There are lots of ways to describe maternal mortality. But it doesn't matter how you calculate it, as long you count every maternal death. And bring it down.
There are lots of ways to describe maternal mortality. But it doesn't matter how you calculate it, as long you count every maternal death. And bring it down.Every year there are about 7,900 maternal deaths in Tanzania. But this is only meaningful if you know the size of the childbearing population.Maternal mortality ratio (MMR), defined as the number of maternal deaths per every 100,000 live births is high in Tanzania, currently estimated at 454 deaths. The MMR denotes the probability of a woman dying for every 100,000 live births.Maternal mortality can also be expressed as a rate per woman-years of exposure. For Tanzania, this is estimated at 0.8 per 1,000 woman-years of exposure. This describes the risk a woman has of dying from maternal causes, usually taken to start from the age of 15 years to 49 years, i.e. the years she is ‘exposed’ to pregnancy.Reporting maternal mortality as a rate and quoting the 454 figure is thus erroneous as ratio and rate have different meanings.The maternal mortality ratio is the most common way to express the figures.We need the dataCalculation of maternal mortality requires counting all maternal deaths (the numerator) and all live births in a given period (the denominator).The maternal mortality ratio can easily be calculated from vital statistics of birth and deaths if they are available and complete.Unfortunately, in Tanzania like in many other developing countries, such statistics are largely incomplete and we therefore rely on regular surveys.Demographic and health surveys are one kind, which is conducted every four to five years. The last survey in Tanzania was in 2010. Obtaining sub-national figures for regions or districts from such surveys is difficult due to sample size constraints and, often sub-national estimates are based on epidemiological studies or health facility-based data.For health facility data, for instance, only half of Tanzanian women deliver in health facilities and community deaths are rarely reported consistently. Therefore using hospital data has a potential bias of excluding deaths which occur in the community thus underestimating or overestimating the true magnitude of maternal mortality if they are extrapolated to apply for the entire district, region or zone. This is true because neither the numerator (number of all women who die) nor the denominator (all live births) is captured completely.Unfortunately, health facility maternal mortality data are often used by health professionals in the country to calculate district or regional specific maternal mortality ratio and such figures reported widely to imply maternal mortality ratio for the particular district or region.These are health facility maternal deaths and should be referred to as such. If they are assumed to represent district or regional maternal mortality levels, they do not mirror the national average as levels as low as 100 deaths per 100,000 live births are commonly reported! In fact, the true maternal mortality ratio of this magnitude may aggregate to well below the national MDG5 target of 220 deaths per 100,000 live births by 2015.Even for health facility-based maternal mortality, it is important to ensure that all maternal deaths are counted as under-reporting can occur even in health facilities, especially if the deaths occurred in early pregnancy or outside the maternity unit.The public will be better informed if you also admit that what is reported is from health facility data-often an under-estimate of the true level. To capture the true regional or district maternal mortality data requires counting of both health facility and community maternal deaths and calculating and reporting the maternal ratio correctly.Every maternal death counts. Count them all and calculate it right to inform the public correctly. And take action!