Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

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Abstract

The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.

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Most cited references 68

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Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

Rafael Lozano, Mohsen Naghavi, Kyle Foreman … (2013)

Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Zulfiqar A Bhutta, Jai K Das, Arjumand Rizvi … (2013)

The Lancet, 382(9890), 452-477

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Generation of political priority for global health initiatives: a framework and case study of maternal mortality.

Jeremy Shiffman, Stephanie Smith (2007)

Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself. We apply this framework to the case of a global initiative to reduce maternal mortality, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's 20th year, 2007, presents opportunities to build political momentum. To generate political priority, advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship.

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Author and article information

Journal

Journal ID (iso-abbrev): Lancet

Title: Lancet (London, England)

Publisher: Elsevier BV

ISSN (Electronic): 1474-547X

ISSN (Print): 0140-6736

Publication date (Electronic): Sep 13 2014

Volume: 384

Issue: 9947

Affiliations

[1 ] Institute for Health Metrics and Evaluation, Seattle, WA, USA; Pediatric Anesthesiology and Pain Medicine, Seattle Children's Hospital, School of Medicine, Seattle, WA, USA. Electronic address: nickjk@uw.edu.

[2 ] Institute for Health Metrics and Evaluation, Seattle, WA, USA.

[3 ] Hacettepe University Institute of Population Studies, Ankara, Turkey.

[4 ] Faculty of Medicine, Cairo University, Cairo, Egypt.

[5 ] School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.

[6 ] University College London, London, UK.

[7 ] Ministry of Health, Gaborone, Botswana.

[8 ] Public Health Promotion Alliance, Osogbp, Nigeria.

[9 ] University of Melbourne, Melbourne, VIC, Australia.

[10 ] Association Ivoirienne Pour Le Bien Etre Familial, Abidjan, Côte d'Ivoire.

[11 ] University of Extremadura, Cáceres, Spain.

[12 ] Institution of Public Health Sciences, Stockholm, Sweden.

[13 ] Makerere University, Kampala, Uganda.

[14 ] Ministry of Health, Muscat, Oman.

[15 ] Debre Markos University, Debre Markos, Amhara, Ethiopia.

[16 ] University of Washington, Seattle, WA, USA.

[17 ] National Guard Health Affairs, Riyadh, Saudi Arabia.

[18 ] University of Oxford, Oxford, UK.

[19 ] School of Public Health, University of Lorraine, Nancy, France.

[20 ] Ministry of Health, Belmopan, Cayo, Belize.

[21 ] Saudi Ministry of Health, Riyadh, Saudi Arabia.

[22 ] Charité Universitätsmedizin Berlin, Berlin, Germany.

[23 ] Spanish Observatory on Drugs, Government Delegation for the National Plan on Drugs, Madrid, Spain; Ministry of Health, Social Services and Equality, Madrid, Spain.

[24 ] Universidad de Cartagena, Cartagena de Indias, Colombia.

[25 ] Albany State University, Albany, GA, USA.

[26 ] Department of Epidemiology, University of Groningen, Groningen, Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.

[27 ] Kurdistan Environmental Health Research Centre, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran.

[28 ] Ministry of Public Health, Beirut, Lebanon.

[29 ] College of Public Health, University of the Philippines Manila, Manila, Philippines.

[30 ] UN Population Fund, Kabul, Afghanistan.

[31 ] Uppsala University, Uppsala, Sweden.

[32 ] Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Belgrade, Serbia.

[33 ] Median, Windsor, ON, Canada.

[34 ] Ministry of Health, Amman, Jordan.

[35 ] Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan.

[36 ] Mashhad University of Medical Sciences, Mashhad, Iran.

[37 ] Ministry Of Health, Wellness, Human Services and Gender Relations, Sans Souci, Castries, Saint Lucia.

[38 ] Public Health Agency of Canada, Toronto, ON, Canada.

[39 ] Sri Ramachandra University, Chennai, India.

[40 ] School of Health Sciences, University of Canterbury, Christchurch, New Zealand.

[41 ] Stanford University, Stanford, CA, USA.

[42 ] Oxford University, Ho Chi Minh City, Vietnam.

[43 ] College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.

[44 ] Madawalabu University, Bale Goba, Oromia, Ethiopia.

[45 ] Yale University, New Haven, CT, USA.

[46 ] King's College London, London, UK.

[47 ] Addis Ababa University, Debre Zeit, Ethiopia.

[48 ] Aga Khan University Medical Centre, Karachi, Pakistan.

[49 ] University of Missouri-Kansas City, Kansas City, MO, USA.

[50 ] General Directorate of Health Research, Ankara, Turkey.

[51 ] World Bank, Washington, DC, USA.

[52 ] University of Arizona, Tucson, AZ, USA.

[53 ] Universidad Autonoma Metropolitana, Mexico City, Mexico.

[54 ] Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia.

[55 ] Universidad Diego Portales, Santiago, Chile.

[56 ] Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency, Madrid, Spain.

[57 ] National Taiwan University, Taipei, Taiwan.

[58 ] National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.

[59 ] Cyprus University of Technology, Limassol, Cyprus.

[60 ] Cedars-Sinai Medical Centre, Los Angeles, CA, USA.

[61 ] University of Salerno, Baronissi, Italy.

[62 ] Centre for International Child Health, Melbourne, VIC, Australia.

[63 ] Mayo Clinic, Rochester, MN, USA.

[64 ] Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.

[65 ] National School of Public Health (ENSP/Fiocruz), Rio de Janeiro, Brazil.

[66 ] Institute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India.

[67 ] Public Health Foundation of India, New Delhi, India.

[68 ] Public Health England, London, UK.

[69 ] School of Medicine, Atlanta, GA, USA.

[70 ] University of New South Wales, Sydney, NSW, Australia.

[71 ] Griffith University, Brisbane, QLD, Australia.

[72 ] University of Auckland, Auckland, New Zealand.

[73 ] Africa Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia.

[74 ] Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

[75 ] University of Peradeniya, Peradeniya, Sri Lanka.

[76 ] Harvard School of Public Health, Boston, MA, USA.

[77 ] University of Cape Town, Cape Town, South Africa.

[78 ] Sydney School of Public Health, NSW, Australia.

[79 ] The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia.

[80 ] Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

[81 ] Non-Communicable Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

[82 ] Departamento de Saúde Pública, ARS Norte IP, Porto, Portugal.

[83 ] Karolinska Institutet, Stockholm, Sweden.

[84 ] Public Health Department, Unidade Local de Saúde de Matosinhos, Porto, Portugal.

[85 ] Federal University of Minas Gerais, Belo Horizonte, Brazil.

[86 ] School of Medicine, Stanford, CA, USA.

[87 ] National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia.

[88 ] Clinique Coopérative de Parakou, Parakou, Borgou, Benin.

[89 ] Public Health Unit of Primary Health Care Group of Almada-Seixal, Almada, Setúbal, Portugal.

[90 ] Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.

[91 ] Monash University, Melbourne, VIC, Australia.

[92 ] University Hospital of Dijon, Dijon, France.

[93 ] Heller School for Social Policy and Management, Waltham, MA, USA.

[94 ] Ministry of Labour, Health and Social Affairs, Tbilisi, Georgia.

[95 ] University of Massachusetts Medical School, Worcester, MA, USA.

[96 ] National Institute of Public Health, Cuernavaca, Mexico.

[97 ] Department of Diabetes Research, National Centre for Global Health and Medicine, Tokyo, Japan.

[98 ] University of Queensland, Brisbane, QLD, Australia.

[99 ] Saint James School of Medicine, Kralendijk, Bonaire, Netherlands.

[100 ] Kanawha Charleston Health Department, Charleston, WV, USA.

[101 ] Fortis Escorts Hospital, Jaipur, India.

[102 ] Arabian Gulf University, Manama, Bahrain.

[103 ] Wayne County Department of Health and Human Services, Detroit, MI, USA.

[104 ] School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.

[105 ] Parnassia Psychiatric Institute, The Hague, Netherlands.

[106 ] Albert Einstein College of Medicine, Bronx, NY, USA.

[107 ] School of Population Health, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia.

[108 ] Birzeit University, Birzeit, Ramallah, Palestine.

[109 ] Brandeis University, Waltham, MA, USA.

[110 ] National Institute for Health Development, Tallinn, Estonia.

[111 ] Graduate School of Medicine, Tokyo, Japan.

[112 ] George Mason University, Fairfax, VA, USA.

[113 ] Ochsner Medical Centre, New Orleans, LA, USA.

[114 ] Graduate School of Public Health, Yonsei University, Seoul, South Korea.

[115 ] Postgraduate Institute of Medical Education and Research, Chandigarh, India.

[116 ] Tianjin Centres for Diseases Control and Prevention, Tianjin, China.

[117 ] Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.

[118 ] National Institute of Public Health, Copenhagen, Denmark.

[119 ] Vanderbilt University, Nashville, TN, USA.

[120 ] Fudan University, Shanghai, China.

[121 ] University of Balamand, Beirut, Lebanon.

[122 ] Helmholtz Centre for Infection Research, Braunschweig, Germany.

[123 ] Malaria and Other Parasitic Diseases Division, Kigali, Rwanda.

[124 ] Oklahoma State University, Tulsa, OK, USA.

[125 ] School of Public Health, Tokyo, Japan.

[126 ] University of California San Francisco, San Francisco, CA, USA.

[127 ] University of São Paulo, São Paulo, Brazil.

[128 ] South African Medical Research Council, Cape Town, South Africa.

[129 ] Jordan University of Science and Technology, Al-Ramtha, Jordan.

[130 ] Supreme Council of Health, Doha, Qatar.

[131 ] Health Services Academy, Islamabad, Pakistan.

[132 ] Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea.

[133 ] Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan.

[134 ] Centre for Community Empowerment, Health Policy and Humanities, National Institute of Health Research and Development, Jakarta, Indonesia.

[135 ] University of Montreal, Montreal, QC, Canada.

[136 ] Rajrajeshwari Medical College and Hospital, Bangalore, India.

[137 ] Arkansas State University, Jonesboro, AR, USA.

[138 ] International Institute for Population Sciences, Mumbai, India.

[139 ] Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, India.

[140 ] Boston Medical Centre, Boston, MA, USA.

[141 ] Fourth View Consulting, Tallinn, Estonia.

[142 ] Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry, University of Adelaide, Adelaide, SA, Australia.

[143 ] Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines.

[144 ] International Agency for the Prevention of Blindness and Vision 2020, Weston, FL, USA.

[145 ] Korea University, Seoul, South Korea.

[146 ] University of Sydney, NSW, Australia.

[147 ] University at Albany, Rensselaer, NY, USA.

[148 ] National Centre for Birth Defects Monitoring of China, Chengdu, China.

[149 ] National Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China.

[150 ] Genentech, South San Francisco, CA, USA.

[151 ] National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China.

[152 ] Chinese Centre for Disease Control and Prevention, Beijing, China.

[153 ] College of Public Health, Taipei, Taiwan.

[154 ] Wayne State University, Miami, FL, USA.

[155 ] University of the East Ramon Magsaysay Memorial Medical Centre, Quezon City, Philippines.

[156 ] National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.

[157 ] Ministry of Health Singapore, Singapore, Singapore.

[158 ] Northern Region Health Administration, Porto, Portugal.

[159 ] Xpharmconsult, Kumasi, Ghana.

[160 ] Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia.

[161 ] University of Zambia, Lusaka, Zambia.

[162 ] Queen Mary University of London, London, UK.

[163 ] University of York, York, UK.

[164 ] Janakpuri Super Specialty Hospital, New Delhi, India.

[165 ] UN Population Fund, Lima, Peru.

[166 ] Pacific Institute for Research and Evaluation, Calverton, MD, USA.

[167 ] University of Ottawa, Ottawa, ON, Canada.

[168 ] University of Papua New Guinea, Port Moresby, Papua New Guinea.

[169 ] Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy.

[170 ] Bureau of International Health Cooperation, Manila City, Philippines.

[171 ] University of North Texas, Denton, TX, USA.

[172 ] Institute for Health Metrics and Evaluation, Seattle, WA, USA; Iran University of Medical Sciences, Department of Community Medicine, Tehran, Iran.

[173 ] National Centre for Child Health and Development, Setagaya, Tokyo, Japan.

[174 ] Philipps-University Marburg, Marburg, Germany.

[175 ] Tokyo Medical and Dental University, Tokyo, Japan.

[176 ] International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.

[177 ] University of KwaZulu-Natal, Durban, South Africa.

[178 ] Ministry of Health Fiji, Suva, Fiji.

[179 ] Suraj Eye Institute, Nagpur, India.

[180 ] School of Public Health, State University of New York, New York, NY, USA.

[181 ] Faculty of Medicine, Fez, Morocco.

[182 ] National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.

[183 ] Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway.

[184 ] Kenya Medical Research Institute Wellcome Trust Programme, Kilifi, Kenya.

[185 ] Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.

[186 ] Aga Khan University, Karachi, Pakistan.

[187 ] University of Bergen, Bergen, Norway.

[188 ] Kyung Hee Unversity, Seoul, South Korea.

[189 ] Teikyo University School of Medicine, Tokyo, Japan.

[190 ] Centre for Healthy Start Initiative, Lagos, Nigeria.

[191 ] Emory University, Atlanta, GA, USA.

[192 ] Lira District Local Government, Lira Municipal Council, Lira, Uganda.

[193 ] Toxicology Unit, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Nigeria.

[194 ] Christian Medical College Ludhiana, Ludhiana, India.

[195 ] Sungkyunkwan University School of Medicine, Suwon, South Korea.

[196 ] Universidad de Cartagena, Cartagena, Colombia.

[197 ] University of Calgary, Calgary, AB, Canada.

[198 ] All India Institute of Medical Sciences (AIIMS), New Delhi, India.

[199 ] WHO, Waigani, Papua New Guinea.

[200 ] London School of Hygiene & Tropical Medicine, London, UK.

[201 ] 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, and ICVS/3B's PT Government Associate Laboratory, Braga Portugal.

[202 ] Flinders University, Adelaide, SA, Australia.

[203 ] Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Sweden.

[204 ] McMaster University, Hamilton, ON, Canada.

[205 ] Erasmus Medical Center, Department of Public Health, Rotterdam, Netherlands.

[206 ] University of Liverpool, Liverpool, UK.

[207 ] University of British Columbia, Vancouver, BC, Canada.

[208 ] College of Pharmacy, Chicago, IL, USA.

[209 ] Contech International, Lahore, Pakistan.

[210 ] Sina Trauma and Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

[211 ] Hamad Medical Corporation, Doha, Qatar.

[212 ] University of Missouri, Columbia, MO, USA.

[213 ] Department of Public Health, University of the Punjab, Lahore, Pakistan.

[214 ] Walden University, Minneapolis, MN, USA.

[215 ] Bhaba Atomic Research Center Hospital, Mumbai, India.

[216 ] MS Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

[217 ] Harvard University, Boston, MA, USA.

[218 ] Marshall University, Huntington, WV, USA.

[219 ] Ministry of Health, Kigali, Rwanda.

[220 ] Federal University of Santa Catarina, Florianópolis, Brazil.

[221 ] University of Alabama at Birmingham, Birmingham, AL, USA.

[222 ] Stellenbosch University, Cape Town, South Africa.

[223 ] Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

[224 ] University of Tokyo, Tokyo, Japan.

[225 ] Health Canada, Ottawa, ON, Canada.

[226 ] Heriot-Watt University, Edinburgh, UK.

[227 ] Reykjavik University, Reykjavik, Iceland.

[228 ] University of Pennsylvania, Philadelphia, PA, USA.

[229 ] Instituto Nacional de Epidemiología Dr Juan H Jara, Mar del Plata, Buenos Aires, Argentina.

[230 ] Norwegian Institute of Public Health, Oslo, Norway.

[231 ] Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Cape Town, South Africa.

[232 ] Federal Research Institute for Health Organisation and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia.

[233 ] Department of Clinical Neurological Sciences, Western University, London, ON, Canada.

[234 ] University Tunku Abdul Rahman, Kajang, Malaysia.

[235 ] Hellenic Centre for Disease Control and Prevention (KEELPNO) Greece, Athens, Greece.

[236 ] Department of Criminology, Law and Society (and Sociology), University of California Irvine, Irvine, CA, USA.

[237 ] University of Illinois, Chicago, IL, USA.

[238 ] Ministry of Public Health, Yaounde, Cameroon.

[239 ] National Institute of Occupational Health and Poison Control, Beijing, China.

[240 ] Memorial University, St John's, NL, Canada.

[241 ] Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.

[242 ] The Earth Institute, Columbia University, New York, NY, USA.

[243 ] Department of Neurology, Seattle, WA, USA.

[244 ] Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA.

[245 ] Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

[246 ] Department of Medicine, University of Crete, Heraklion, Greece.

[247 ] Department of Veterans Affairs, Washington, DC, USA.

[248 ] Department of Internal Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Nigeria.

[249 ] Ministry of Health, Ankara, Turkey.

[250 ] The Kirby Institute, Sydney, NSW, Australia.

[251 ] National Institute for Public Health and the Environment, Bilthoven, Netherlands.

[252 ] UKK Institute for Health Promotion Research, Tampere, Finland.

[253 ] Neuroscience Centre, Raffles Hospital, Singapore.

[254 ] University of Bologna, Bologna, Italy.

[255 ] Higher School of Economics, Moscow, Russia.

[256 ] Uniformed Services University of Health Sciences, Bethesda, MD, USA.

[257 ] Shandong University Affiliated Jinan Central Hospital, Jinan, China.

[258 ] Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.

[259 ] University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.

[260 ] University of Miami, Miami, FL, USA.

[261 ] Institute of Public Health, University of Gondar, Gondar, Ethiopia.

[262 ] Ateneo School of Medicine and Public Health, City of Pasig, Manila, Philippines.

[263 ] Jimma University, Jimma, Ethiopia.

[264 ] Nanjing University School of Medicine, Jinling Hospital, Nanjing, China.

[265 ] University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

[266 ] Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.

[267 ] University of Hong Kong, Hong Kong Special Administrative Region, China.

[268 ] National Centre of Neurology and Psychiatry, Kodaira, Japan.

[269 ] Jackson State University, Jackson, MS, USA.

[270 ] Department of Epidemiology and Biostatistics, Global Health Institute, School of Public Health, Wuhan University, Wuhan, China.

[271 ] TCM Medical Tk, Nusajaya, Johor Bahru, Malaysia.

[272 ] Mansoura Faculty of Medicine, Mansoura, Egypt.

[273 ] Chongqing Medical University, Chongqing, China.

[274 ] Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China.

[275 ] Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China.

[276 ] Institute for Health Metrics and Evaluation, Seattle, WA, USA; National Institute of Public Health, Cuernavaca, Mexico.

Article

Mid ID: EMS60028 Publisher Item ID: S0140-6736(14)60696-6

DOI: 10.1016/S0140-6736(14)60696-6

PMC ID: 4255481

PubMed ID: 24797575

SO-VID: 82aecd0d-27ec-4931-8725-fd47560f0e66

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Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

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Most cited references 68

Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Generation of political priority for global health initiatives: a framework and case study of maternal mortality.

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