Foetal and maternal mortality methods and data

We examined the Demographic and Health Surveys (DHS) data from 31 countries over the last 20 years to estimate the levels and trends of first-day mortality rates considering potential differences in socioeconomic and healthcare factors. The trends in first-day mortality rates and 95% confidence intervals were estimated adjusting for potential clustering effects, comparing three successive DHS held across countries covering sub-Saharan Africa, South and Southeast Asia and Latin America. The findings show that first-day mortality rates varied widely from 21 deaths per 1000 live births in Mali and Ethiopia to about 17 per 1000 in Kenya and Nepal to less than 10 per 1000 in Dominican Republic, Philippines, Jordan and Egypt. The absolute change in the rates between DHS2 and DHS3 were not significant in about 24 countries and the levels were stagnantly high or increased in about 8 countries. First-day mortality increased consistently in Zimbabwe, Zambia, Senegal, Cambodia and Philippines. A negative linear relationship was found between skilled birth attendance, per-capita income and first-day mortality rates whereas a negative curvilinear relationship was observed between years of maternal schooling and first-day mortality rates. In countries where there is high medical intervention in births had relatively low first-day mortality.

One of the Millenium Development Goals (MDG5) is to reduce the maternal mortality ratio in all developing countries by 75% between 1990 and 2015. Progress toward this goal has been documented by the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME), using similar models to estimate levels and trends in virtually all countries. The Demographic and Health Surveys (DHS) are the principal source of data for the WHO and IHME models. Approximately 120 DHS surveys have included the maternal mortality module, using the direct sisterhood method; all of those surveys will be included. Estimates of adult mortality are also produced from these data, sometimes including information about brothers of the respondent. This will be the first such assessment since 1997, when only 14 surveys had included the module. Several strategies will be used, including comparisons of the reports from related members of the same household and comparisons across successive surveys in the same country. The paper will include recommendations for interpreting the estimates, will discuss potential adjustments (although DHS will continue to publish only unadjusted estimates) and will describe potential implications for the WHO and IHME models.

Recent studies have pointed out the importance of stillbirth mortality and foetal mortality in general on childhood mortality and other demographic estimates during the demographic transition. Good example of these studies were those carried out by Robert Woods who undertook an analysis of the probability of surviving from conception till delivery, highlighting the importance of this period of life, many times neglected in the analysis in favour of other early mortality estimates, such us neonatal or infant mortality. Most of the models regarding foetal mortality used data from Northern European countries due to their quality and availability. We will show the complexities of modelling foetal mortality using data and examples from other countries especially Southern European countries and Japan, using different datasets, from aggregated data to individual level material. We will try to answer some of the Key questions, such as: What might we expect of the age pattern of foetal and infant mortality in high-mortality populations where life expectancy at birth was less than 40 years? Is it legitimate to estimate the stillbirth rate from “knowledge” of other mortality rates (e.g. early neonatal, endogenous) and, if so, what form of predictive association should be used?