School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
The George Institute for Global Health, Imperial College London, London, UK.
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-004233.
Maternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in Africa. We examined the spatial distribution of maternal mortality in Africa and explored the influence of SDoH on the spatial distribution.
We used country-level secondary data of 54 African countries collected between 2006 and 2018 from three databases namely, World Development Indicator, WHO's Global Health Observatory Data and Human Development Report. We performed descriptive analyses, presented in tables and maps. The spatial analysis involved local indicator of spatial autocorrelation maps and spatial regression. Finally, we built Bayesian networks to determine and show the strength of social determinants associated with maternal mortality.
We found that the average prevalence of maternal mortality ratio (MMR) in Africa was 415 per 100 000 live births. Findings from the spatial analyses showed clusters (hotspots) of MMR with seven countries (Guinea-Bissau, Guinea, Sierra Leone, Cote d'Ivoire, Chad and Cameroon, Mauritania), all within the Middle and West Africa. On the other hand, the cold spot clusters were formed by two countries; South Africa and Namibia; eight countries (Algeria, Tunisia, Libya, Ghana, Gabon and Congo, Equatorial Guinea and Cape Verde) formed low-high clusters; thus, indicating that these countries have significantly low MMR but within the neighbourhood of countries with significantly high MMR. The findings from the regression and Bayesian network analysis showed that gender inequities and the proportion of skilled birth attendant are strongest social determinants that drive the variations in maternal mortality across Africa.
Maternal mortality is very high in Africa especially in countries in the middle and western African subregions. To achieve the target 3.1 of the sustainable development goal on maternal health, there is a need to design effective strategies that will address gender inequalities and the shortage of health professionals.
尽管全球做出了多项努力，孕产妇死亡率仍然是一个公共卫生问题。全球范围内，每天约有 830 名妇女死于与妊娠相关的死亡，其中三分之二以上发生在非洲。我们研究了非洲的孕产妇死亡率的空间分布，并探讨了社会决定因素对其空间分布的影响。
我们使用了来自三个数据库（世界发展指标、世界卫生组织全球卫生观察站数据和人类发展报告）的 2006 年至 2018 年期间收集的 54 个非洲国家的国家级二级数据。我们进行了描述性分析，以表格和地图形式呈现。空间分析包括局部空间自相关地图和空间回归。最后，我们构建了贝叶斯网络，以确定和展示与孕产妇死亡率相关的社会决定因素的强度。
我们发现，非洲的孕产妇死亡率平均流行率为每 10 万活产儿 415 例。空间分析结果显示，有七个国家（几内亚比绍、几内亚、塞拉利昂、科特迪瓦、乍得和喀麦隆、毛里塔尼亚）存在孕产妇死亡率的热点集群，这些国家都位于中非和西非地区。另一方面，冷点集群则由两个国家组成；南非和纳米比亚；还有八个国家（阿尔及利亚、突尼斯、利比亚、加纳、加蓬和刚果、赤道几内亚和佛得角）形成了低-高集群；这表明这些国家的孕产妇死亡率明显较低，但周边国家的孕产妇死亡率却很高。回归和贝叶斯网络分析的结果表明，性别不平等和熟练接生员的比例是导致非洲各地孕产妇死亡率差异的最强社会决定因素。
非洲的孕产妇死亡率非常高，特别是在中非和西非次区域的国家。为了实现可持续发展目标 3.1 中关于孕产妇健康的目标，需要制定有效的策略，解决性别不平等和卫生专业人员短缺的问题。
