go back to reference Montgomery AL, Fadel S, Kumar R, Bondy S, Moineddin R, Jha P. The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis. PLoS One. 2014;9(6):e95696.CrossRefPubMedPubMedCentral Montgomery AL, Fadel S, Kumar R, Bondy S, Moineddin R, Jha P. The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis. PLoS One. 2014;9(6):e95696.CrossRefPubMedPubMedCentral
31.
go back to reference Montgomery AL, Ram U, Kumar R, Jha P, Million Death Study C. Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One. 2014;9(1):e83331.CrossRefPubMedPubMedCentral Montgomery AL, Ram U, Kumar R, Jha P, Million Death Study C. Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One. 2014;9(1):e83331.CrossRefPubMedPubMedCentral
32.
go back to reference Chou D, Tuncalp O, Firoz T, Barreix M, Filippi V, von Dadelszen P, van den Broek N, Cecatti JG, Say L, Maternal Morbidity Working G. Constructing maternal morbidity - towards a standard tool to measure and monitor maternal health beyond mortality. BMC pregnancy and childbirth. 2016;16:45.CrossRefPubMedPubMedCentral Chou D, Tuncalp O, Firoz T, Barreix M, Filippi V, von Dadelszen P, van den Broek N, Cecatti JG, Say L, Maternal Morbidity Working G. Constructing maternal morbidity - towards a standard tool to measure and monitor maternal health beyond mortality. BMC pregnancy and childbirth. 2016;16:45.CrossRefPubMedPubMedCentral
33.
go back to reference Bale JRS, B J, Lucas AO. Improving birth outcomes: meeting the Challange in the developing world. Washington: The National Academy Press; 2003. Bale JRS, B J, Lucas AO. Improving birth outcomes: meeting the Challange in the developing world. Washington: The National Academy Press; 2003.
34.
go back to reference Prual A. Reducing maternal mortality in developing countries: theory and practice. Medecine tropicale : revue du Corps de sante colonial. 2004;64(6):569–75. Prual A. Reducing maternal mortality in developing countries: theory and practice. Medecine tropicale : revue du Corps de sante colonial. 2004;64(6):569–75.
35.
go back to reference Prual A, Bouvier-Colle MH, de Bernis L, Breart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ. 2000;78(5):593–602.PubMedPubMedCentral Prual A, Bouvier-Colle MH, de Bernis L, Breart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ. 2000;78(5):593–602.PubMedPubMedCentral
36.
go back to reference Prual A, De Bernis L, El Joud DO. Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa. Journal de gynecologie, obstetrique et biologie de la reproduction. 2002;31(1):90–9.PubMed Prual A, De Bernis L, El Joud DO. Potential role of prenatal care in reducing maternal and perinatal mortality in sub-Saharan Africa. Journal de gynecologie, obstetrique et biologie de la reproduction. 2002;31(1):90–9.PubMed
37.
go back to reference Prual A, Gamatie Y, Djakounda M, Huguet D. Traditional uvulectomy in Niger: a public health problem? Soc Sci Med. 1994;39(8):1077–82.CrossRefPubMed Prual A, Gamatie Y, Djakounda M, Huguet D. Traditional uvulectomy in Niger: a public health problem? Soc Sci Med. 1994;39(8):1077–82.CrossRefPubMed
38.
go back to reference Prual A, Huguet D, Garbin O, Rabe G. Severe obstetric morbidity of the third trimester, delivery and early puerperium in Niamey (Niger). Afr J Reprod Health. 1998;2(1):10–9.PubMed Prual A, Huguet D, Garbin O, Rabe G. Severe obstetric morbidity of the third trimester, delivery and early puerperium in Niamey (Niger). Afr J Reprod Health. 1998;2(1):10–9.PubMed
39.
go back to reference Yi S, Tuot S, Chhoun P, Pal K, Ngin C, Choub SC, Brody C. Improving prevention and care for HIV and sexually transmitted infections among men who have sex with men in Cambodia: the sustainable action against HIV and AIDS in communities (SAHACOM). BMC Health Serv Res. 2016;16(1):599.CrossRefPubMedPubMedCentral Yi S, Tuot S, Chhoun P, Pal K, Ngin C, Choub SC, Brody C. Improving prevention and care for HIV and sexually transmitted infections among men who have sex with men in Cambodia: the sustainable action against HIV and AIDS in communities (SAHACOM). BMC Health Serv Res. 2016;16(1):599.CrossRefPubMedPubMedCentral
40.
go back to reference Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. N Engl J Med. 2005;352(20):2091–9.CrossRefPubMed Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. N Engl J Med. 2005;352(20):2091–9.CrossRefPubMed
41.
go back to reference Van Lerberghe W, De Brouwere V. Reducing maternal mortality in a context of poverty. Safe motherhood strategies: a review of the evidence. 2001;17:1–5. Van Lerberghe W, De Brouwere V. Reducing maternal mortality in a context of poverty. Safe motherhood strategies: a review of the evidence. 2001;17:1–5.
42.
go back to reference Graham WJ, Bell JS, Bullough CH. Can skilled attendance at delivery reduce maternal mortality in developing countries. Safe motherhood strategies: a review of the evidence. 2001;17:97–130. Graham WJ, Bell JS, Bullough CH. Can skilled attendance at delivery reduce maternal mortality in developing countries. Safe motherhood strategies: a review of the evidence. 2001;17:97–130.
43.
go back to reference Jat TR, Deo PR, Goicolea I, Hurtig AK, San Sebastian M. The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study. BMC pregnancy and childbirth. 2013;13:181.CrossRefPubMedPubMedCentral Jat TR, Deo PR, Goicolea I, Hurtig AK, San Sebastian M. The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study. BMC pregnancy and childbirth. 2013;13:181.CrossRefPubMedPubMedCentral
44.
go back to reference Stover J, Ross J. How increased contraceptive use has reduced maternal mortality. Matern Child Health J. 2010;14(5):687–95.CrossRefPubMed Stover J, Ross J. How increased contraceptive use has reduced maternal mortality. Matern Child Health J. 2010;14(5):687–95.CrossRefPubMed
45.
go back to reference Briozzo L. From risk and harm reduction to decriminalizing abortion: the Uruguayan model for women’s rights. Int J Gynaecol Obstet. 2016;134(Suppl 1):S3–6.CrossRef Briozzo L. From risk and harm reduction to decriminalizing abortion: the Uruguayan model for women’s rights. Int J Gynaecol Obstet. 2016;134(Suppl 1):S3–6.CrossRef
46.
go back to reference Mbaruku G, Bergstrom S. Reducing maternal mortality in Kigoma, Tanzania. Health Policy Plan. 1995;10(1):71–8.CrossRefPubMed Mbaruku G, Bergstrom S. Reducing maternal mortality in Kigoma, Tanzania. Health Policy Plan. 1995;10(1):71–8.CrossRefPubMed
47.
go back to reference Lassi ZS, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2015;(3) CD007754 Lassi ZS, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2015;(3) CD007754
48.
go back to reference Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380(9837):111–25.CrossRefPubMed Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380(9837):111–25.CrossRefPubMed
Metadata
Title
Optimal profile limits for maternal mortality rate (MMR) in South Sudan
Authors
Gabriel Makuei
Mali Abdollahian
Kaye Marion
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1892-0

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