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Maternal mortality: a cross-sectional study in global health

BACKGROUND: Although most of maternal deaths are preventable, maternal mortality reduction programs have not been completely successful. As targeting individuals alone does not seem to be an effective strategy to reduce maternal mortality (Millennium Development Goal 5), the present study sought to...

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Autores principales: Sajedinejad, Sima, Majdzadeh, Reza, Vedadhir, AbouAli, Tabatabaei, Mahmoud Ghazi, Mohammad, Kazem
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353673/
https://www.ncbi.nlm.nih.gov/pubmed/25889910
http://dx.doi.org/10.1186/s12992-015-0087-y
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author Sajedinejad, Sima
Majdzadeh, Reza
Vedadhir, AbouAli
Tabatabaei, Mahmoud Ghazi
Mohammad, Kazem
author_facet Sajedinejad, Sima
Majdzadeh, Reza
Vedadhir, AbouAli
Tabatabaei, Mahmoud Ghazi
Mohammad, Kazem
author_sort Sajedinejad, Sima
collection PubMed
description BACKGROUND: Although most of maternal deaths are preventable, maternal mortality reduction programs have not been completely successful. As targeting individuals alone does not seem to be an effective strategy to reduce maternal mortality (Millennium Development Goal 5), the present study sought to reveal the role of many distant macrostructural factors affecting maternal mortality at the global level. METHODS: After preparing a global dataset, 439 indicators were selected from nearly 1800 indicators based on their relevance and the application of proper inclusion and exclusion criteria. Then Pearson correlation coefficients were computed to assess the relationship between these indicators and maternal mortality. Only indicators with statistically significant correlation more than 0.2, and missing values less than 20% were maintained. Due to the high multicollinearity among the remaining indicators, after missing values analysis and imputation, factor analysis was performed with principal component analysis as the method of extraction. Ten factors were finally extracted and entered into a multiple regression analysis. RESULTS: The findings of this study not only consolidated the results of earlier studies about maternal mortality, but also added new evidence. Education (std. B = −0.442), private sector and trade (std. B = −0.316), and governance (std. B = −0.280) were found to be the most important macrostructural factors associated with maternal mortality. Employment and labor structure, economic policy and debt, agriculture and food production, private sector infrastructure investment, and health finance were also some other critical factors. These distal factors explained about 65% of the variability in maternal mortality between different countries. CONCLUSION: Decreasing maternal mortality requires dealing with various factors other than individual determinants including political will, reallocation of national resources (especially health resources) in the governmental sector, education, attention to the expansion of the private sector trade and improving spectrums of governance. In other words, sustainable reduction in maternal mortality (as a development indicator) will depend on long-term planning for multi-faceted development. Moreover, trade, debt, political stability, and strength of legal rights can be affected by elements outside the borders of countries and global determinants. These findings are believed to be beneficial for sustainable development in Post-2015 Development Agenda. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12992-015-0087-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-43536732015-03-10 Maternal mortality: a cross-sectional study in global health Sajedinejad, Sima Majdzadeh, Reza Vedadhir, AbouAli Tabatabaei, Mahmoud Ghazi Mohammad, Kazem Global Health Research BACKGROUND: Although most of maternal deaths are preventable, maternal mortality reduction programs have not been completely successful. As targeting individuals alone does not seem to be an effective strategy to reduce maternal mortality (Millennium Development Goal 5), the present study sought to reveal the role of many distant macrostructural factors affecting maternal mortality at the global level. METHODS: After preparing a global dataset, 439 indicators were selected from nearly 1800 indicators based on their relevance and the application of proper inclusion and exclusion criteria. Then Pearson correlation coefficients were computed to assess the relationship between these indicators and maternal mortality. Only indicators with statistically significant correlation more than 0.2, and missing values less than 20% were maintained. Due to the high multicollinearity among the remaining indicators, after missing values analysis and imputation, factor analysis was performed with principal component analysis as the method of extraction. Ten factors were finally extracted and entered into a multiple regression analysis. RESULTS: The findings of this study not only consolidated the results of earlier studies about maternal mortality, but also added new evidence. Education (std. B = −0.442), private sector and trade (std. B = −0.316), and governance (std. B = −0.280) were found to be the most important macrostructural factors associated with maternal mortality. Employment and labor structure, economic policy and debt, agriculture and food production, private sector infrastructure investment, and health finance were also some other critical factors. These distal factors explained about 65% of the variability in maternal mortality between different countries. CONCLUSION: Decreasing maternal mortality requires dealing with various factors other than individual determinants including political will, reallocation of national resources (especially health resources) in the governmental sector, education, attention to the expansion of the private sector trade and improving spectrums of governance. In other words, sustainable reduction in maternal mortality (as a development indicator) will depend on long-term planning for multi-faceted development. Moreover, trade, debt, political stability, and strength of legal rights can be affected by elements outside the borders of countries and global determinants. These findings are believed to be beneficial for sustainable development in Post-2015 Development Agenda. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12992-015-0087-y) contains supplementary material, which is available to authorized users. BioMed Central 2015-02-12 /pmc/articles/PMC4353673/ /pubmed/25889910 http://dx.doi.org/10.1186/s12992-015-0087-y Text en © Sajedinejad et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Sajedinejad, Sima
Majdzadeh, Reza
Vedadhir, AbouAli
Tabatabaei, Mahmoud Ghazi
Mohammad, Kazem
Maternal mortality: a cross-sectional study in global health
title Maternal mortality: a cross-sectional study in global health
title_full Maternal mortality: a cross-sectional study in global health
title_fullStr Maternal mortality: a cross-sectional study in global health
title_full_unstemmed Maternal mortality: a cross-sectional study in global health
title_short Maternal mortality: a cross-sectional study in global health
title_sort maternal mortality: a cross-sectional study in global health
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353673/
https://www.ncbi.nlm.nih.gov/pubmed/25889910
http://dx.doi.org/10.1186/s12992-015-0087-y
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