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 Adou & 329 andre José 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 Arnlöv, 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, Uğur 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, XiaoRong 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

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Resumé

    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 different 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.

    OriginalsprogEngelsk
    TidsskriftLancet
    Vol/bind384
    Udgave nummer9947
    Sider (fra-til)980-1004
    ISSN0140-6736
    DOI
    StatusUdgivet - 13 sep. 2014

    Fingeraftryk

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

    Emneord

      Citer dette

      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. Lancet, 384(9947), 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 ; Arnlöv, 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 ; Bin Abdulhak, Aref ; 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, Uğur ; 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 ; Caicedo, Angel J Paternina ; 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, XiaoRong ; 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. I: Lancet. 2014 ; Bind 384, Nr. 9947. s. 980-1004.
      @article{502409157df840ccb53a3af432d06bb9,
      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 different 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.",
      keywords = "Age Distribution, Cause of Death, Female, HIV Infections, Humans, Maternal Mortality, Models, Statistical, Organizational Objectives, Pregnancy, Pregnancy Complications, Infectious, Risk Factors, Socioeconomic Factors, Time Factors, World Health",
      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 Arnl{\"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 {Bin Abdulhak}, Aref 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 Jung-Chen Chang 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 Uğur 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 Seyed-Mohammad Fereshtehnejad 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 Young-Ho Khang 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 Jong-Tae Lee 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 Hsien-Ho Lin 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 In-Hwan Oh 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 Jae-Hyun Park and Caicedo, {Angel J Paternina} 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 XiaoRong Wang 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 Seok-Jun Yoon 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",
      note = "Copyright {\circledC} 2014 Elsevier Ltd. All rights reserved.",
      year = "2014",
      month = "9",
      day = "13",
      doi = "10.1016/S0140-6736(14)60696-6",
      language = "English",
      volume = "384",
      pages = "980--1004",
      journal = "Lancet",
      issn = "0140-6736",
      publisher = "TheLancet Publishing Group",
      number = "9947",

      }

      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, Arnlöv, 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, Bin Abdulhak, A, Blore, JD, Basara, BB, Bose, D, Breitborde, N, Cárdenas, R, Castañeda-Orjuela, CA, Castro, RE, Catalá-López, F, Cavlin, A, Chang, J-C, 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, S-M, 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, Y-H, 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, J-T, Leigh, J, Leinsalu, M, Leung, R, Li, X, Li, Y, Li, Y, Liang, J, Liang, X, Lim, SS, Lin, H-H, 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, I-H, Ohkubo, T, Olusanya, BO, Omer, SB, Opio, JN, Orisakwe, OE, Pandian, JD, Papachristou, C, Park, J-H, Caicedo, AJP, 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, X, 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, S-J, 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' Lancet, bind 384, nr. 9947, s. 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; Arnlöv, 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; Bin Abdulhak, Aref; 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, Uğur; 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; Caicedo, Angel J Paternina; 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, XiaoRong; 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.

      I: Lancet, Bind 384, Nr. 9947, 13.09.2014, s. 980-1004.

      Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

      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 - Arnlöv, 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 - Bin Abdulhak, Aref

      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, Uğur

      AU - Ding, Eric L

      AU - Dorrington, Rob E

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      N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.

      PY - 2014/9/13

      Y1 - 2014/9/13

      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 different 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 different 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.

      KW - Age Distribution

      KW - Cause of Death

      KW - Female

      KW - HIV Infections

      KW - Humans

      KW - Maternal Mortality

      KW - Models, Statistical

      KW - Organizational Objectives

      KW - Pregnancy

      KW - Pregnancy Complications, Infectious

      KW - Risk Factors

      KW - Socioeconomic Factors

      KW - Time Factors

      KW - World Health

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

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

      M3 - Journal article

      VL - 384

      SP - 980

      EP - 1004

      JO - Lancet

      JF - Lancet

      SN - 0140-6736

      IS - 9947

      ER -