What explains sub-national variation in maternal mortality rates within developing countries? A political economy explanation

Bukenya, Badru; Golooba-Mutebi, Frederick

doi:10.1016/j.socscimed.2020.113066

Cited by 11 publications

(13 citation statements)

References 36 publications

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“…Social scientists using political economy methods explored the explanations for the variations in maternal mortality rates between countries. They established that country-level political commitment differences might explain these MMR variations between developing countries [11]. Political goodwill and commitment are vital for the success of health initiatives.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

“…While the causes of maternal death remain largely similar between African countries, there is variation in the Maternal Mortality Ratio (MMR) between and within African countries [10]. Understanding the factors contributing to the variation in MMR at national and sub-national levels remains either understudied or underreported [11].…”

Section: Introductionmentioning

confidence: 99%

“…So far, most articles that have explored the relationship between contributory factors and maternal deaths in Africa used statistically modelled population-level data from the WHO Global Health Observatory, Human Development Report, World Bank and United Nations bodies [11,[19][20][21][22][23][24]. A single study utilised primary data from hospital-based studies [25].…”

Section: Introductionmentioning

confidence: 99%

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Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review

Muriithi

Banke-Thomas

Gakuo

et al. 2022

PLOS Glob Public Health

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The number of women dying during pregnancy and after childbirth remains unacceptably high, with African countries showing the slowest decline. The leading causes of maternal deaths in Africa are preventable direct obstetric causes such as haemorrhage, infection, hypertension, unsafe abortion, and obstructed labour. There is an information gap on factors contributing to maternal deaths in Africa. Our objective was to identify these contributing factors and assess the frequency of their reporting in published literature. We followed the Arksey and O’Malley methodological framework for scoping reviews. We searched six electronic bibliographic databases: MEDLINE, SCOPUS, African Index Medicus, African Journals Online (AJOL), French humanities and social sciences databases, and Web of Science. We included articles published between 1987 and 2021 without language restriction. Our conceptual framework was informed by a combination of the socio-ecological model, the three delays conceptual framework for analysing the determinants of maternal mortality and the signal functions of emergency obstetric care. We included 104 articles from 27 African countries. The most frequently reported contributory factors by level were: (1) Individual—level: Delay in deciding to seek help and in recognition of danger signs (37.5% of articles), (2) Health facility—level: Suboptimal service delivery relating to triage, monitoring, and referral (80.8% of articles) and (3) Wider health system—level: Transport to and between health facilities (84.6% of articles). Our findings indicate that health facility—level factors were the most frequently reported contributing factors to maternal deaths in Africa. There is a lack of data from some African countries, especially those countries with armed conflict currently or in the recent past. Information gaps exist in the following areas: Statistical significance of each contributing factor and whether contributing factors alone adequately explain the variations in maternal mortality ratios (MMR) seen between countries and at sub-national levels.

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Section: Interpretation Of Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review

Muriithi

Banke-Thomas

Gakuo

et al. 2022

PLOS Glob Public Health

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“…In addition, a better governance commitment in each country apart from the level of wealth is associated with lower MM [ 107 ]. On the other hand, sub-national variations in MM need to be considered beyond national figures to explain its determinants [ 108 ]. An example could be the situation of the Maghreb, with MM rates close to United Nations targets required but with high regional disparity and high differences in MM rates [ 109 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal Mortality in Africa: Regional Trends (2000–2017)

Onambele

Ortega-Leon

Guillen-Aguinaga

et al. 2022

IJERPH

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Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa’s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children’s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of −3.0% (95% CI −2.9; −3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations’ sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations’ target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

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“…In addition, a better governance commitment in each country apart from the level of wealth is associated with lower MM [109]. On the other hand, sub-national variations in MM need to be considered beyond national figures to explain its determinants [110]. An example could be the situation of the Maghreb, with MM rates close to United Nations targets required but with high regional disparity and high differences in MM rates [111].…”

Section: Discussionmentioning

confidence: 99%

Maternal Mortality in Africa, Regional Trends (2000-2017)

Onambele¹,

Ortega-Leon²,

Guillen-Aguinaga³

et al. 2022

Preprint

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Background: United Nations Sustainable Development Goals state that by 2030, the Global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. This research aims to study regional trends in maternal mortality in Africa. Methods: We extracted data for Maternal mortality rates per 100,000 births from the UNICE data bank from 2000 to 2017, being 2017 the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9;-3,2%). All regions showed significant downward trends, with the sharpest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining sub-Saharan African regions are still far from achieving the goals. Conclusions: maternal mortality has decreased in Africa, especially in the South Africa region. The only region closed to the United Nations target is North Africa. The remaining sub-Saharan African regions are still far from achieving the goals. These results could be used for the development of Regional Policies.

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What explains sub-national variation in maternal mortality rates within developing countries? A political economy explanation

Cited by 11 publications

References 36 publications

Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review

Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review

Maternal Mortality in Africa: Regional Trends (2000–2017)

Maternal Mortality in Africa, Regional Trends (2000-2017)

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