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  • Reply to: South Asia’s Quest for Reduced Maternal Mortality: What the Data Show   2 days 6 hours ago
    Dear Rajan,
     
    Thank you for sharing this updated information, which is really critical particularly that it comes from the Nepalese the Central Bureau of Statistics that estimated the country’s maternal mortality ratio at 480 per 100,000 live births, which is far from the UN estimated ratio of 190 per 100,000 live births.   The UN estimate for Nepal has a range with the upper limit of 340 maternal deaths per 10,000 live births!
     
    This latest ratio will imply that the country is far from meeting the MMR target of 134 under the Millennium Development Goals by 2015 after being among the countries on track to achieve it.
     
    Equally interesting is the MMR estimate done by the Institute of Health Metrics at Washington University, which was published in May 2014 in a Lancet article and that put the MMR for Nepal at 272 per 100,000 live births in 2013, which is still higher than that of the UN.  The authors also identified 1, 588 maternal deaths, which is higher than the 1,100 deaths estimated by the UN.
    The large discrepancy between the three estimates reveals the difficulty of measuring maternal mortality, which makes it even harder to track its progress.
     
    Strengthening vital registration and use of systems intelligence to triangulate different sources of data will be key to address such a challenge.
  • Reply to: Is Unemployment Bad for Your Health?   1 week 1 day ago

    Another impacted area is onset of criminal or anti-social activities such as armed robbery, shop lifting and drug trafficking. Families are forced to indulge in these anti-social vices to enable them give some decent living to their families - such as pay school fees, utility bills, house rent etc. Perhaps some protective measures needs to be formulated by governments to take care of the vulnerable for a reasonable period.

  • Reply to: South Asia’s Quest for Reduced Maternal Mortality: What the Data Show   1 week 1 day ago
    Dear Joy,
     
    Thank you very much for your thoughtful comments in which you raised excellent points.  First, we agree and acknowledge that Sri Lanka should be commended for its remarkable achievement in reducing maternal mortality compared to other countries with comparable income, which was noted in the Knowledge Brief "Sri Lanka: Maternal and Reproductive Health at a Glance". Also, the first graph in the blog clearly shows Sri Lanka’s extremely low level of MMR compared to its neighboring countries. This blog, however, is focusing on the pace of MMR reduction, i.e., progress towards achieving the MDG 5 target rather than the status.  In our view, this is a flaw in the design of MDGs, which was raised in several publications. For example, Matsubayashi, T. et al. conducted an “Analysis of Cross-Country Changes in Health Services”, Chapter 5 in Peters, D. et al. (2009) "Improving Health Services in Developing Countries: From Evidence to Action” and concluded that:
    • Less than two-thirds of LMICs are projected to reach international and Millennium Development Goal targets for health services by the target date of 2015, but identifying negative or slow rates of change in a country is probably a more important strategy than setting universal targets for health attainment.
    • Individual country differences (in delivery of health services, health status, and macro context) may be more important than international averages imply, undermining the relevance of targets set without reference to country-specific experience.
    • Rather than showing a common pattern of progress for health services, countries tend to follow their own pathways.
    • Countries’ very different starting points affect their prospects of achieving the targets and their rate of change.
     
    Second, on your question of whether there is an MMR at which it makes less sense to refer to these tragic deaths as "avoidable", we believe that each maternal death is a tragic incident and should be avoided. Belarus, for example, was able to reduce its MMR to only 1 death per 100,000 live births in 2013.
     
    Third, as for the number of deaths, you are right! These numbers were taken from earlier UN estimates of maternal deaths, which were subsequently revised in the UN 2014 report and we have therefore updated them in table 3 for all the countries to reflect the revised figures.  Thanks for noting that.
     
    Sameh and Naoko.
  • Reply to: South Asia’s Quest for Reduced Maternal Mortality: What the Data Show   1 week 6 days ago

    New data on MMR (Nepal) 480: http://thehimalayantimes.com/fullNews.php?headline=Govt%26sbquo%3B+NPC+to+review+maternal+mortality+ratio&NewsID=439686

  • Reply to: South Asia’s Quest for Reduced Maternal Mortality: What the Data Show   2 weeks 1 day ago

    A great blog, packed with information. But doesnt Sri Lanka deserve (more)explicit credit for its earlier sharp reduction and current low MMR rate? Is there a MMR at which it makes less sense to refer to these tragic deaths as "avoidable"? Would it have made sense to set the target as a 75% reduction or to below some absolute level of the MMR? (btw, Are the MMR and number of deaths in Sri Lanka correct for 1990 and 1995? They look inconsistent - a decrease in the number of maternal deaths from 300 to 250 and yet a rise in the MMR from 55 to 71).