Fast track — ArticlesWHO analysis of causes of maternal death: a systematic review
Introduction
The reduction of maternal deaths is a high priority for the international community, especially in view of the increased attention on the Millennium Development Goals.1 Maternal deaths arise from the risks attributable to pregnancy and childbirth as well as from the poor-quality care from health services.2 Effective services to improve overall maternal health need targeted health and social policies that are informed by reliable and valid epidemiological data. A comprehensive summary of the magnitude and distribution of the causes of maternal deaths is critical to inform reproductive health policies and programmes. The most widely referred source that is currently available3 dates back to the 1990s, although its methodology is not clear and it assumes a fixed distribution across all regions. Regional variations are likely to exist, although their magnitude and direction are unknown. A more recent WHO Global Burden of Disease estimate gave a breakdown by cause and region but the methodology and the data sources for cause attribution and regional differences were not reported.4
Systematic reviews are increasingly used to summarise descriptive epidemiological evidence to provide summary estimates for the extent of important public-health problems.5, 6 We undertook a systematic review that aimed to estimate incidence and prevalence of a range of maternal conditions, including maternal mortality and its causes.7 The aim of this study was to ascertain and map the distribution of causes of maternal deaths, to identify data gaps in regional coverage, and to explore the extent to which countries' development status, geographical location, and datasets' methodological features explain variable distribution of causes of deaths.
Section snippets
Methods
Our systematic review followed an a-priori protocol developed with a widely recommended methodology7, 8, 9 to generate a comprehensive, standardised, and reliable evidence summary for conditions contributing to maternal deaths worldwide. This process included the breakdown of causes of maternal deaths and examination of heterogeneity of causes.
Results
The search strategy yielded 64 585 citations for all defined maternal morbidity conditions and maternal mortality, of which 4606 were assessed in full-text form. Of these, 2581 reporting on a range of morbidities or mortality were included in the systematic review. 305 datasets provided information on causes of maternal deaths for 1 or more years or geographical locations (or both), with 1143 datasets (for a particular time or location) potentially eligible for this analysis. Figure 1 shows the
Discussion
As expected, our systematic analysis of the causes of maternal deaths, showed variation both across and within geographical regions. Our findings confirm the prominent role of haemorrhage as a cause of maternal death in developing countries. Hypertensive disorders are among the leading causes of deaths in Latin America and the Caribbean. In developed countries, most deaths are due to other direct causes, mainly complications of anaesthesia and caesarean sections. The contributions of sepsis and
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