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[afro-nets] Trends in maternal mortality: 1990 to 2008 - Estimates developed by WHO, UNICEF, UNFPA and The World Bank (2)
- From: "Ikuo Takizawa." <Takizawa.Ikuo@jica.go.jp>
- Date: Mon, 27 Sep 2010 16:45:30 +0900
Owing to the UN Millennium Summit, health indicators such as maternal mortality and child mortality are now center of attention. As a public health practitioner, I appreciate the commitment of the global leaders, including our own (linked below), in mobilizing resources for the health of mothers and children, even though we need continued advocacy and monitoring.
While we are all concerned about the numbers to tell us where we are in the achievement of MDGs, it seems we have two different sets of trend estimate for both maternal mortality and child mortality, i.e., the one by inter-agency group of international organizations and another set by Institute for Health Metrics and Evaluation (IHME), the University of Washington.
It is a good news for the world that both estimates are in agreement in important aspects. Both indicate that there is an acceleration of child mortality decline in 2000s compared to the previous decade. Both suggest that maternal mortality is likely to be in decline since 1990 unlike previous estimates. Sub-Saharan Africa is not an exception.
However, when you look at the trend estimates for individual countries, there are several important disagreements. Some examples;
- Countdown to 2010 Group classifies countries which achieved annual reduction of 4% or more in under five mortality rate since 1990 (or countries with the latest under five mortality of less than 40 per 1,000 live births) as "On Track" for achieving MDG4. If you apply the criteria to the inter-agency group estimate, Eritrea, Malawi, Cape Verde, Botswana, Mauritius and the Seychelles are classified as On Track in Sub-Saharan Africa, as of 2008. On the other hand, if we use the IHME estimate, Liberia, Madagascar, Mauritius and Cape Verde will be the ones On Track (the estimate for the Seychelles is not provided in IHME estimate), as of 2010.
- Annual rate of reduction in maternal mortality of 5.5% or more is needed to achieve MDG5. According to the inter-agency group estimate, Equatorial Guinea and Eritrea are the only two countries on track in Sub-Saharan Africa, while it is Cape Verde only if we use the IHME estimate, both as of 2008.
I fully understand estimating mortality trend at country level is not an easy task and both groups are trying hard to come up with the best possible estimate. We should not interpret these numbers with too rigid precision because of statistical errors and wide intervals, especially for MMR. I also appreciate that having different expert groups working on the same numbers will contribute to better understanding of the issue and refinement of the methodology.
However, most of the public health practitioners like mysel are "information takers" rather than "information makers". We need to rely on the works of those experts who are dedicated to the production of these numbers. Having two sets of "best estimate" for the same numbers leads us into confusion.
How are the information makers going to deal with this situation? Do we expect to have another set of "best" estimate in near future consolidating the two?
Ikuo TAKIZAWA, MSc.
Regional Project Formulation Advisor for Health
Regional Strategy Unit for Africa (Nairobi)
Japan International Cooperation Agency (JICA)