Maternal mortality in Malawi, 1977–2012
Background Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortalit...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2013-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/3/12/e004150.full |
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| author | Bejoy Nambiar Iqbal Anwar Tim Colbourn Sonia Lewycka Chisale Mhango Ann Phoya |
| author_facet | Bejoy Nambiar Iqbal Anwar Tim Colbourn Sonia Lewycka Chisale Mhango Ann Phoya |
| author_sort | Bejoy Nambiar |
| collection | DOAJ |
| description | Background Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortality.Methods We reviewed the literature for population-based studies that provide estimates of the maternal mortality ratio (MMR) in Malawi, and for studies that list and justify variables potentially associated with trends in MMR. We used all population-based estimates of MMR representative of the whole of Malawi to construct a best-fit trend-line for the range of years with available data, calculated the proportion attributable to HIV and qualitatively analysed trends and evidence related to other covariates to logically assess likely candidate drivers of the observed trend in MMR.Results 14 suitable estimates of MMR were found, covering the years 1977–2010. The resulting best-fit line predicted MMR in Malawi to have increased from 317 maternal deaths/100 000 live-births in 1980 to 748 in 1990, before peaking at 971 in 1999, and falling to 846 in 2005 and 484 in 2010. Concurrent deteriorations and improvements in HIV and health system investment and provisions are the most plausible explanations for the trend. Female literacy and education, family planning and poverty reduction could play more of a role if thresholds are passed in the coming years.Conclusions The decrease in MMR in Malawi is encouraging as it appears that recent efforts to control HIV and improve the health system are bearing fruit. Sustained efforts to prevent and treat maternal complications are required if Malawi is to attain the MDG 5 target and save the lives of more of its mothers in years to come. |
| format | Article |
| id | doaj-art-41e009ce81124ec2b2195df0b7375863 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2013-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-41e009ce81124ec2b2195df0b73758632025-02-08T18:15:14ZengBMJ Publishing GroupBMJ Open2044-60552013-12-0131210.1136/bmjopen-2013-004150Maternal mortality in Malawi, 1977–2012Bejoy Nambiar0Iqbal Anwar1Tim Colbourn2Sonia Lewycka3Chisale Mhango4Ann Phoya5UCL Institute for Global Health, London, UK3 Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh1 Institute for Global Health, University College London, London, UKOxford University Clinical Research Unit, Hanoi, VietnamMinistry of Health Reproductive Health Unit, Government of the Republic of Malawi, Lilongwe, MalawiGovernment of the Republic of Malawi, Ministry of Health Sector-Wide Approach (SWAp), Lilongwe, MalawiBackground Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortality.Methods We reviewed the literature for population-based studies that provide estimates of the maternal mortality ratio (MMR) in Malawi, and for studies that list and justify variables potentially associated with trends in MMR. We used all population-based estimates of MMR representative of the whole of Malawi to construct a best-fit trend-line for the range of years with available data, calculated the proportion attributable to HIV and qualitatively analysed trends and evidence related to other covariates to logically assess likely candidate drivers of the observed trend in MMR.Results 14 suitable estimates of MMR were found, covering the years 1977–2010. The resulting best-fit line predicted MMR in Malawi to have increased from 317 maternal deaths/100 000 live-births in 1980 to 748 in 1990, before peaking at 971 in 1999, and falling to 846 in 2005 and 484 in 2010. Concurrent deteriorations and improvements in HIV and health system investment and provisions are the most plausible explanations for the trend. Female literacy and education, family planning and poverty reduction could play more of a role if thresholds are passed in the coming years.Conclusions The decrease in MMR in Malawi is encouraging as it appears that recent efforts to control HIV and improve the health system are bearing fruit. Sustained efforts to prevent and treat maternal complications are required if Malawi is to attain the MDG 5 target and save the lives of more of its mothers in years to come.https://bmjopen.bmj.com/content/3/12/e004150.full |
| spellingShingle | Bejoy Nambiar Iqbal Anwar Tim Colbourn Sonia Lewycka Chisale Mhango Ann Phoya Maternal mortality in Malawi, 1977–2012 BMJ Open |
| title | Maternal mortality in Malawi, 1977–2012 |
| title_full | Maternal mortality in Malawi, 1977–2012 |
| title_fullStr | Maternal mortality in Malawi, 1977–2012 |
| title_full_unstemmed | Maternal mortality in Malawi, 1977–2012 |
| title_short | Maternal mortality in Malawi, 1977–2012 |
| title_sort | maternal mortality in malawi 1977 2012 |
| url | https://bmjopen.bmj.com/content/3/12/e004150.full |
| work_keys_str_mv | AT bejoynambiar maternalmortalityinmalawi19772012 AT iqbalanwar maternalmortalityinmalawi19772012 AT timcolbourn maternalmortalityinmalawi19772012 AT sonialewycka maternalmortalityinmalawi19772012 AT chisalemhango maternalmortalityinmalawi19772012 AT annphoya maternalmortalityinmalawi19772012 |