An appraisal of the maternal mortality decline in Nepal

Julia Hussein, Jacqueline Bell, Maureen Dar Iang, Natasha Mesko, Jenny Amery, Wendy Graham

Research output: Contribution to journalArticle

30 Citations (Scopus)
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Abstract

Background

A decline in the national maternal mortality ratio in Nepal has been observed from surveys conducted between 1996 and 2008. This paper aims to assess the plausibility of the decline and to identify drivers of change.

Methods

National and sub-national trends in mortality data were investigated using existing demographic and health surveys and maternal mortality and morbidity surveys. Potential drivers of the variation in maternal mortality between districts were identified by regressing district-level indicators from the Nepal demographic health surveys against maternal mortality estimates.

Results

A statistically significant decline of the maternal mortality ratio from 539 maternal deaths to 281 per 100,000 (95% CI 91,507) live births between 1993 and 2003 was demonstrated. The sub-national changes are of similar magnitude and direction to those observed nationally, and in the terai region (plains) the differences are statistically significant with a reduction of 361 per 100,000 live births (95% CI 36,686) during the same time period.

The reduction in fertility, changes in education and wealth, improvements in components of the human development index, gender empowerment and anaemia each explained more than 10% of the district variation in maternal mortality. A number of limitations in each of the data sources used were identified. Of these, the most important relate to the underestimation of numbers of deaths.

Conclusion

It is likely that there has been a decline in Nepal's maternal mortality since 1993. This is good news for the country's sustained commitments in this area. Conclusions on the magnitude, pattern of the change and drivers of the decline are constrained by lack of data. We recommend close tracking of maternal mortality and its determinants in Nepal, attention to the communication of future estimates, and various options for bridging data gaps.
Original languageEnglish
Article numbere19898
Number of pages10
JournalPloS ONE
Volume6
Issue number5
DOIs
Publication statusPublished - 26 May 2011

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Nepal
Maternal Mortality
economic valuation
Mortality
Education
Communication
Live Birth
Demography
demographic statistics
Maternal Death
death
Health Surveys
Information Storage and Retrieval
Human Development
human development
communication (human)
Fertility
Anemia
anemia
morbidity

Cite this

Hussein, J., Bell, J., Dar Iang, M., Mesko, N., Amery, J., & Graham, W. (2011). An appraisal of the maternal mortality decline in Nepal. PloS ONE, 6(5), [e19898]. https://doi.org/10.1371/journal.pone.0019898

An appraisal of the maternal mortality decline in Nepal. / Hussein, Julia; Bell, Jacqueline; Dar Iang, Maureen ; Mesko, Natasha ; Amery, Jenny ; Graham, Wendy.

In: PloS ONE, Vol. 6, No. 5, e19898, 26.05.2011.

Research output: Contribution to journalArticle

Hussein, J, Bell, J, Dar Iang, M, Mesko, N, Amery, J & Graham, W 2011, 'An appraisal of the maternal mortality decline in Nepal', PloS ONE, vol. 6, no. 5, e19898. https://doi.org/10.1371/journal.pone.0019898
Hussein J, Bell J, Dar Iang M, Mesko N, Amery J, Graham W. An appraisal of the maternal mortality decline in Nepal. PloS ONE. 2011 May 26;6(5). e19898. https://doi.org/10.1371/journal.pone.0019898
Hussein, Julia ; Bell, Jacqueline ; Dar Iang, Maureen ; Mesko, Natasha ; Amery, Jenny ; Graham, Wendy. / An appraisal of the maternal mortality decline in Nepal. In: PloS ONE. 2011 ; Vol. 6, No. 5.
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