Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

作者：Imran Ahmed, Said Mohammed Ali, Seeba Amenga‐Etego, Shabina Ariff, Rajiv Bahl, Abdullah Hel Baqui, Nazma Begum, Nita Bhandari, Kiran Bhatia, Zulfiqar Ahmed Bhutta, Godfrey Biemba, Saikat Sovan Deb, Usha Dhingra, Brinda Dube, Arup Dutta, Karen Margaret Edmond, Fabian Esamai, Wafaie Wahib Fawzi, Amit Kumar Ghosh, Peter Gisore, Caroline Grogan, Davidson Howes Hamer, Julie M. Herlihy, Lisa S. Hurt, Muhammad Ilyas, Fyezah Jehan, Michel Kalonji, Jasmine Kaur, Rasheda Khanam, BETTY R KIRKWOOD, Aarti Kumar, Alok Kumar, Vishwajeet Kumar, Alexander Ansah Manu, Irene Marete, Honorati Masanja, Sarmila Mazumder, Usma Mehmood, Shambhavi Mishra, Dipak Kumar Mitra, Erick Mlay, Sanjana Brahmawar Mohan, Mamun Ibne Moin, Karim B. Muhammad, Alfa J. Muhihi, Samuel Sathyanesan Newton, Serge Ngaima, Andre Nguwo, Muhammad Imran Nisar, Maureen O’Leary, John Otomba, Pawankumar Patil, Mohammad Abdul Quaiyum, Mohammed Rahman, Sunil Sazawal, Katherine E. A. Semrau, Caitlin S. Shannon, Emily R. Smith, Sajid Bashir Soofi, Seyi Soremekun, Venantius Sunday, Sunita Taneja, Antoinette Kitoto Tshefu, Yaqub Wasan, Kojo Yeboah‐Antwi, Sachiyo Yoshida, Anita K. M. Zaidi · 发表于：The Lancet Global Health · 年份：2018 · DOI：10.1016/s2214-109x(18)30385-1 · 被引用次数：356 · 研究领域：Global Maternal and Child Health、Global Health and Surgery、Maternal and Neonatal Healthcare

BACKGROUND: Modelled mortality estimates have been useful for health programmes in low-income and middle-income countries. However, these estimates are often based on sparse and low-quality data. We aimed to generate high quality data about the burden, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa. METHODS: In this prospective cohort study done in 11 community-based research sites in south Asia and sub-Saharan Africa, between July, 2012, and February, 2016, we conducted population-based surveillance of women of reproductive age (15-49 years) to identify pregnancies, which were followed up to birth and 42 days post partum. We used standard operating procedures, data collection instruments, training, and standardisation to harmonise study implementation across sites. Verbal autopsies were done for deaths of all women of reproductive age, neonatal deaths, and stillbirths. Physicians used standardised methods for cause of death assignment. Site-specific rates and proportions were pooled at the regional level using a meta-analysis approach. FINDINGS: We identified 278 186 pregnancies and 263 563 births across the study sites, with outcomes ascertained for 269 630 (96·9%) pregnancies, including 8761 (3·2%) that ended in miscarriage or abortion. Maternal mortality ratios in sub-Saharan Africa (351 per 100 000 livebirths, 95% CI 168-732) were similar to those in south Asia (336 per 100 000 livebirths, 247-458), with far g...