Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

Nicholas J. Kassebaum, Amelia Bertozzi-Villa, Megan S. Coggeshall, Katya A. Shackelford, Caitlyn Steiner, Kyle R. Heuton, Diego Gonzalez-Medina, Ryan Barber, Chantal Huynh, Daniel Dicker, Tara Templin, Timothy M. Wolock, Ayse Abbasoglu Ozgoren, Foad Abd-Allah, Semaw Ferede Abera, Ibrahim Abubakar, Tom Achoki, Ademola Adelekan, Zanfina Ademi, Arsène Kouablan AdouJosé C. Adsuar, Emilie E. Agardh, Dickens Akena, Deena Alasfoor, Zewdie Aderaw Alemu, Rafael Alfonso-Cristancho, Samia Alhabib, Raghib Ali, Mazin J. Al Kahbouri, François Alla, Peter J. Allen, Mohammad A. AlMazroa, Ubai Alsharif, Elena Alvarez, Nelson Alvis-Guzmán, Adansi A. Amankwaa, Azmeraw T. Amare, Hassan Amini, Walid Ammar, Carl A.T. Antonio, Palwasha Anwari, Johan Ärnlöv, Valentina S.Arsic Arsenijevic, Ali Artaman, Majed Masoud Asad, Rana J. Asghar, Reza Assadi, Lydia S. Atkins, Alaa Badawi, Kalpana Balakrishnan, Arindam Basu, Sanjay Basu, Justin Beardsley, Neeraj Bedi, Tolesa Bekele, Michelle L. Bell, Eduardo Bernabe, Tariku J. Beyene, Zulfiqar Bhutta, Aref Bin Abdulhak, Jed D. Blore, Berrak Bora Basara, Dipan Bose, Nicholas Breitborde, Rosario Cárdenas, Carlos A. Castañeda-Orjuela, Ruben Estanislao Castro, Ferrán Catalá-López, Alanur Cavlin, Jung Chen Chang, Xuan Che, Costas A. Christophi, Sumeet S. Chugh, Massimo Cirillo, Samantha M. Colquhoun, Leslie Trumbull Cooper, Cyrus Cooper, Iuri Da Costa Leite, Lalit Dandona, Rakhi Dandona, Adrian Davis, Anand Dayama, Louisa Degenhardt, Diego De Leo, Borja Del Pozo-Cruz, Kebede Deribe, Muluken Dessalegn, Gabrielle A. DeVeber, Samath D. Dharmaratne, Uʇur Dilmen, Eric L. Ding, Rob E. Dorrington, Tim R. Driscoll, Sergei Petrovich Ermakov, Alireza Esteghamati, Emerito Jose A. Faraon, Farshad Farzadfar, Manuela Mendonca Felicio, Seyed Mohammad Fereshtehnejad, Graça Maria Ferreira De Lima, Mohammad H. Forouzanfar, Elisabeth B. França, Lynne Gaffikin, Ketevan Gambashidze, Fortuné Gbètoho Gankpé, Ana C. Garcia, Johanna M. Geleijnse, Katherine B. Gibney, Maurice Giroud, Elizabeth L. Glaser, Ketevan Goginashvili, Philimon Gona, Dinorah González-Castell, Atsushi Goto, Hebe N. Gouda, Harish Chander Gugnani, Rahul Gupta, Rajeev Gupta, Nima Hafezi-Nejad, Randah Ribhi Hamadeh, Mouhanad Hammami, Graeme J. Hankey, Hilda L. Harb, Rasmus Havmoeller, Simon I. Hay, Ileana B.Heredia Pi, Hans W. Hoek, H. Dean Hosgood, Damian G. Hoy, Abdullatif Husseini, Bulat T. Idrisov, Kaire Innos, Manami Inoue, Kathryn H. Jacobsen, Eiman Jahangir, Sun Ha Jee, Paul N. Jensen, Vivekanand Jha, Guohong Jiang, Jost B. Jonas, Knud Juel, Edmond Kato Kabagambe, Haidong Kan, Nadim E. Karam, André Karch, Corine Kakizi Karema, Anil Kaul, Norito Kawakami, Konstantin Kazanjan, Dhruv S. Kazi, Andrew H. Kemp, Andre Pascal Kengne, Maia Kereselidze, Yousef Saleh Khader, Shams Eldin Ali Hassan Khalifa, Ejaz Ahmed Khan, Young Ho Khang, Luke Knibbs, Yoshihiro Kokubo, Soewarta Kosen, Barthelemy Kuate Defo, Chanda Kulkarni, Veena S. Kulkarni, G. Anil Kumar, Kaushalendra Kumar, Ravi B. Kumar, Gene Kwan, Taavi Lai, Ratilal Lalloo, Hilton Lam, Van C. Lansingh, Anders Larsson, Jong Tae Lee, James Leigh, Mall Leinsalu, Ricky Leung, Xiaohong Li, Yichong Li, Yongmei Li, Juan Liang, Xiaofeng Liang, Stephen S. Lim, Hsien Ho Lin, Steven E. Lipshultz, Shiwei Liu, Yang Liu, Belinda K. Lloyd, Stephanie J. London, Paulo A. Lotufo, Jixiang Ma, Stefan Ma, Vasco Manuel Pedro Machado, Nana Kwaku Mainoo, Marek Majdan, Christopher Chabila Mapoma, Wagner Marcenes, Melvin Barrientos Marzan, Amanda J. Mason-Jones, Man Mohan Mehndiratta, Fabiola Mejia-Rodriguez, Ziad A. Memish, Walter Mendoza, Ted R. Miller, Edward J. Mills, Ali H. Mokdad, Glen Liddell Mola, Lorenzo Monasta, Jonathan De La Cruz Monis, Julio Cesar Montañez Hernandez, Ami R. Moore, Maziar Moradi-Lakeh, Rintaro Mori, Ulrich O. Mueller, Mitsuru Mukaigawara, Aliya Naheed, Kovin S. Naidoo, Devina Nand, Vinay Nangia, Denis Nash, Chakib Nejjari, Robert G. Nelson, Sudan Prasad Neupane, Charles R. Newton, Marie Ng, Mark J. Nieuwenhuijsen, Muhammad Imran Nisar, Sandra Nolte, Ole F. Norheim, Luke Nyakarahuka, In Hwan Oh, Takayoshi Ohkubo, Bolajoko O. Olusanya, Saad B. Omer, John Nelson Opio, Orish Ebere Orisakwe, Jeyaraj D. Pandian, Christina Papachristou, Jae Hyun Park, Angel J. Paternina Caicedo, Scott B. Patten, Vinod K. Paul, Boris Igor Pavlin, Neil Pearce, David M. Pereira, Konrad Pesudovs, Max Petzold, Dan Poenaru, Guilherme V. Polanczyk, Suzanne Polinder, Dan Pope, Farshad Pourmalek, Dima Qato, D. Alex Quistberg, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Sajjad Ur Rahman, Murugesan Raju, Saleem M. Rana, Amany Refaat, Luca Ronfani, Nobhojit Roy, Tania Georgina Sánchez Pimienta, Mohammad Ali Sahraian, Joshua A. Salomon, Uchechukwu Sampson, Itamar S. Santos, Monika Sawhney, Felix Sayinzoga, Ione J.C. Schneider, Austin Schumacher, David C. Schwebel, Soraya Seedat, Sadaf G. Sepanlou, Edson E. Servan-Mori, Marina Shakh-Nazarova, Sara Sheikhbahaei, Kenji Shibuya, Hwashin Hyun Shin, Ivy Shiue, Inga Dora Sigfusdottir, Donald H. Silberberg, Andrea P. Silva, Jasvinder A. Singh, Vegard Skirbekk, Karen Sliwa, Sergey S. Soshnikov, Luciano A. Sposato, Chandrashekhar T. Sreeramareddy, Konstantinos Stroumpoulis, Lela Sturua, Bryan L. Sykes, Karen M. Tabb, Roberto Tchio Talongwa, Feng Tan, Carolina Maria Teixeira, Eric Yeboah Tenkorang, Abdullah Sulieman Terkawi, Andrew L. Thorne-Lyman, David L. Tirschwell, Jeffrey A. Towbin, Bach X. Tran, Miltiadis Tsilimbaris, Uche S. Uchendu, Kingsley N. Ukwaja, Eduardo A. Undurraga, Selen Begüm Uzun, Andrew J. Vallely, Coen H. Van Gool, Tommi J. Vasankari, Monica S. Vavilala, N. Venketasubramanian, Salvador Villalpando, Francesco S. Violante, Vasiliy Victorovich Vlassov, Theo Vos, Stephen Waller, Haidong Wang, Linhong Wang, Xiao Rong Wang, Yanping Wang, Scott Weichenthal, Elisabete Weiderpass, Robert G. Weintraub, Ronny Westerman, James D. Wilkinson, Solomon Meseret Woldeyohannes, John Q. Wong, Muluemebet Abera Wordofa, Gelin Xu, Yang C. Yang, Yuichiro Yano, Gokalp Kadri Yentur, Paul Yip, Naohiro Yonemoto, Seok Jun Yoon, Mustafa Z. Younis, Chuanhua Yu, Kim Yun Jin, Maysaa El Sayed Zaki, Yong Zhao, Yingfeng Zheng, Maigeng Zhou, Jun Zhu, Xiao Nong Zou, Alan D. Lopez, Mohsen Naghavi, Christopher J.L. Murray, Rafael Lozano

Research output: Contribution to journalArticle

Abstract

Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.

Original languageEnglish (US)
Pages (from-to)980-1004
Number of pages25
JournalThe Lancet
Volume384
Issue number9947
DOIs
StatePublished - Sep 22 2014

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Maternal Death
Maternal Mortality
HIV
Pregnancy
Uncertainty
Central Africa
Iceland
Global Burden of Disease
Southeastern Asia
Western Africa
Far East
Africa South of the Sahara
Postpartum Period
Cause of Death
Age Groups
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., ... Lozano, R. (2014). Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9947), 980-1004. https://doi.org/10.1016/S0140-6736(14)60696-6

Global, regional, and national levels and causes of maternal mortality during 1990-2013 : A systematic analysis for the Global Burden of Disease Study 2013. / Kassebaum, Nicholas J.; Bertozzi-Villa, Amelia; Coggeshall, Megan S.; Shackelford, Katya A.; Steiner, Caitlyn; Heuton, Kyle R.; Gonzalez-Medina, Diego; Barber, Ryan; Huynh, Chantal; Dicker, Daniel; Templin, Tara; Wolock, Timothy M.; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsène Kouablan; Adsuar, José C.; Agardh, Emilie E.; Akena, Dickens; Alasfoor, Deena; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Al Kahbouri, Mazin J.; Alla, François; Allen, Peter J.; AlMazroa, Mohammad A.; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzmán, Nelson; Amankwaa, Adansi A.; Amare, Azmeraw T.; Amini, Hassan; Ammar, Walid; Antonio, Carl A.T.; Anwari, Palwasha; Ärnlöv, Johan; Arsenijevic, Valentina S.Arsic; Artaman, Ali; Asad, Majed Masoud; Asghar, Rana J.; Assadi, Reza; Atkins, Lydia S.; Badawi, Alaa; Balakrishnan, Kalpana; Basu, Arindam; Basu, Sanjay; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L.; Bernabe, Eduardo; Beyene, Tariku J.; Bhutta, Zulfiqar; Abdulhak, Aref Bin; Blore, Jed D.; Basara, Berrak Bora; Bose, Dipan; Breitborde, Nicholas; Cárdenas, Rosario; Castañeda-Orjuela, Carlos A.; Castro, Ruben Estanislao; Catalá-López, Ferrán; Cavlin, Alanur; Chang, Jung Chen; Che, Xuan; Christophi, Costas A.; Chugh, Sumeet S.; Cirillo, Massimo; Colquhoun, Samantha M.; Cooper, Leslie Trumbull; Cooper, Cyrus; Da Costa Leite, Iuri; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Degenhardt, Louisa; De Leo, Diego; Del Pozo-Cruz, Borja; Deribe, Kebede; Dessalegn, Muluken; DeVeber, Gabrielle A.; Dharmaratne, Samath D.; Dilmen, Uʇur; Ding, Eric L.; Dorrington, Rob E.; Driscoll, Tim R.; Ermakov, Sergei Petrovich; Esteghamati, Alireza; Faraon, Emerito Jose A.; Farzadfar, Farshad; Felicio, Manuela Mendonca; Fereshtehnejad, Seyed Mohammad; De Lima, Graça Maria Ferreira; Forouzanfar, Mohammad H.; França, Elisabeth B.; Gaffikin, Lynne; Gambashidze, Ketevan; Gankpé, Fortuné Gbètoho; Garcia, Ana C.; Geleijnse, Johanna M.; Gibney, Katherine B.; Giroud, Maurice; Glaser, Elizabeth L.; Goginashvili, Ketevan; Gona, Philimon; González-Castell, Dinorah; Goto, Atsushi; Gouda, Hebe N.; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Hankey, Graeme J.; Harb, Hilda L.; Havmoeller, Rasmus; Hay, Simon I.; Pi, Ileana B.Heredia; Hoek, Hans W.; Hosgood, H. Dean; Hoy, Damian G.; Husseini, Abdullatif; Idrisov, Bulat T.; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H.; Jahangir, Eiman; Jee, Sun Ha; Jensen, Paul N.; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B.; Juel, Knud; Kabagambe, Edmond Kato; Kan, Haidong; Karam, Nadim E.; Karch, André; Karema, Corine Kakizi; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kazi, Dhruv S.; Kemp, Andrew H.; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz Ahmed; Khang, Young Ho; Knibbs, Luke; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kulkarni, Chanda; Kulkarni, Veena S.; Kumar, G. Anil; Kumar, Kaushalendra; Kumar, Ravi B.; Kwan, Gene; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lansingh, Van C.; Larsson, Anders; Lee, Jong Tae; Leigh, James; Leinsalu, Mall; Leung, Ricky; Li, Xiaohong; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S.; Lin, Hsien Ho; Lipshultz, Steven E.; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K.; London, Stephanie J.; Lotufo, Paulo A.; Ma, Jixiang; Ma, Stefan; Machado, Vasco Manuel Pedro; Mainoo, Nana Kwaku; Majdan, Marek; Mapoma, Christopher Chabila; Marcenes, Wagner; Marzan, Melvin Barrientos; Mason-Jones, Amanda J.; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Memish, Ziad A.; Mendoza, Walter; Miller, Ted R.; Mills, Edward J.; Mokdad, Ali H.; Mola, Glen Liddell; Monasta, Lorenzo; De La Cruz Monis, Jonathan; Hernandez, Julio Cesar Montañez; Moore, Ami R.; Moradi-Lakeh, Maziar; Mori, Rintaro; Mueller, Ulrich O.; Mukaigawara, Mitsuru; Naheed, Aliya; Naidoo, Kovin S.; Nand, Devina; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Nelson, Robert G.; Neupane, Sudan Prasad; Newton, Charles R.; Ng, Marie; Nieuwenhuijsen, Mark J.; Nisar, Muhammad Imran; Nolte, Sandra; Norheim, Ole F.; Nyakarahuka, Luke; Oh, In Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O.; Omer, Saad B.; Opio, John Nelson; Orisakwe, Orish Ebere; Pandian, Jeyaraj D.; Papachristou, Christina; Park, Jae Hyun; Paternina Caicedo, Angel J.; Patten, Scott B.; Paul, Vinod K.; Pavlin, Boris Igor; Pearce, Neil; Pereira, David M.; Pesudovs, Konrad; Petzold, Max; Poenaru, Dan; Polanczyk, Guilherme V.; Polinder, Suzanne; Pope, Dan; Pourmalek, Farshad; Qato, Dima; Quistberg, D. Alex; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Ur Rahman, Sajjad; Raju, Murugesan; Rana, Saleem M.; Refaat, Amany; Ronfani, Luca; Roy, Nobhojit; Pimienta, Tania Georgina Sánchez; Sahraian, Mohammad Ali; Salomon, Joshua A.; Sampson, Uchechukwu; Santos, Itamar S.; Sawhney, Monika; Sayinzoga, Felix; Schneider, Ione J.C.; Schumacher, Austin; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Servan-Mori, Edson E.; Shakh-Nazarova, Marina; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shiue, Ivy; Sigfusdottir, Inga Dora; Silberberg, Donald H.; Silva, Andrea P.; Singh, Jasvinder A.; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S.; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar T.; Stroumpoulis, Konstantinos; Sturua, Lela; Sykes, Bryan L.; Tabb, Karen M.; Talongwa, Roberto Tchio; Tan, Feng; Teixeira, Carolina Maria; Tenkorang, Eric Yeboah; Terkawi, Abdullah Sulieman; Thorne-Lyman, Andrew L.; Tirschwell, David L.; Towbin, Jeffrey A.; Tran, Bach X.; Tsilimbaris, Miltiadis; Uchendu, Uche S.; Ukwaja, Kingsley N.; Undurraga, Eduardo A.; Uzun, Selen Begüm; Vallely, Andrew J.; Van Gool, Coen H.; Vasankari, Tommi J.; Vavilala, Monica S.; Venketasubramanian, N.; Villalpando, Salvador; Violante, Francesco S.; Vlassov, Vasiliy Victorovich; Vos, Theo; Waller, Stephen; Wang, Haidong; Wang, Linhong; Wang, Xiao Rong; Wang, Yanping; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Westerman, Ronny; Wilkinson, James D.; Woldeyohannes, Solomon Meseret; Wong, John Q.; Wordofa, Muluemebet Abera; Xu, Gelin; Yang, Yang C.; Yano, Yuichiro; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok Jun; Younis, Mustafa Z.; Yu, Chuanhua; Jin, Kim Yun; El Sayed Zaki, Maysaa; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zhu, Jun; Zou, Xiao Nong; Lopez, Alan D.; Naghavi, Mohsen; Murray, Christopher J.L.; Lozano, Rafael.

In: The Lancet, Vol. 384, No. 9947, 22.09.2014, p. 980-1004.

Research output: Contribution to journalArticle

Kassebaum, NJ, Bertozzi-Villa, A, Coggeshall, MS, Shackelford, KA, Steiner, C, Heuton, KR, Gonzalez-Medina, D, Barber, R, Huynh, C, Dicker, D, Templin, T, Wolock, TM, Ozgoren, AA, Abd-Allah, F, Abera, SF, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Adou, AK, Adsuar, JC, Agardh, EE, Akena, D, Alasfoor, D, Alemu, ZA, Alfonso-Cristancho, R, Alhabib, S, Ali, R, Al Kahbouri, MJ, Alla, F, Allen, PJ, AlMazroa, MA, Alsharif, U, Alvarez, E, Alvis-Guzmán, N, Amankwaa, AA, Amare, AT, Amini, H, Ammar, W, Antonio, CAT, Anwari, P, Ärnlöv, J, Arsenijevic, VSA, Artaman, A, Asad, MM, Asghar, RJ, Assadi, R, Atkins, LS, Badawi, A, Balakrishnan, K, Basu, A, Basu, S, Beardsley, J, Bedi, N, Bekele, T, Bell, ML, Bernabe, E, Beyene, TJ, Bhutta, Z, Abdulhak, AB, Blore, JD, Basara, BB, Bose, D, Breitborde, N, Cárdenas, R, Castañeda-Orjuela, CA, Castro, RE, Catalá-López, F, Cavlin, A, Chang, JC, Che, X, Christophi, CA, Chugh, SS, Cirillo, M, Colquhoun, SM, Cooper, LT, Cooper, C, Da Costa Leite, I, Dandona, L, Dandona, R, Davis, A, Dayama, A, Degenhardt, L, De Leo, D, Del Pozo-Cruz, B, Deribe, K, Dessalegn, M, DeVeber, GA, Dharmaratne, SD, Dilmen, U, Ding, EL, Dorrington, RE, Driscoll, TR, Ermakov, SP, Esteghamati, A, Faraon, EJA, Farzadfar, F, Felicio, MM, Fereshtehnejad, SM, De Lima, GMF, Forouzanfar, MH, França, EB, Gaffikin, L, Gambashidze, K, Gankpé, FG, Garcia, AC, Geleijnse, JM, Gibney, KB, Giroud, M, Glaser, EL, Goginashvili, K, Gona, P, González-Castell, D, Goto, A, Gouda, HN, Gugnani, HC, Gupta, R, Gupta, R, Hafezi-Nejad, N, Hamadeh, RR, Hammami, M, Hankey, GJ, Harb, HL, Havmoeller, R, Hay, SI, Pi, IBH, Hoek, HW, Hosgood, HD, Hoy, DG, Husseini, A, Idrisov, BT, Innos, K, Inoue, M, Jacobsen, KH, Jahangir, E, Jee, SH, Jensen, PN, Jha, V, Jiang, G, Jonas, JB, Juel, K, Kabagambe, EK, Kan, H, Karam, NE, Karch, A, Karema, CK, Kaul, A, Kawakami, N, Kazanjan, K, Kazi, DS, Kemp, AH, Kengne, AP, Kereselidze, M, Khader, YS, Khalifa, SEAH, Khan, EA, Khang, YH, Knibbs, L, Kokubo, Y, Kosen, S, Defo, BK, Kulkarni, C, Kulkarni, VS, Kumar, GA, Kumar, K, Kumar, RB, Kwan, G, Lai, T, Lalloo, R, Lam, H, Lansingh, VC, Larsson, A, Lee, JT, Leigh, J, Leinsalu, M, Leung, R, Li, X, Li, Y, Li, Y, Liang, J, Liang, X, Lim, SS, Lin, HH, Lipshultz, SE, Liu, S, Liu, Y, Lloyd, BK, London, SJ, Lotufo, PA, Ma, J, Ma, S, Machado, VMP, Mainoo, NK, Majdan, M, Mapoma, CC, Marcenes, W, Marzan, MB, Mason-Jones, AJ, Mehndiratta, MM, Mejia-Rodriguez, F, Memish, ZA, Mendoza, W, Miller, TR, Mills, EJ, Mokdad, AH, Mola, GL, Monasta, L, De La Cruz Monis, J, Hernandez, JCM, Moore, AR, Moradi-Lakeh, M, Mori, R, Mueller, UO, Mukaigawara, M, Naheed, A, Naidoo, KS, Nand, D, Nangia, V, Nash, D, Nejjari, C, Nelson, RG, Neupane, SP, Newton, CR, Ng, M, Nieuwenhuijsen, MJ, Nisar, MI, Nolte, S, Norheim, OF, Nyakarahuka, L, Oh, IH, Ohkubo, T, Olusanya, BO, Omer, SB, Opio, JN, Orisakwe, OE, Pandian, JD, Papachristou, C, Park, JH, Paternina Caicedo, AJ, Patten, SB, Paul, VK, Pavlin, BI, Pearce, N, Pereira, DM, Pesudovs, K, Petzold, M, Poenaru, D, Polanczyk, GV, Polinder, S, Pope, D, Pourmalek, F, Qato, D, Quistberg, DA, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Ur Rahman, S, Raju, M, Rana, SM, Refaat, A, Ronfani, L, Roy, N, Pimienta, TGS, Sahraian, MA, Salomon, JA, Sampson, U, Santos, IS, Sawhney, M, Sayinzoga, F, Schneider, IJC, Schumacher, A, Schwebel, DC, Seedat, S, Sepanlou, SG, Servan-Mori, EE, Shakh-Nazarova, M, Sheikhbahaei, S, Shibuya, K, Shin, HH, Shiue, I, Sigfusdottir, ID, Silberberg, DH, Silva, AP, Singh, JA, Skirbekk, V, Sliwa, K, Soshnikov, SS, Sposato, LA, Sreeramareddy, CT, Stroumpoulis, K, Sturua, L, Sykes, BL, Tabb, KM, Talongwa, RT, Tan, F, Teixeira, CM, Tenkorang, EY, Terkawi, AS, Thorne-Lyman, AL, Tirschwell, DL, Towbin, JA, Tran, BX, Tsilimbaris, M, Uchendu, US, Ukwaja, KN, Undurraga, EA, Uzun, SB, Vallely, AJ, Van Gool, CH, Vasankari, TJ, Vavilala, MS, Venketasubramanian, N, Villalpando, S, Violante, FS, Vlassov, VV, Vos, T, Waller, S, Wang, H, Wang, L, Wang, XR, Wang, Y, Weichenthal, S, Weiderpass, E, Weintraub, RG, Westerman, R, Wilkinson, JD, Woldeyohannes, SM, Wong, JQ, Wordofa, MA, Xu, G, Yang, YC, Yano, Y, Yentur, GK, Yip, P, Yonemoto, N, Yoon, SJ, Younis, MZ, Yu, C, Jin, KY, El Sayed Zaki, M, Zhao, Y, Zheng, Y, Zhou, M, Zhu, J, Zou, XN, Lopez, AD, Naghavi, M, Murray, CJL & Lozano, R 2014, 'Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013', The Lancet, vol. 384, no. 9947, pp. 980-1004. https://doi.org/10.1016/S0140-6736(14)60696-6
Kassebaum, Nicholas J. ; Bertozzi-Villa, Amelia ; Coggeshall, Megan S. ; Shackelford, Katya A. ; Steiner, Caitlyn ; Heuton, Kyle R. ; Gonzalez-Medina, Diego ; Barber, Ryan ; Huynh, Chantal ; Dicker, Daniel ; Templin, Tara ; Wolock, Timothy M. ; Ozgoren, Ayse Abbasoglu ; Abd-Allah, Foad ; Abera, Semaw Ferede ; Abubakar, Ibrahim ; Achoki, Tom ; Adelekan, Ademola ; Ademi, Zanfina ; Adou, Arsène Kouablan ; Adsuar, José C. ; Agardh, Emilie E. ; Akena, Dickens ; Alasfoor, Deena ; Alemu, Zewdie Aderaw ; Alfonso-Cristancho, Rafael ; Alhabib, Samia ; Ali, Raghib ; Al Kahbouri, Mazin J. ; Alla, François ; Allen, Peter J. ; AlMazroa, Mohammad A. ; Alsharif, Ubai ; Alvarez, Elena ; Alvis-Guzmán, Nelson ; Amankwaa, Adansi A. ; Amare, Azmeraw T. ; Amini, Hassan ; Ammar, Walid ; Antonio, Carl A.T. ; Anwari, Palwasha ; Ärnlöv, Johan ; Arsenijevic, Valentina S.Arsic ; Artaman, Ali ; Asad, Majed Masoud ; Asghar, Rana J. ; Assadi, Reza ; Atkins, Lydia S. ; Badawi, Alaa ; Balakrishnan, Kalpana ; Basu, Arindam ; Basu, Sanjay ; Beardsley, Justin ; Bedi, Neeraj ; Bekele, Tolesa ; Bell, Michelle L. ; Bernabe, Eduardo ; Beyene, Tariku J. ; Bhutta, Zulfiqar ; Abdulhak, Aref Bin ; Blore, Jed D. ; Basara, Berrak Bora ; Bose, Dipan ; Breitborde, Nicholas ; Cárdenas, Rosario ; Castañeda-Orjuela, Carlos A. ; Castro, Ruben Estanislao ; Catalá-López, Ferrán ; Cavlin, Alanur ; Chang, Jung Chen ; Che, Xuan ; Christophi, Costas A. ; Chugh, Sumeet S. ; Cirillo, Massimo ; Colquhoun, Samantha M. ; Cooper, Leslie Trumbull ; Cooper, Cyrus ; Da Costa Leite, Iuri ; Dandona, Lalit ; Dandona, Rakhi ; Davis, Adrian ; Dayama, Anand ; Degenhardt, Louisa ; De Leo, Diego ; Del Pozo-Cruz, Borja ; Deribe, Kebede ; Dessalegn, Muluken ; DeVeber, Gabrielle A. ; Dharmaratne, Samath D. ; Dilmen, Uʇur ; Ding, Eric L. ; Dorrington, Rob E. ; Driscoll, Tim R. ; Ermakov, Sergei Petrovich ; Esteghamati, Alireza ; Faraon, Emerito Jose A. ; Farzadfar, Farshad ; Felicio, Manuela Mendonca ; Fereshtehnejad, Seyed Mohammad ; De Lima, Graça Maria Ferreira ; Forouzanfar, Mohammad H. ; França, Elisabeth B. ; Gaffikin, Lynne ; Gambashidze, Ketevan ; Gankpé, Fortuné Gbètoho ; Garcia, Ana C. ; Geleijnse, Johanna M. ; Gibney, Katherine B. ; Giroud, Maurice ; Glaser, Elizabeth L. ; Goginashvili, Ketevan ; Gona, Philimon ; González-Castell, Dinorah ; Goto, Atsushi ; Gouda, Hebe N. ; Gugnani, Harish Chander ; Gupta, Rahul ; Gupta, Rajeev ; Hafezi-Nejad, Nima ; Hamadeh, Randah Ribhi ; Hammami, Mouhanad ; Hankey, Graeme J. ; Harb, Hilda L. ; Havmoeller, Rasmus ; Hay, Simon I. ; Pi, Ileana B.Heredia ; Hoek, Hans W. ; Hosgood, H. Dean ; Hoy, Damian G. ; Husseini, Abdullatif ; Idrisov, Bulat T. ; Innos, Kaire ; Inoue, Manami ; Jacobsen, Kathryn H. ; Jahangir, Eiman ; Jee, Sun Ha ; Jensen, Paul N. ; Jha, Vivekanand ; Jiang, Guohong ; Jonas, Jost B. ; Juel, Knud ; Kabagambe, Edmond Kato ; Kan, Haidong ; Karam, Nadim E. ; Karch, André ; Karema, Corine Kakizi ; Kaul, Anil ; Kawakami, Norito ; Kazanjan, Konstantin ; Kazi, Dhruv S. ; Kemp, Andrew H. ; Kengne, Andre Pascal ; Kereselidze, Maia ; Khader, Yousef Saleh ; Khalifa, Shams Eldin Ali Hassan ; Khan, Ejaz Ahmed ; Khang, Young Ho ; Knibbs, Luke ; Kokubo, Yoshihiro ; Kosen, Soewarta ; Defo, Barthelemy Kuate ; Kulkarni, Chanda ; Kulkarni, Veena S. ; Kumar, G. Anil ; Kumar, Kaushalendra ; Kumar, Ravi B. ; Kwan, Gene ; Lai, Taavi ; Lalloo, Ratilal ; Lam, Hilton ; Lansingh, Van C. ; Larsson, Anders ; Lee, Jong Tae ; Leigh, James ; Leinsalu, Mall ; Leung, Ricky ; Li, Xiaohong ; Li, Yichong ; Li, Yongmei ; Liang, Juan ; Liang, Xiaofeng ; Lim, Stephen S. ; Lin, Hsien Ho ; Lipshultz, Steven E. ; Liu, Shiwei ; Liu, Yang ; Lloyd, Belinda K. ; London, Stephanie J. ; Lotufo, Paulo A. ; Ma, Jixiang ; Ma, Stefan ; Machado, Vasco Manuel Pedro ; Mainoo, Nana Kwaku ; Majdan, Marek ; Mapoma, Christopher Chabila ; Marcenes, Wagner ; Marzan, Melvin Barrientos ; Mason-Jones, Amanda J. ; Mehndiratta, Man Mohan ; Mejia-Rodriguez, Fabiola ; Memish, Ziad A. ; Mendoza, Walter ; Miller, Ted R. ; Mills, Edward J. ; Mokdad, Ali H. ; Mola, Glen Liddell ; Monasta, Lorenzo ; De La Cruz Monis, Jonathan ; Hernandez, Julio Cesar Montañez ; Moore, Ami R. ; Moradi-Lakeh, Maziar ; Mori, Rintaro ; Mueller, Ulrich O. ; Mukaigawara, Mitsuru ; Naheed, Aliya ; Naidoo, Kovin S. ; Nand, Devina ; Nangia, Vinay ; Nash, Denis ; Nejjari, Chakib ; Nelson, Robert G. ; Neupane, Sudan Prasad ; Newton, Charles R. ; Ng, Marie ; Nieuwenhuijsen, Mark J. ; Nisar, Muhammad Imran ; Nolte, Sandra ; Norheim, Ole F. ; Nyakarahuka, Luke ; Oh, In Hwan ; Ohkubo, Takayoshi ; Olusanya, Bolajoko O. ; Omer, Saad B. ; Opio, John Nelson ; Orisakwe, Orish Ebere ; Pandian, Jeyaraj D. ; Papachristou, Christina ; Park, Jae Hyun ; Paternina Caicedo, Angel J. ; Patten, Scott B. ; Paul, Vinod K. ; Pavlin, Boris Igor ; Pearce, Neil ; Pereira, David M. ; Pesudovs, Konrad ; Petzold, Max ; Poenaru, Dan ; Polanczyk, Guilherme V. ; Polinder, Suzanne ; Pope, Dan ; Pourmalek, Farshad ; Qato, Dima ; Quistberg, D. Alex ; Rafay, Anwar ; Rahimi, Kazem ; Rahimi-Movaghar, Vafa ; Ur Rahman, Sajjad ; Raju, Murugesan ; Rana, Saleem M. ; Refaat, Amany ; Ronfani, Luca ; Roy, Nobhojit ; Pimienta, Tania Georgina Sánchez ; Sahraian, Mohammad Ali ; Salomon, Joshua A. ; Sampson, Uchechukwu ; Santos, Itamar S. ; Sawhney, Monika ; Sayinzoga, Felix ; Schneider, Ione J.C. ; Schumacher, Austin ; Schwebel, David C. ; Seedat, Soraya ; Sepanlou, Sadaf G. ; Servan-Mori, Edson E. ; Shakh-Nazarova, Marina ; Sheikhbahaei, Sara ; Shibuya, Kenji ; Shin, Hwashin Hyun ; Shiue, Ivy ; Sigfusdottir, Inga Dora ; Silberberg, Donald H. ; Silva, Andrea P. ; Singh, Jasvinder A. ; Skirbekk, Vegard ; Sliwa, Karen ; Soshnikov, Sergey S. ; Sposato, Luciano A. ; Sreeramareddy, Chandrashekhar T. ; Stroumpoulis, Konstantinos ; Sturua, Lela ; Sykes, Bryan L. ; Tabb, Karen M. ; Talongwa, Roberto Tchio ; Tan, Feng ; Teixeira, Carolina Maria ; Tenkorang, Eric Yeboah ; Terkawi, Abdullah Sulieman ; Thorne-Lyman, Andrew L. ; Tirschwell, David L. ; Towbin, Jeffrey A. ; Tran, Bach X. ; Tsilimbaris, Miltiadis ; Uchendu, Uche S. ; Ukwaja, Kingsley N. ; Undurraga, Eduardo A. ; Uzun, Selen Begüm ; Vallely, Andrew J. ; Van Gool, Coen H. ; Vasankari, Tommi J. ; Vavilala, Monica S. ; Venketasubramanian, N. ; Villalpando, Salvador ; Violante, Francesco S. ; Vlassov, Vasiliy Victorovich ; Vos, Theo ; Waller, Stephen ; Wang, Haidong ; Wang, Linhong ; Wang, Xiao Rong ; Wang, Yanping ; Weichenthal, Scott ; Weiderpass, Elisabete ; Weintraub, Robert G. ; Westerman, Ronny ; Wilkinson, James D. ; Woldeyohannes, Solomon Meseret ; Wong, John Q. ; Wordofa, Muluemebet Abera ; Xu, Gelin ; Yang, Yang C. ; Yano, Yuichiro ; Yentur, Gokalp Kadri ; Yip, Paul ; Yonemoto, Naohiro ; Yoon, Seok Jun ; Younis, Mustafa Z. ; Yu, Chuanhua ; Jin, Kim Yun ; El Sayed Zaki, Maysaa ; Zhao, Yong ; Zheng, Yingfeng ; Zhou, Maigeng ; Zhu, Jun ; Zou, Xiao Nong ; Lopez, Alan D. ; Naghavi, Mohsen ; Murray, Christopher J.L. ; Lozano, Rafael. / Global, regional, and national levels and causes of maternal mortality during 1990-2013 : A systematic analysis for the Global Burden of Disease Study 2013. In: The Lancet. 2014 ; Vol. 384, No. 9947. pp. 980-1004.
@article{a81c505824764013a25ffc6b448cc99d,
title = "Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013",
abstract = "Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75{\%} reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95{\%} uncertainty intervals (UIs) for all values. Findings 292 982 (95{\%} UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3{\%} (-1.1 to 0.6) from 1990 to 2003, and -2.7{\%} (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4{\%} (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.",
author = "Kassebaum, {Nicholas J.} and Amelia Bertozzi-Villa and Coggeshall, {Megan S.} and Shackelford, {Katya A.} and Caitlyn Steiner and Heuton, {Kyle R.} and Diego Gonzalez-Medina and Ryan Barber and Chantal Huynh and Daniel Dicker and Tara Templin and Wolock, {Timothy M.} and Ozgoren, {Ayse Abbasoglu} and Foad Abd-Allah and Abera, {Semaw Ferede} and Ibrahim Abubakar and Tom Achoki and Ademola Adelekan and Zanfina Ademi and Adou, {Ars{\`e}ne Kouablan} and Adsuar, {Jos{\'e} C.} and Agardh, {Emilie E.} and Dickens Akena and Deena Alasfoor and Alemu, {Zewdie Aderaw} and Rafael Alfonso-Cristancho and Samia Alhabib and Raghib Ali and {Al Kahbouri}, {Mazin J.} and Fran{\cc}ois Alla and Allen, {Peter J.} and AlMazroa, {Mohammad A.} and Ubai Alsharif and Elena Alvarez and Nelson Alvis-Guzm{\'a}n and Amankwaa, {Adansi A.} and Amare, {Azmeraw T.} and Hassan Amini and Walid Ammar and Antonio, {Carl A.T.} and Palwasha Anwari and Johan {\"A}rnl{\"o}v and Arsenijevic, {Valentina S.Arsic} and Ali Artaman and Asad, {Majed Masoud} and Asghar, {Rana J.} and Reza Assadi and Atkins, {Lydia S.} and Alaa Badawi and Kalpana Balakrishnan and Arindam Basu and Sanjay Basu and Justin Beardsley and Neeraj Bedi and Tolesa Bekele and Bell, {Michelle L.} and Eduardo Bernabe and Beyene, {Tariku J.} and Zulfiqar Bhutta and Abdulhak, {Aref Bin} and Blore, {Jed D.} and Basara, {Berrak Bora} and Dipan Bose and Nicholas Breitborde and Rosario C{\'a}rdenas and Casta{\~n}eda-Orjuela, {Carlos A.} and Castro, {Ruben Estanislao} and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Alanur Cavlin and Chang, {Jung Chen} and Xuan Che and Christophi, {Costas A.} and Chugh, {Sumeet S.} and Massimo Cirillo and Colquhoun, {Samantha M.} and Cooper, {Leslie Trumbull} and Cyrus Cooper and {Da Costa Leite}, Iuri and Lalit Dandona and Rakhi Dandona and Adrian Davis and Anand Dayama and Louisa Degenhardt and {De Leo}, Diego and {Del Pozo-Cruz}, Borja and Kebede Deribe and Muluken Dessalegn and DeVeber, {Gabrielle A.} and Dharmaratne, {Samath D.} and Uʇur Dilmen and Ding, {Eric L.} and Dorrington, {Rob E.} and Driscoll, {Tim R.} and Ermakov, {Sergei Petrovich} and Alireza Esteghamati and Faraon, {Emerito Jose A.} and Farshad Farzadfar and Felicio, {Manuela Mendonca} and Fereshtehnejad, {Seyed Mohammad} and {De Lima}, {Gra{\cc}a Maria Ferreira} and Forouzanfar, {Mohammad H.} and Fran{\cc}a, {Elisabeth B.} and Lynne Gaffikin and Ketevan Gambashidze and Gankp{\'e}, {Fortun{\'e} Gb{\`e}toho} and Garcia, {Ana C.} and Geleijnse, {Johanna M.} and Gibney, {Katherine B.} and Maurice Giroud and Glaser, {Elizabeth L.} and Ketevan Goginashvili and Philimon Gona and Dinorah Gonz{\'a}lez-Castell and Atsushi Goto and Gouda, {Hebe N.} and Gugnani, {Harish Chander} and Rahul Gupta and Rajeev Gupta and Nima Hafezi-Nejad and Hamadeh, {Randah Ribhi} and Mouhanad Hammami and Hankey, {Graeme J.} and Harb, {Hilda L.} and Rasmus Havmoeller and Hay, {Simon I.} and Pi, {Ileana B.Heredia} and Hoek, {Hans W.} and Hosgood, {H. Dean} and Hoy, {Damian G.} and Abdullatif Husseini and Idrisov, {Bulat T.} and Kaire Innos and Manami Inoue and Jacobsen, {Kathryn H.} and Eiman Jahangir and Jee, {Sun Ha} and Jensen, {Paul N.} and Vivekanand Jha and Guohong Jiang and Jonas, {Jost B.} and Knud Juel and Kabagambe, {Edmond Kato} and Haidong Kan and Karam, {Nadim E.} and Andr{\'e} Karch and Karema, {Corine Kakizi} and Anil Kaul and Norito Kawakami and Konstantin Kazanjan and Kazi, {Dhruv S.} and Kemp, {Andrew H.} and Kengne, {Andre Pascal} and Maia Kereselidze and Khader, {Yousef Saleh} and Khalifa, {Shams Eldin Ali Hassan} and Khan, {Ejaz Ahmed} and Khang, {Young Ho} and Luke Knibbs and Yoshihiro Kokubo and Soewarta Kosen and Defo, {Barthelemy Kuate} and Chanda Kulkarni and Kulkarni, {Veena S.} and Kumar, {G. Anil} and Kaushalendra Kumar and Kumar, {Ravi B.} and Gene Kwan and Taavi Lai and Ratilal Lalloo and Hilton Lam and Lansingh, {Van C.} and Anders Larsson and Lee, {Jong Tae} and James Leigh and Mall Leinsalu and Ricky Leung and Xiaohong Li and Yichong Li and Yongmei Li and Juan Liang and Xiaofeng Liang and Lim, {Stephen S.} and Lin, {Hsien Ho} and Lipshultz, {Steven E.} and Shiwei Liu and Yang Liu and Lloyd, {Belinda K.} and London, {Stephanie J.} and Lotufo, {Paulo A.} and Jixiang Ma and Stefan Ma and Machado, {Vasco Manuel Pedro} and Mainoo, {Nana Kwaku} and Marek Majdan and Mapoma, {Christopher Chabila} and Wagner Marcenes and Marzan, {Melvin Barrientos} and Mason-Jones, {Amanda J.} and Mehndiratta, {Man Mohan} and Fabiola Mejia-Rodriguez and Memish, {Ziad A.} and Walter Mendoza and Miller, {Ted R.} and Mills, {Edward J.} and Mokdad, {Ali H.} and Mola, {Glen Liddell} and Lorenzo Monasta and {De La Cruz Monis}, Jonathan and Hernandez, {Julio Cesar Monta{\~n}ez} and Moore, {Ami R.} and Maziar Moradi-Lakeh and Rintaro Mori and Mueller, {Ulrich O.} and Mitsuru Mukaigawara and Aliya Naheed and Naidoo, {Kovin S.} and Devina Nand and Vinay Nangia and Denis Nash and Chakib Nejjari and Nelson, {Robert G.} and Neupane, {Sudan Prasad} and Newton, {Charles R.} and Marie Ng and Nieuwenhuijsen, {Mark J.} and Nisar, {Muhammad Imran} and Sandra Nolte and Norheim, {Ole F.} and Luke Nyakarahuka and Oh, {In Hwan} and Takayoshi Ohkubo and Olusanya, {Bolajoko O.} and Omer, {Saad B.} and Opio, {John Nelson} and Orisakwe, {Orish Ebere} and Pandian, {Jeyaraj D.} and Christina Papachristou and Park, {Jae Hyun} and {Paternina Caicedo}, {Angel J.} and Patten, {Scott B.} and Paul, {Vinod K.} and Pavlin, {Boris Igor} and Neil Pearce and Pereira, {David M.} and Konrad Pesudovs and Max Petzold and Dan Poenaru and Polanczyk, {Guilherme V.} and Suzanne Polinder and Dan Pope and Farshad Pourmalek and Dima Qato and Quistberg, {D. Alex} and Anwar Rafay and Kazem Rahimi and Vafa Rahimi-Movaghar and {Ur Rahman}, Sajjad and Murugesan Raju and Rana, {Saleem M.} and Amany Refaat and Luca Ronfani and Nobhojit Roy and Pimienta, {Tania Georgina S{\'a}nchez} and Sahraian, {Mohammad Ali} and Salomon, {Joshua A.} and Uchechukwu Sampson and Santos, {Itamar S.} and Monika Sawhney and Felix Sayinzoga and Schneider, {Ione J.C.} and Austin Schumacher and Schwebel, {David C.} and Soraya Seedat and Sepanlou, {Sadaf G.} and Servan-Mori, {Edson E.} and Marina Shakh-Nazarova and Sara Sheikhbahaei and Kenji Shibuya and Shin, {Hwashin Hyun} and Ivy Shiue and Sigfusdottir, {Inga Dora} and Silberberg, {Donald H.} and Silva, {Andrea P.} and Singh, {Jasvinder A.} and Vegard Skirbekk and Karen Sliwa and Soshnikov, {Sergey S.} and Sposato, {Luciano A.} and Sreeramareddy, {Chandrashekhar T.} and Konstantinos Stroumpoulis and Lela Sturua and Sykes, {Bryan L.} and Tabb, {Karen M.} and Talongwa, {Roberto Tchio} and Feng Tan and Teixeira, {Carolina Maria} and Tenkorang, {Eric Yeboah} and Terkawi, {Abdullah Sulieman} and Thorne-Lyman, {Andrew L.} and Tirschwell, {David L.} and Towbin, {Jeffrey A.} and Tran, {Bach X.} and Miltiadis Tsilimbaris and Uchendu, {Uche S.} and Ukwaja, {Kingsley N.} and Undurraga, {Eduardo A.} and Uzun, {Selen Beg{\"u}m} and Vallely, {Andrew J.} and {Van Gool}, {Coen H.} and Vasankari, {Tommi J.} and Vavilala, {Monica S.} and N. Venketasubramanian and Salvador Villalpando and Violante, {Francesco S.} and Vlassov, {Vasiliy Victorovich} and Theo Vos and Stephen Waller and Haidong Wang and Linhong Wang and Wang, {Xiao Rong} and Yanping Wang and Scott Weichenthal and Elisabete Weiderpass and Weintraub, {Robert G.} and Ronny Westerman and Wilkinson, {James D.} and Woldeyohannes, {Solomon Meseret} and Wong, {John Q.} and Wordofa, {Muluemebet Abera} and Gelin Xu and Yang, {Yang C.} and Yuichiro Yano and Yentur, {Gokalp Kadri} and Paul Yip and Naohiro Yonemoto and Yoon, {Seok Jun} and Younis, {Mustafa Z.} and Chuanhua Yu and Jin, {Kim Yun} and {El Sayed Zaki}, Maysaa and Yong Zhao and Yingfeng Zheng and Maigeng Zhou and Jun Zhu and Zou, {Xiao Nong} and Lopez, {Alan D.} and Mohsen Naghavi and Murray, {Christopher J.L.} and Rafael Lozano",
year = "2014",
month = "9",
day = "22",
doi = "10.1016/S0140-6736(14)60696-6",
language = "English (US)",
volume = "384",
pages = "980--1004",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9947",

}

TY - JOUR

T1 - Global, regional, and national levels and causes of maternal mortality during 1990-2013

T2 - A systematic analysis for the Global Burden of Disease Study 2013

AU - Kassebaum, Nicholas J.

AU - Bertozzi-Villa, Amelia

AU - Coggeshall, Megan S.

AU - Shackelford, Katya A.

AU - Steiner, Caitlyn

AU - Heuton, Kyle R.

AU - Gonzalez-Medina, Diego

AU - Barber, Ryan

AU - Huynh, Chantal

AU - Dicker, Daniel

AU - Templin, Tara

AU - Wolock, Timothy M.

AU - Ozgoren, Ayse Abbasoglu

AU - Abd-Allah, Foad

AU - Abera, Semaw Ferede

AU - Abubakar, Ibrahim

AU - Achoki, Tom

AU - Adelekan, Ademola

AU - Ademi, Zanfina

AU - Adou, Arsène Kouablan

AU - Adsuar, José C.

AU - Agardh, Emilie E.

AU - Akena, Dickens

AU - Alasfoor, Deena

AU - Alemu, Zewdie Aderaw

AU - Alfonso-Cristancho, Rafael

AU - Alhabib, Samia

AU - Ali, Raghib

AU - Al Kahbouri, Mazin J.

AU - Alla, François

AU - Allen, Peter J.

AU - AlMazroa, Mohammad A.

AU - Alsharif, Ubai

AU - Alvarez, Elena

AU - Alvis-Guzmán, Nelson

AU - Amankwaa, Adansi A.

AU - Amare, Azmeraw T.

AU - Amini, Hassan

AU - Ammar, Walid

AU - Antonio, Carl A.T.

AU - Anwari, Palwasha

AU - Ärnlöv, Johan

AU - Arsenijevic, Valentina S.Arsic

AU - Artaman, Ali

AU - Asad, Majed Masoud

AU - Asghar, Rana J.

AU - Assadi, Reza

AU - Atkins, Lydia S.

AU - Badawi, Alaa

AU - Balakrishnan, Kalpana

AU - Basu, Arindam

AU - Basu, Sanjay

AU - Beardsley, Justin

AU - Bedi, Neeraj

AU - Bekele, Tolesa

AU - Bell, Michelle L.

AU - Bernabe, Eduardo

AU - Beyene, Tariku J.

AU - Bhutta, Zulfiqar

AU - Abdulhak, Aref Bin

AU - Blore, Jed D.

AU - Basara, Berrak Bora

AU - Bose, Dipan

AU - Breitborde, Nicholas

AU - Cárdenas, Rosario

AU - Castañeda-Orjuela, Carlos A.

AU - Castro, Ruben Estanislao

AU - Catalá-López, Ferrán

AU - Cavlin, Alanur

AU - Chang, Jung Chen

AU - Che, Xuan

AU - Christophi, Costas A.

AU - Chugh, Sumeet S.

AU - Cirillo, Massimo

AU - Colquhoun, Samantha M.

AU - Cooper, Leslie Trumbull

AU - Cooper, Cyrus

AU - Da Costa Leite, Iuri

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Davis, Adrian

AU - Dayama, Anand

AU - Degenhardt, Louisa

AU - De Leo, Diego

AU - Del Pozo-Cruz, Borja

AU - Deribe, Kebede

AU - Dessalegn, Muluken

AU - DeVeber, Gabrielle A.

AU - Dharmaratne, Samath D.

AU - Dilmen, Uʇur

AU - Ding, Eric L.

AU - Dorrington, Rob E.

AU - Driscoll, Tim R.

AU - Ermakov, Sergei Petrovich

AU - Esteghamati, Alireza

AU - Faraon, Emerito Jose A.

AU - Farzadfar, Farshad

AU - Felicio, Manuela Mendonca

AU - Fereshtehnejad, Seyed Mohammad

AU - De Lima, Graça Maria Ferreira

AU - Forouzanfar, Mohammad H.

AU - França, Elisabeth B.

AU - Gaffikin, Lynne

AU - Gambashidze, Ketevan

AU - Gankpé, Fortuné Gbètoho

AU - Garcia, Ana C.

AU - Geleijnse, Johanna M.

AU - Gibney, Katherine B.

AU - Giroud, Maurice

AU - Glaser, Elizabeth L.

AU - Goginashvili, Ketevan

AU - Gona, Philimon

AU - González-Castell, Dinorah

AU - Goto, Atsushi

AU - Gouda, Hebe N.

AU - Gugnani, Harish Chander

AU - Gupta, Rahul

AU - Gupta, Rajeev

AU - Hafezi-Nejad, Nima

AU - Hamadeh, Randah Ribhi

AU - Hammami, Mouhanad

AU - Hankey, Graeme J.

AU - Harb, Hilda L.

AU - Havmoeller, Rasmus

AU - Hay, Simon I.

AU - Pi, Ileana B.Heredia

AU - Hoek, Hans W.

AU - Hosgood, H. Dean

AU - Hoy, Damian G.

AU - Husseini, Abdullatif

AU - Idrisov, Bulat T.

AU - Innos, Kaire

AU - Inoue, Manami

AU - Jacobsen, Kathryn H.

AU - Jahangir, Eiman

AU - Jee, Sun Ha

AU - Jensen, Paul N.

AU - Jha, Vivekanand

AU - Jiang, Guohong

AU - Jonas, Jost B.

AU - Juel, Knud

AU - Kabagambe, Edmond Kato

AU - Kan, Haidong

AU - Karam, Nadim E.

AU - Karch, André

AU - Karema, Corine Kakizi

AU - Kaul, Anil

AU - Kawakami, Norito

AU - Kazanjan, Konstantin

AU - Kazi, Dhruv S.

AU - Kemp, Andrew H.

AU - Kengne, Andre Pascal

AU - Kereselidze, Maia

AU - Khader, Yousef Saleh

AU - Khalifa, Shams Eldin Ali Hassan

AU - Khan, Ejaz Ahmed

AU - Khang, Young Ho

AU - Knibbs, Luke

AU - Kokubo, Yoshihiro

AU - Kosen, Soewarta

AU - Defo, Barthelemy Kuate

AU - Kulkarni, Chanda

AU - Kulkarni, Veena S.

AU - Kumar, G. Anil

AU - Kumar, Kaushalendra

AU - Kumar, Ravi B.

AU - Kwan, Gene

AU - Lai, Taavi

AU - Lalloo, Ratilal

AU - Lam, Hilton

AU - Lansingh, Van C.

AU - Larsson, Anders

AU - Lee, Jong Tae

AU - Leigh, James

AU - Leinsalu, Mall

AU - Leung, Ricky

AU - Li, Xiaohong

AU - Li, Yichong

AU - Li, Yongmei

AU - Liang, Juan

AU - Liang, Xiaofeng

AU - Lim, Stephen S.

AU - Lin, Hsien Ho

AU - Lipshultz, Steven E.

AU - Liu, Shiwei

AU - Liu, Yang

AU - Lloyd, Belinda K.

AU - London, Stephanie J.

AU - Lotufo, Paulo A.

AU - Ma, Jixiang

AU - Ma, Stefan

AU - Machado, Vasco Manuel Pedro

AU - Mainoo, Nana Kwaku

AU - Majdan, Marek

AU - Mapoma, Christopher Chabila

AU - Marcenes, Wagner

AU - Marzan, Melvin Barrientos

AU - Mason-Jones, Amanda J.

AU - Mehndiratta, Man Mohan

AU - Mejia-Rodriguez, Fabiola

AU - Memish, Ziad A.

AU - Mendoza, Walter

AU - Miller, Ted R.

AU - Mills, Edward J.

AU - Mokdad, Ali H.

AU - Mola, Glen Liddell

AU - Monasta, Lorenzo

AU - De La Cruz Monis, Jonathan

AU - Hernandez, Julio Cesar Montañez

AU - Moore, Ami R.

AU - Moradi-Lakeh, Maziar

AU - Mori, Rintaro

AU - Mueller, Ulrich O.

AU - Mukaigawara, Mitsuru

AU - Naheed, Aliya

AU - Naidoo, Kovin S.

AU - Nand, Devina

AU - Nangia, Vinay

AU - Nash, Denis

AU - Nejjari, Chakib

AU - Nelson, Robert G.

AU - Neupane, Sudan Prasad

AU - Newton, Charles R.

AU - Ng, Marie

AU - Nieuwenhuijsen, Mark J.

AU - Nisar, Muhammad Imran

AU - Nolte, Sandra

AU - Norheim, Ole F.

AU - Nyakarahuka, Luke

AU - Oh, In Hwan

AU - Ohkubo, Takayoshi

AU - Olusanya, Bolajoko O.

AU - Omer, Saad B.

AU - Opio, John Nelson

AU - Orisakwe, Orish Ebere

AU - Pandian, Jeyaraj D.

AU - Papachristou, Christina

AU - Park, Jae Hyun

AU - Paternina Caicedo, Angel J.

AU - Patten, Scott B.

AU - Paul, Vinod K.

AU - Pavlin, Boris Igor

AU - Pearce, Neil

AU - Pereira, David M.

AU - Pesudovs, Konrad

AU - Petzold, Max

AU - Poenaru, Dan

AU - Polanczyk, Guilherme V.

AU - Polinder, Suzanne

AU - Pope, Dan

AU - Pourmalek, Farshad

AU - Qato, Dima

AU - Quistberg, D. Alex

AU - Rafay, Anwar

AU - Rahimi, Kazem

AU - Rahimi-Movaghar, Vafa

AU - Ur Rahman, Sajjad

AU - Raju, Murugesan

AU - Rana, Saleem M.

AU - Refaat, Amany

AU - Ronfani, Luca

AU - Roy, Nobhojit

AU - Pimienta, Tania Georgina Sánchez

AU - Sahraian, Mohammad Ali

AU - Salomon, Joshua A.

AU - Sampson, Uchechukwu

AU - Santos, Itamar S.

AU - Sawhney, Monika

AU - Sayinzoga, Felix

AU - Schneider, Ione J.C.

AU - Schumacher, Austin

AU - Schwebel, David C.

AU - Seedat, Soraya

AU - Sepanlou, Sadaf G.

AU - Servan-Mori, Edson E.

AU - Shakh-Nazarova, Marina

AU - Sheikhbahaei, Sara

AU - Shibuya, Kenji

AU - Shin, Hwashin Hyun

AU - Shiue, Ivy

AU - Sigfusdottir, Inga Dora

AU - Silberberg, Donald H.

AU - Silva, Andrea P.

AU - Singh, Jasvinder A.

AU - Skirbekk, Vegard

AU - Sliwa, Karen

AU - Soshnikov, Sergey S.

AU - Sposato, Luciano A.

AU - Sreeramareddy, Chandrashekhar T.

AU - Stroumpoulis, Konstantinos

AU - Sturua, Lela

AU - Sykes, Bryan L.

AU - Tabb, Karen M.

AU - Talongwa, Roberto Tchio

AU - Tan, Feng

AU - Teixeira, Carolina Maria

AU - Tenkorang, Eric Yeboah

AU - Terkawi, Abdullah Sulieman

AU - Thorne-Lyman, Andrew L.

AU - Tirschwell, David L.

AU - Towbin, Jeffrey A.

AU - Tran, Bach X.

AU - Tsilimbaris, Miltiadis

AU - Uchendu, Uche S.

AU - Ukwaja, Kingsley N.

AU - Undurraga, Eduardo A.

AU - Uzun, Selen Begüm

AU - Vallely, Andrew J.

AU - Van Gool, Coen H.

AU - Vasankari, Tommi J.

AU - Vavilala, Monica S.

AU - Venketasubramanian, N.

AU - Villalpando, Salvador

AU - Violante, Francesco S.

AU - Vlassov, Vasiliy Victorovich

AU - Vos, Theo

AU - Waller, Stephen

AU - Wang, Haidong

AU - Wang, Linhong

AU - Wang, Xiao Rong

AU - Wang, Yanping

AU - Weichenthal, Scott

AU - Weiderpass, Elisabete

AU - Weintraub, Robert G.

AU - Westerman, Ronny

AU - Wilkinson, James D.

AU - Woldeyohannes, Solomon Meseret

AU - Wong, John Q.

AU - Wordofa, Muluemebet Abera

AU - Xu, Gelin

AU - Yang, Yang C.

AU - Yano, Yuichiro

AU - Yentur, Gokalp Kadri

AU - Yip, Paul

AU - Yonemoto, Naohiro

AU - Yoon, Seok Jun

AU - Younis, Mustafa Z.

AU - Yu, Chuanhua

AU - Jin, Kim Yun

AU - El Sayed Zaki, Maysaa

AU - Zhao, Yong

AU - Zheng, Yingfeng

AU - Zhou, Maigeng

AU - Zhu, Jun

AU - Zou, Xiao Nong

AU - Lopez, Alan D.

AU - Naghavi, Mohsen

AU - Murray, Christopher J.L.

AU - Lozano, Rafael

PY - 2014/9/22

Y1 - 2014/9/22

N2 - Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.

AB - Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.

UR - http://www.scopus.com/inward/record.url?scp=84907272570&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907272570&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(14)60696-6

DO - 10.1016/S0140-6736(14)60696-6

M3 - Article

C2 - 24797575

AN - SCOPUS:84907272570

VL - 384

SP - 980

EP - 1004

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9947

ER -