International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Harvard Center for Population and Development Studies, Cambridge, MA, USA.
Lancet. 2014 Oct 11;384(9951):1366-74. doi: 10.1016/S0140-6736(14)60955-7. Epub 2014 Jun 29.
Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.
We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression.
The MMR fell from 322 deaths per 100,000 livebirths (95% CI 253-391) in 1998-2001 to 194 deaths per 100,000 livebirths (149-238) in 2007-10, an annual rate of decrease of 5·6%. This decrease rate is slightly higher than that required (5·5%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal death.
The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This finding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in Bangladesh.
United States Agency for International Development, UK Department for International Development, Bill & Melinda Gates Foundation.
孟加拉国是仅有的九个有望在 2015 年实现千年发展目标 5 主要目标的倒计时国家之一。它也是唯一一个拥有两个大型、全国性、高质量家庭调查的低收入或中等收入国家，这些调查侧重于衡量产妇死亡率和服务利用情况。
我们使用来自 2001 年和 2010 年孟加拉国产妇死亡率调查的数据来衡量产妇死亡率比（MMR）的变化，并使用这些数据以及六个孟加拉国人口与健康调查来衡量可能与这种变化相关的因素的变化。我们使用泊松回归估计两次调查之间产妇死亡风险的变化。
1998-2001 年，MMR 从每 10 万活产 322 例死亡（95%CI 253-391）降至 2007-10 年的每 10 万活产 194 例死亡（149-238），年下降率为 5.6%。这一下降速度略高于实现 1990 年至 2015 年千年发展目标所需的速度（5.5%）。这一降幅主要归因于获得和利用卫生设施的机会增加，导致死亡率风险降低。此外，在此期间还发生了一些有利的变化：生育率下降，与母亲风险较高相关的分娩比例下降；人均收入大幅增加，贫困率下降；育龄妇女的教育水平大幅提高。我们估计，由于生育率和产妇死亡风险的下降，2010 年因 2001 年的死亡率而发生的 52%的产妇死亡得以避免。
孟加拉国 MMR 的下降似乎是卫生部门内外因素共同作用的结果。这一发现为其他国家提供了重要的经验教训，因为世界正在讨论和决定千年发展目标之后的目标和战略。对于孟加拉国来说，这种案例研究为在追求更广泛的发展议程的同时，增加和加速投资于改善获得和改善公共和私人医疗保健设施提供产妇保健提供了强有力的理由。
美国国际开发署、英国国际发展部、比尔及梅琳达·盖茨基金会。
