A bayesian approach to the global estimation of maternal mortality

Leontine Alkema, Sanqian Zhang, Doris Chou, Alison Gemmill, Ann Beth Moller, Doris Ma Fat, Lale Say, Colin Mathers, Daniel Hogan

Research output: Contribution to journalArticlepeer-review

Abstract

The maternal mortality ratio (MMR) is defined as the number of maternal deaths in a population per 100,000 live births. Country-specific MMR estimates are published on a regular basis by the United Nations Maternal Mortality Estimation Inter-agency Group (UN MMEIG) to track progress in reducing maternal deaths and were used to evaluate regional and national performance related to Millennium Development Goal (MDG) 5, which called for a 75% reduction in the MMR between 1990 and 2015. Until 2014, the UN MMEIG used a multilevel regression model for producing estimates for countries without sufficient data from vital registration systems. While this model worked well in the past to assess MMR levels for countries with limited data, it was deemed unsatisfactory for final MDG 5 reporting for countries where longer time series of observations had become available because, by construction, estimated trends in the MMR were covariate-driven only and did not necessarily track data-driven trends. We developed a Bayesian maternal mortality estimation model, which extends upon the UN MMEIG multilevel regression model. The new model assesses data-driven trends through the inclusion of an ARIMA time series model that captures accelerations and decelerations in the rate of change in the MMR. Varying reporting and data quality issues are accounted for in source-specific data models. The revised model provides data-driven estimates of MMR levels and trends and was used for MDG 5 reporting for all countries.

Original languageEnglish (US)
Pages (from-to)1245-1274
Number of pages30
JournalAnnals of Applied Statistics
Volume11
Issue number3
DOIs
StatePublished - Sep 2017
Externally publishedYes

Keywords

  • ARIMA time series models
  • Bayesian inference
  • Maternal mortality ratio
  • Millennium development goal 5
  • Multilevel regression model
  • UN maternal mortality estimation inter-agency group (UN MMEIG)

ASJC Scopus subject areas

  • Statistics and Probability
  • Modeling and Simulation
  • Statistics, Probability and Uncertainty

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