Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
Lancet. 2010 May 8;375(9726):1609-23. doi: 10.1016/S0140-6736(10)60518-1. Epub 2010 Apr 9.
Maternal mortality remains a major challenge to health systems worldwide. Reliable information about the rates and trends in maternal mortality is essential for resource mobilisation, and for planning and assessment of progress towards Millennium Development Goal 5 (MDG 5), the target for which is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. We assessed levels and trends in maternal mortality for 181 countries.
We constructed a database of 2651 observations of maternal mortality for 181 countries for 1980-2008, from vital registration data, censuses, surveys, and verbal autopsy studies. We used robust analytical methods to generate estimates of maternal deaths and the MMR for each year between 1980 and 2008. We explored the sensitivity of our data to model specification and show the out-of-sample predictive validity of our methods.
We estimated that there were 342,900 (uncertainty interval 302,100-394,300) maternal deaths worldwide in 2008, down from 526,300 (446,400-629,600) in 1980. The global MMR decreased from 422 (358-505) in 1980 to 320 (272-388) in 1990, and was 251 (221-289) per 100,000 livebirths in 2008. The yearly rate of decline of the global MMR since 1990 was 1.3% (1.0-1.5). During 1990-2008, rates of yearly decline in the MMR varied between countries, from 8.8% (8.7-14.1) in the Maldives to an increase of 5.5% (5.2-5.6) in Zimbabwe. More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo). In the absence of HIV, there would have been 281 500 (243,900-327,900) maternal deaths worldwide in 2008.
Substantial, albeit varied, progress has been made towards MDG 5. Although only 23 countries are on track to achieve a 75% decrease in MMR by 2015, countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress.
Bill & Melinda Gates Foundation.
孕产妇死亡率仍然是全球卫生系统面临的主要挑战。可靠的孕产妇死亡率数据对于资源动员以及千年发展目标 5（MDG 5）的规划和评估至关重要，MDG 5 的目标是将 1990 年至 2015 年期间的孕产妇死亡率降低 75%。我们评估了 181 个国家的孕产妇死亡率水平和趋势。
我们从 1980 年至 2008 年期间的 181 个国家的生命登记数据、人口普查、调查和死因推断研究中构建了一个包含 2651 个孕产妇死亡观察值的数据库。我们使用稳健的分析方法来生成每年的孕产妇死亡人数和孕产妇死亡率估计值。我们探讨了我们的数据对模型规范的敏感性，并展示了我们方法的样本外预测有效性。
我们估计，2008 年全球有 342900 名（95%置信区间为 302100-394300）孕产妇死亡，而 1980 年为 526300（446400-629600）。全球孕产妇死亡率从 1980 年的 422（358-505）降至 1990 年的 320（272-388），2008 年每 100000 例活产的孕产妇死亡率为 251（221-289）。自 1990 年以来，全球孕产妇死亡率的年下降率为 1.3%（1.0-1.5）。1990 年至 2008 年期间，各国的孕产妇死亡率年下降率有所不同，马尔代夫为 8.8%（8.7-14.1），津巴布韦则略有上升，为 5.5%（5.2-5.6）。2008 年，全球超过 50%的孕产妇死亡发生在 6 个国家（印度、尼日利亚、巴基斯坦、阿富汗、埃塞俄比亚和刚果民主共和国）。如果没有艾滋病毒，2008 年全球将有 281500 名（243900-327900）孕产妇死亡。
在实现千年发展目标 5 方面取得了实质性但存在差异的进展。尽管只有 23 个国家有望在 2015 年前实现孕产妇死亡率降低 75%的目标，但埃及、中国、厄瓜多尔和玻利维亚等国家的进展速度正在加快。
比尔及梅琳达·盖茨基金会。
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