Optimal Profile Limits for Maternal Mortality Rates (MMR) Influenced by Haemorrhage and Unsafe Abortion in South Sudan.

IF 3.2 Q1 OBSTETRICS & GYNECOLOGY
Journal of Pregnancy Pub Date : 2020-05-28 eCollection Date: 2020-01-01 DOI:10.1155/2020/2793960
Gabriel Makuei, Mali Abdollahian, Kaye Marion
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引用次数: 7

Abstract

Maternal mortality rate (MMR) is one of the main worldwide public health challenges. Presently, the high levels of MMR are a common problem in the world public health and especially, in developing countries. Half of these maternal deaths occur in Sub-Saharan Africa where little or nothing progress has been made. South Sudan is one of the developing countries which has the highest MMR. Thus, this paper deploys statistical analysis to identify the significant physiological causes of MMR in South Sudan. Prediction models based on Poisson Regression are then developed to predict MMR in terms of the significant physiological causes. Coefficients of determination and variance inflation factor are deployed to assess the influence of the individual causes on MMR. Efficacy of the models is assessed by analyzing their prediction errors. The paper for the first time has used optimization procedures to develop yearly lower and upper profile limits for MMR. Hemorrhaging and unsafe abortion are used to achieve UN 2030 lower and upper MMR targets. The statistical analysis indicates that reducing haemorrhaging by 1.91% per year would reduce MMR by 1.91% (95% CI (42.85-52.53)), reducing unsafe abortion by 0.49% per year would reduce MMR by 0.49% (95% CI (11.06-13.56)). The results indicate that the most influential predictors of MMR are; hemorrhaging (38%), sepsis (11.5%), obstructed labour (11.5%), unsafe abortion (10%), and indirect causes such as anaemia, malaria, and HIV/AIDs virus (29%). The results also show that to obtain the UN recommended MMR levels of minimum 21 and maximum 42 by 2030, the Government and other stakeholders should simultaneously, reduce haemorrhaging from the current value of 62 to 33.38 and 16.69, reduce unsafe abortion from the current value of 16 to 8.62 and 4.31. Thirty years of data is used to develop the optimal reduced Poisson Model based on hemorrhaging and unsafe abortion. The model with R 2 of 92.68% can predict MMR with mean error of -0.42329 and SE-mean of 0.02268. The yearly optimal level of hemorrhage, unsafe abortion, and MMR can aid the government and other stakeholders on resources allocation to reduce the risk of maternal death.

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南苏丹受出血和不安全堕胎影响的产妇死亡率(MMR)的最佳剖面限制
产妇死亡率(MMR)是世界范围内主要的公共卫生挑战之一。目前,高水平的MMR是世界公共卫生的一个共同问题,特别是在发展中国家。这些产妇死亡中有一半发生在撒哈拉以南非洲,那里几乎没有取得任何进展。南苏丹是孕产妇死亡率最高的发展中国家之一。因此,本文采用统计分析来确定南苏丹MMR的重要生理原因。然后,基于泊松回归的预测模型被开发用于根据显著生理原因预测MMR。采用决定系数和方差膨胀系数来评估个体原因对MMR的影响。通过分析模型的预测误差来评价模型的有效性。本文首次采用优化程序制定了MMR的年上剖面下限。出血流产和不安全流产用于实现联合国2030年孕产妇死亡率低和高目标。统计分析表明,每年减少出血1.91%可使产妇死亡率降低1.91% (95% CI(42.85 ~ 52.53)),每年减少不安全流产0.49%可使产妇死亡率降低0.49% (95% CI(11.06 ~ 13.56))。结果表明,对MMR影响最大的预测因子有;出血(38%)、败血症(11.5%)、难产(11.5%)、不安全流产(10%)以及间接原因,如贫血、疟疾和艾滋病毒/艾滋病(29%)。结果还表明,为了到2030年达到联合国建议的最低21和最高42的产妇死亡率水平,政府和其他利益攸关方应同时将大出血从目前的62减少到33.38和16.69,将不安全堕胎从目前的16减少到8.62和4.31。利用30年的数据,建立了基于出血和不安全流产的最优简化泊松模型。r2为92.68%的模型预测MMR的平均误差为-0.42329,SE-mean为0.02268。每年出血、不安全堕胎和产妇死亡率的最佳水平可以帮助政府和其他利益攸关方分配资源,以降低孕产妇死亡风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pregnancy
Journal of Pregnancy OBSTETRICS & GYNECOLOGY-
CiteScore
6.10
自引率
0.00%
发文量
15
审稿时长
14 weeks
期刊介绍: Journal of Pregnancy is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to all aspects of pregnancy and childbirth. The journal welcomes submissions on breastfeeding, labor, maternal health and the biomedical aspects of pregnancy.
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