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An Appraisal of the Maternal Mortality Decline in Nepal 英文参考文献
AnAppraisaloftheMaternalMortalityDeclineinNepal
JuliaHussein1*,JacquelineBell1,MaureenDarIang2,NatashaMesko3,JennyAmery4,WendyGraham1
1Immpact,UniversityofAberdeen,Aberdeen,Scotland,2UnitedMissiontoNepal,Kathmandu,Nepal,3DepartmentforInternationalDevelopmentNepal,Kathmandu,
Nepal,4DepartmentforInternationalDevelopmentLondon,London,UnitedKingdom
Abstract
Background: A decline in the national maternal mortality ratio in Nepal has been observed from surveys conducted
between1996and2008.Thispaperaimstoassesstheplausibilityofthedeclineandtoidentifydriversofchange.
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
districtswereidentifiedbyregressingdistrict-levelindicatorsfromtheNepaldemographichealthsurveysagainstmaternal
mortalityestimates.
Results:Astatisticallysignificantdeclineofthematernalmortalityratiofrom539maternaldeathsto281per100,000(95%
CI91,507)livebirthsbetween1993and2003wasdemonstrated.Thesub-nationalchangesareofsimilarmagnitudeand
direction to those observed nationally, and in the terai region (plains) the differences are statistically significant with a
reductionof361per100,000livebirths(95%CI36,686)duringthesametimeperiod. Thereductioninfertility,changesin
education and wealth, improvements in components of the human development index, gender empowerment and
anaemiaeachexplainedmorethan10%ofthedistrictvariationinmaternalmortality.Anumberoflimitationsineachofthe
datasourcesusedwereidentified.Ofthese,themostimportantrelatetotheunderestimationofnumbersofdeaths.
Conclusion:It islikelythattherehasbeenadeclineinNepal’s maternalmortality since1993. Thisisgoodnews forthe
country’s sustained commitments in this area. Conclusions on the magnitude, pattern of the change and drivers of the
declineareconstrainedbylackofdata.Werecommendclosetrackingofmaternalmortalityand
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