Hill K, AbouZhar C, Wardlaw T
Hopkins Population Center, Johns Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore MD 21205-2179, USA.
Bull World Health Organ. 2001;79(3):182-93.
To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability.
For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age.
On the basis of this exercise, we have obtained a global estimate of 515,000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100,000 live births. The differences, by region, were very great, with over half (273,000 maternal deaths) occurring in Africa (MMRatio: > 1000 per 100,000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100,000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100,000 live births. These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time.
The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes.
运用旨在提高可比性的方法，呈现1995年188个国家、地区和领地的孕产妇死亡率估计值。
对于拥有与孕产妇死亡率测量直接相关数据的国家，可根据所使用数据的性质应用多种调整程序。对于缺乏相关数据的国家，可使用根据被判定质量良好的国家的信息拟合的统计模型进行估计。该模型并非直接估计孕产妇死亡率（MMRatio），而是估计育龄妇女中因孕产妇原因导致的死亡比例。然后，通过将该比例应用于育龄妇女总死亡数的最佳可用数据，得出孕产妇死亡数的估计值。
基于此项工作，我们得出1995年全球孕产妇死亡数估计值为515,000例，全球孕产妇死亡率为每10万例活产397例。各区域之间的差异非常大，超过半数（273,000例孕产妇死亡）发生在非洲（孕产妇死亡率：每10万例>1000例），而欧洲仅有2000例孕产妇死亡（孕产妇死亡率：每10万例28例）。还估计了上下不确定性界限，据此全球孕产妇死亡率不太可能低于每10万例活产234例或高于635例。这些不确定性界限以及国家估计值的界限非常宽泛，因此各国之间的比较必须谨慎进行，且无法就一段时间内的趋势得出有效结论。
因此，孕产妇死亡率是生殖健康的一个不完美指标，因为它难以精确测量。在比较国家间或不同时间段的生殖健康情况以及用于监测和评估目的时，最好使用过程指标。
