An ecologic analysis of maternal mortality ratios.

Ecological associations have provided the basis for numerous programs to reduce maternal mortality. The authors argue that indices ecologically associated with maternal mortality ratios are highly intercorrelated and do not necessarily indicate that improving one aspect of the health system such as the skills of delivery attendants will in fact reduce maternal deaths. In 1993 they conducted an ecologic analysis of the correlates of maternal mortality from the data published by UN Childrens Fund in 1999 from 84 countries in order to evaluate the potential of promising interventions. Variables such as receipt of antenatal care tetanus toxoid immunization contraceptive prevalence adult literacy skilled attendant at delivery and institutional delivery were included in the analysis. A backward stepwise linear and fitted regression analyses for contraceptive prevalence and institutional deliveries using these variables to predict the maternal mortality ratio (MMR) was conducted. Overall results noted that MMR was inversely proportional with the variables included in the analyses. With the exception of tetanus toxoid for immunization it is noted that all the remaining variables were positively associated with one another. Moreover the study indicated that lower national MMRs were associated with skilled attendant at delivery and high contraceptive prevalence rates. Based on the results the authors argue that ecological indices associated with MMR are highly intercorrelated and do not necessarily indicate that the improvement of one aspect of the health system can reduce maternal mortality.

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