Magnitude of maternal and neonatal mortality in Tanzania: A systematic review

The researchers wanted to explore the levels of maternal and neonatal mortality across Tanzania, yet the only data commonly available for decision-making and performance monitoring is from facility records which cannot capture the full picture, considering that half of women do not deliver in a facility. The national level maternal mortality ratio (MMR) is an average for the whole country, and hides any variation in maternal mortality across the different regions. The same is true for the neonatal mortality rate (NMR). Geographically disaggregated data is important for understanding the inequities between regions and zones, but the estimates at national level cannot show this level of detail.This study looked at all the available data for maternal and neonatal mortality that had ever been published, through a rigorous method called a 'systematic review', which allowed information from smaller studies to be collected together. The sub national MMR and NMR were plotted and mapped to show the regional spread of the data (where the studies took place), and the different levels of maternal and neonatal mortality across the country over several years. All of the studies were assessed for their risk of bias and potential for providing good or poor quality data.The data were compared with the national estimates available from Demographic and Health Surveys, United Nations and other groups, showing the huge variation between the national MMR and NMR and the local data. The researchers conclude that national level data for maternal and neonatal mortality is less useful for regional decision-makers, yet the sub national mortality data available is usually of quite poor quality, and many regions had no sub national data available. It was also noted that combined reporting of MMR and NMR  was rare, even though the connection between the mother and newborn's survival is well known. These results suggest that quality and useful mortality data can be hard to collect, therefore a move towards process indicators, such as availability of comprehensive emergency obstetric care, is more appropriate for performance monitoring and policy generation, and that vital registration and central data collection systems should be strengthened, to improve progress and accountability for maternal and newborn survival. To read the article for free, click here. No subscription required. Armstrong, C., Magoma, M., & Ronsmans, C. (2015). Magnitude of maternal and neonatal mortality in Tanzania: A systematic review International Journal of Gynecology Obstetrics, (In press corrected proof published online April 24, 2015).