Evidence map›Paper›PMID 24797575›Full record

ArticleLancet (London, England)2014

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

Nicholas J Kassebaum, Amelia Bertozzi-Villa, Megan S Coggeshall, Katya A Shackelford, Caitlyn Steiner, Kyle R Heuton, Diego Gonzalez-Medina, Ryan Barber, Chantal Huynh, Daniel Dicker and 339 more

Erratum issued 2 registry-linked trialsAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Lancet (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 716 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
716citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04226807 naterminatednot on this mapstarted 2021, after this paper: background citation

Re-imagining the Postpartum Process: The Impact of Earlier Postpartum Contact on Attendance at Postpartum Visits and Maternal Wellbeing

TypeinterventionalSponsorMontefiore Medical CenterRan2021 to 2022Enrolled52ConditionsPostpartum CareArmsEarly Postpartum Phone Call
NCT04298034 phase3active not recruitingnot on this mapstarted 2020, after this paper: background citation

Randomized Controlled Trial for Postpartum Antihypertensive Treatment of Women With Preeclampsia

TypeinterventionalSponsorMedical College of WisconsinRan2020 to 2026Enrolled300ConditionsPreeclampsia, Hypertension in PregnancyArmsLabetalol, Nifedipine
3 · Its place in the literature

Who cites it

716 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. The use of telemedicine services for medical abortion.The Cochrane database of systematic reviews · 2025
    Pooled it
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  5. Pooled it
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  9. Trial
  10. Trial
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  12. Trial
  13. Article
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  15. Article
  16. Measurement of maternal mortality, United Republic of Tanzania.Bulletin of the World Health Organization · 2026
    Article
  17. Observational
  18. Article
  19. Article
  20. Article

656 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

349 authors.

Nicholas J KassebaumInstitute 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.
Amelia Bertozzi-VillaInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Megan S CoggeshallInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Katya A ShackelfordInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Caitlyn SteinerInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Kyle R HeutonInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Diego Gonzalez-MedinaInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Ryan BarberInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Chantal HuynhInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Daniel DickerInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Tara TemplinInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Timothy M WolockInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Ayse Abbasoglu OzgorenHacettepe University Institute of Population Studies, Ankara, Turkey.
Foad Abd-AllahFaculty of Medicine, Cairo University, Cairo, Egypt.
Semaw Ferede AberaSchool of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
Ibrahim AbubakarUniversity College London, London, UK.
Tom AchokiMinistry of Health, Gaborone, Botswana.
Ademola AdelekanPublic Health Promotion Alliance, Osogbp, Nigeria.
Zanfina AdemiUniversity of Melbourne, Melbourne, VIC, Australia.
Arsène Kouablan AdouAssociation Ivoirienne Pour Le Bien Etre Familial, Abidjan, Côte d'Ivoire.
José C AdsuarUniversity of Extremadura, Cáceres, Spain.
Emilie E AgardhInstitution of Public Health Sciences, Stockholm, Sweden.
Dickens AkenaMakerere University, Kampala, Uganda.
Deena AlasfoorMinistry of Health, Muscat, Oman.
Zewdie Aderaw AlemuDebre Markos University, Debre Markos, Amhara, Ethiopia.
Rafael Alfonso-CristanchoUniversity of Washington, Seattle, WA, USA.
Samia AlhabibNational Guard Health Affairs, Riyadh, Saudi Arabia.
Raghib AliUniversity of Oxford, Oxford, UK.
Mazin J Al KahbouriMinistry of Health, Muscat, Oman.
François AllaSchool of Public Health, University of Lorraine, Nancy, France.
Peter J AllenMinistry of Health, Belmopan, Cayo, Belize.
Mohammad A AlMazroaSaudi Ministry of Health, Riyadh, Saudi Arabia.
Ubai AlsharifCharité Universitätsmedizin Berlin, Berlin, Germany.
Elena AlvarezSpanish Observatory on Drugs, Government Delegation for the National Plan on Drugs, Madrid, Spain; Ministry of Health, Social Services and Equality, Madrid, Spain.
Nelson Alvis-GuzmánUniversidad de Cartagena, Cartagena de Indias, Colombia.
Adansi A AmankwaaAlbany State University, Albany, GA, USA.
Azmeraw T AmareDepartment of Epidemiology, University of Groningen, Groningen, Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Hassan AminiKurdistan Environmental Health Research Centre, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran.
Walid AmmarMinistry of Public Health, Beirut, Lebanon.
Carl A T AntonioCollege of Public Health, University of the Philippines Manila, Manila, Philippines.
Palwasha AnwariUN Population Fund, Kabul, Afghanistan.
Johan ArnlövUppsala University, Uppsala, Sweden.
Valentina S Arsic ArsenijevicInstitute of Microbiology and Immunology, School of Medicine, University of Belgrade, Belgrade, Serbia.
Ali ArtamanMedian, Windsor, ON, Canada.
Majed Masoud AsadMinistry of Health, Amman, Jordan.
Rana J AsgharField Epidemiology and Laboratory Training Program, Islamabad, Pakistan.
Reza AssadiMashhad University of Medical Sciences, Mashhad, Iran.
Lydia S AtkinsMinistry Of Health, Wellness, Human Services and Gender Relations, Sans Souci, Castries, Saint Lucia.
Alaa BadawiPublic Health Agency of Canada, Toronto, ON, Canada.
Kalpana BalakrishnanSri Ramachandra University, Chennai, India.
Arindam BasuSchool of Health Sciences, University of Canterbury, Christchurch, New Zealand.
Sanjay BasuStanford University, Stanford, CA, USA.
Justin BeardsleyOxford University, Ho Chi Minh City, Vietnam.
Neeraj BediCollege of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
Tolesa BekeleMadawalabu University, Bale Goba, Oromia, Ethiopia.
Michelle L BellYale University, New Haven, CT, USA.
Eduardo BernabeKing's College London, London, UK.
Tariku J BeyeneAddis Ababa University, Debre Zeit, Ethiopia.
Zulfiqar BhuttaAga Khan University Medical Centre, Karachi, Pakistan.
Aref Bin AbdulhakUniversity of Missouri-Kansas City, Kansas City, MO, USA.
Jed D BloreUniversity of Melbourne, Melbourne, VIC, Australia.
Berrak Bora BasaraGeneral Directorate of Health Research, Ankara, Turkey.
Dipan BoseWorld Bank, Washington, DC, USA.
Nicholas BreitbordeUniversity of Arizona, Tucson, AZ, USA.
Rosario CárdenasUniversidad Autonoma Metropolitana, Mexico City, Mexico.
Carlos A Castañeda-OrjuelaColombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia.
Ruben Estanislao CastroUniversidad Diego Portales, Santiago, Chile.
Ferrán Catalá-LópezDivision of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency, Madrid, Spain.
Alanur CavlinHacettepe University Institute of Population Studies, Ankara, Turkey.
Jung-Chen ChangNational Taiwan University, Taipei, Taiwan.
Xuan CheNational Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Costas A ChristophiCyprus University of Technology, Limassol, Cyprus.
Sumeet S ChughCedars-Sinai Medical Centre, Los Angeles, CA, USA.
Massimo CirilloUniversity of Salerno, Baronissi, Italy.
Samantha M ColquhounCentre for International Child Health, Melbourne, VIC, Australia.
Leslie Trumbull CooperMayo Clinic, Rochester, MN, USA.
Cyrus CooperMedical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Iuri da Costa LeiteNational School of Public Health (ENSP/Fiocruz), Rio de Janeiro, Brazil.
Lalit DandonaInstitute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India.
Rakhi DandonaPublic Health Foundation of India, New Delhi, India.
Adrian DavisPublic Health England, London, UK.
Anand DayamaSchool of Medicine, Atlanta, GA, USA.
Louisa DegenhardtUniversity of New South Wales, Sydney, NSW, Australia.
Diego De LeoGriffith University, Brisbane, QLD, Australia.
Borja del Pozo-CruzUniversity of Auckland, Auckland, New Zealand.
Kebede DeribeAddis Ababa University, Debre Zeit, Ethiopia.
Muluken DessalegnAfrica Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia.
Gabrielle A deVeberHospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Samath D DharmaratneUniversity of Peradeniya, Peradeniya, Sri Lanka.
Uğur DilmenGeneral Directorate of Health Research, Ankara, Turkey.
Eric L DingHarvard School of Public Health, Boston, MA, USA.
Rob E DorringtonUniversity of Cape Town, Cape Town, South Africa.
Tim R DriscollSydney School of Public Health, NSW, Australia.
Sergei Petrovich ErmakovThe Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia.
Alireza EsteghamatiEndocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Emerito Jose A FaraonCollege of Public Health, University of the Philippines Manila, Manila, Philippines.
Farshad FarzadfarNon-Communicable Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Manuela Mendonca FelicioDepartamento de Saúde Pública, ARS Norte IP, Porto, Portugal.
Seyed-Mohammad FereshtehnejadKarolinska Institutet, Stockholm, Sweden.
Graça Maria Ferreira de LimaPublic Health Department, Unidade Local de Saúde de Matosinhos, Porto, Portugal.
Mohammad H ForouzanfarInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Elisabeth B FrançaFederal University of Minas Gerais, Belo Horizonte, Brazil.
Lynne GaffikinSchool of Medicine, Stanford, CA, USA.
Ketevan GambashidzeNational Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia.
Fortuné Gbètoho GankpéClinique Coopérative de Parakou, Parakou, Borgou, Benin.
Ana C GarciaPublic Health Unit of Primary Health Care Group of Almada-Seixal, Almada, Setúbal, Portugal.
Johanna M GeleijnseDivision of Human Nutrition, Wageningen University, Wageningen, Netherlands.
Katherine B GibneyMonash University, Melbourne, VIC, Australia.
Maurice GiroudUniversity Hospital of Dijon, Dijon, France.
Elizabeth L GlaserHeller School for Social Policy and Management, Waltham, MA, USA.
Ketevan GoginashviliMinistry of Labour, Health and Social Affairs, Tbilisi, Georgia.
Philimon GonaUniversity of Massachusetts Medical School, Worcester, MA, USA.
Dinorah González-CastellNational Institute of Public Health, Cuernavaca, Mexico.
Atsushi GotoDepartment of Diabetes Research, National Centre for Global Health and Medicine, Tokyo, Japan.
Hebe N GoudaUniversity of Queensland, Brisbane, QLD, Australia.
Harish Chander GugnaniSaint James School of Medicine, Kralendijk, Bonaire, Netherlands.
Rahul GuptaKanawha Charleston Health Department, Charleston, WV, USA.
Rajeev GuptaFortis Escorts Hospital, Jaipur, India.
Nima Hafezi-NejadEndocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Randah Ribhi HamadehArabian Gulf University, Manama, Bahrain.
Mouhanad HammamiWayne County Department of Health and Human Services, Detroit, MI, USA.
Graeme J HankeySchool of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
Hilda L HarbMinistry of Public Health, Beirut, Lebanon.
Rasmus HavmoellerKarolinska Institutet, Stockholm, Sweden.
Simon I HayUniversity of Oxford, Oxford, UK.
Ileana B Heredia PiNational Institute of Public Health, Cuernavaca, Mexico.
Hans W HoekParnassia Psychiatric Institute, The Hague, Netherlands.
H Dean HosgoodAlbert Einstein College of Medicine, Bronx, NY, USA.
Damian G HoySchool of Population Health, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia.
Abdullatif HusseiniBirzeit University, Birzeit, Ramallah, Palestine.
Bulat T IdrisovBrandeis University, Waltham, MA, USA.
Kaire InnosNational Institute for Health Development, Tallinn, Estonia.
Manami InoueGraduate School of Medicine, Tokyo, Japan.
Kathryn H JacobsenGeorge Mason University, Fairfax, VA, USA.
Eiman JahangirOchsner Medical Centre, New Orleans, LA, USA.
Sun Ha JeeGraduate School of Public Health, Yonsei University, Seoul, South Korea.
Paul N JensenUniversity of Washington, Seattle, WA, USA.
Vivekanand JhaPostgraduate Institute of Medical Education and Research, Chandigarh, India.
Guohong JiangTianjin Centres for Diseases Control and Prevention, Tianjin, China.
Jost B JonasDepartment of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
Knud JuelNational Institute of Public Health, Copenhagen, Denmark.
Edmond Kato KabagambeVanderbilt University, Nashville, TN, USA.
Haidong KanFudan University, Shanghai, China.
Nadim E KaramUniversity of Balamand, Beirut, Lebanon.
André KarchHelmholtz Centre for Infection Research, Braunschweig, Germany.
Corine Kakizi KaremaMalaria and Other Parasitic Diseases Division, Kigali, Rwanda.
Anil KaulOklahoma State University, Tulsa, OK, USA.
Norito KawakamiSchool of Public Health, Tokyo, Japan.
Konstantin KazanjanNational Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia.
Dhruv S KaziUniversity of California San Francisco, San Francisco, CA, USA.
Andrew H KempUniversity of São Paulo, São Paulo, Brazil.
Andre Pascal KengneSouth African Medical Research Council, Cape Town, South Africa.
Maia KereselidzeNational Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia.
Yousef Saleh KhaderJordan University of Science and Technology, Al-Ramtha, Jordan.
Shams Eldin Ali Hassan KhalifaSupreme Council of Health, Doha, Qatar.
Ejaz Ahmed KhanHealth Services Academy, Islamabad, Pakistan.
Young-Ho KhangInstitute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea.
Luke KnibbsUniversity of Queensland, Brisbane, QLD, Australia.
Yoshihiro KokuboDepartment of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan.
Soewarta KosenCentre for Community Empowerment, Health Policy and Humanities, National Institute of Health Research and Development, Jakarta, Indonesia.
Barthelemy Kuate DefoUniversity of Montreal, Montreal, QC, Canada.
Chanda KulkarniRajrajeshwari Medical College and Hospital, Bangalore, India.
Veena S KulkarniArkansas State University, Jonesboro, AR, USA.
G Anil KumarPublic Health Foundation of India, New Delhi, India.
Kaushalendra KumarInternational Institute for Population Sciences, Mumbai, India.
Ravi B KumarIndian Institute of Public Health, Public Health Foundation of India, Gurgaon, India.
Gene KwanBoston Medical Centre, Boston, MA, USA.
Taavi LaiFourth View Consulting, Tallinn, Estonia.
Ratilal LallooAustralian Research Centre for Population Oral Health (ARCPOH), School of Dentistry, University of Adelaide, Adelaide, SA, Australia.
Hilton LamInstitute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines.
Van C LansinghInternational Agency for the Prevention of Blindness and Vision 2020, Weston, FL, USA.
Anders LarssonUppsala University, Uppsala, Sweden.
Jong-Tae LeeKorea University, Seoul, South Korea.
James LeighUniversity of Sydney, NSW, Australia.
Mall LeinsaluNational Institute for Health Development, Tallinn, Estonia.
Ricky LeungUniversity at Albany, Rensselaer, NY, USA.
Xiaohong LiNational Centre for Birth Defects Monitoring of China, Chengdu, China.
Yichong LiNational Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China.
Yongmei LiGenentech, South San Francisco, CA, USA.
Juan LiangNational Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China.
Xiaofeng LiangChinese Centre for Disease Control and Prevention, Beijing, China.
Stephen S LimInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Hsien-Ho LinCollege of Public Health, Taipei, Taiwan.
Steven E LipshultzWayne State University, Miami, FL, USA.
Shiwei LiuNational Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China.
Yang LiuUniversity of the East Ramon Magsaysay Memorial Medical Centre, Quezon City, Philippines.
Belinda K LloydMonash University, Melbourne, VIC, Australia.
Stephanie J LondonNational Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
Paulo A LotufoUniversity of São Paulo, São Paulo, Brazil.
Jixiang MaNational Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China.
Stefan MaMinistry of Health Singapore, Singapore, Singapore.
Vasco Manuel Pedro MachadoNorthern Region Health Administration, Porto, Portugal.
Nana Kwaku MainooXpharmconsult, Kumasi, Ghana.
Marek MajdanDepartment of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia.
Christopher Chabila MapomaUniversity of Zambia, Lusaka, Zambia.
Wagner MarcenesQueen Mary University of London, London, UK.
Melvin Barrientos MarzanUniversity of the East Ramon Magsaysay Memorial Medical Centre, Quezon City, Philippines.
Amanda J Mason-JonesUniversity of York, York, UK.
Man Mohan MehndirattaJanakpuri Super Specialty Hospital, New Delhi, India.
Fabiola Mejia-RodriguezNational Institute of Public Health, Cuernavaca, Mexico.
Ziad A MemishSaudi Ministry of Health, Riyadh, Saudi Arabia.
Walter MendozaUN Population Fund, Lima, Peru.
Ted R MillerPacific Institute for Research and Evaluation, Calverton, MD, USA.
Edward J MillsUniversity of Ottawa, Ottawa, ON, Canada.
Ali H MokdadInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Glen Liddell MolaUniversity of Papua New Guinea, Port Moresby, Papua New Guinea.
Lorenzo MonastaInstitute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy.
Jonathan de la Cruz MonisBureau of International Health Cooperation, Manila City, Philippines.
Julio Cesar Montañez HernandezNational Institute of Public Health, Cuernavaca, Mexico.
Ami R MooreUniversity of North Texas, Denton, TX, USA.
Maziar Moradi-LakehInstitute for Health Metrics and Evaluation, Seattle, WA, USA; Iran University of Medical Sciences, Department of Community Medicine, Tehran, Iran.
Rintaro MoriNational Centre for Child Health and Development, Setagaya, Tokyo, Japan.
Ulrich O MuellerPhilipps-University Marburg, Marburg, Germany.
Mitsuru MukaigawaraTokyo Medical and Dental University, Tokyo, Japan.
Aliya NaheedInternational Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
Kovin S NaidooUniversity of KwaZulu-Natal, Durban, South Africa.
Devina NandMinistry of Health Fiji, Suva, Fiji.
Vinay NangiaSuraj Eye Institute, Nagpur, India.
Denis NashSchool of Public Health, State University of New York, New York, NY, USA.
Chakib NejjariFaculty of Medicine, Fez, Morocco.
Robert G NelsonNational Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
Sudan Prasad NeupaneNorwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway.
Charles R NewtonKenya Medical Research Institute Wellcome Trust Programme, Kilifi, Kenya.
Marie NgInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Mark J NieuwenhuijsenCentre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
Muhammad Imran NisarAga Khan University, Karachi, Pakistan.
Sandra NolteCharité Universitätsmedizin Berlin, Berlin, Germany.
Ole F NorheimUniversity of Bergen, Bergen, Norway.
Luke NyakarahukaMakerere University, Kampala, Uganda.
In-Hwan OhKyung Hee Unversity, Seoul, South Korea.
Takayoshi OhkuboTeikyo University School of Medicine, Tokyo, Japan.
Bolajoko O OlusanyaCentre for Healthy Start Initiative, Lagos, Nigeria.
Saad B OmerEmory University, Atlanta, GA, USA.
John Nelson OpioLira District Local Government, Lira Municipal Council, Lira, Uganda.
Orish Ebere OrisakweToxicology Unit, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Nigeria.
Jeyaraj D PandianChristian Medical College Ludhiana, Ludhiana, India.
Christina PapachristouCharité Universitätsmedizin Berlin, Berlin, Germany.
Jae-Hyun ParkSungkyunkwan University School of Medicine, Suwon, South Korea.
Angel J Paternina CaicedoUniversidad de Cartagena, Cartagena, Colombia.
Scott B PattenUniversity of Calgary, Calgary, AB, Canada.
Vinod K PaulAll India Institute of Medical Sciences (AIIMS), New Delhi, India.
Boris Igor PavlinWHO, Waigani, Papua New Guinea.
Neil PearceLondon School of Hygiene & Tropical Medicine, London, UK.
David M Pereira3B'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.
Konrad PesudovsFlinders University, Adelaide, SA, Australia.
Max PetzoldCentre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Sweden.
Dan PoenaruMcMaster University, Hamilton, ON, Canada.
Guilherme V PolanczykUniversity of São Paulo, São Paulo, Brazil.
Suzanne PolinderErasmus Medical Center, Department of Public Health, Rotterdam, Netherlands.
Dan PopeUniversity of Liverpool, Liverpool, UK.
Farshad PourmalekUniversity of British Columbia, Vancouver, BC, Canada.
Dima QatoCollege of Pharmacy, Chicago, IL, USA.
D Alex QuistbergUniversity of Washington, Seattle, WA, USA.
Anwar RafayContech International, Lahore, Pakistan.
Kazem RahimiUniversity of Oxford, Oxford, UK.
Vafa Rahimi-MovagharSina Trauma and Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Sajjad ur RahmanHamad Medical Corporation, Doha, Qatar.
Murugesan RajuUniversity of Missouri, Columbia, MO, USA.
Saleem M RanaDepartment of Public Health, University of the Punjab, Lahore, Pakistan.
Amany RefaatWalden University, Minneapolis, MN, USA.
Luca RonfaniInstitute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy.
Nobhojit RoyBhaba Atomic Research Center Hospital, Mumbai, India.
Tania Georgina Sánchez PimientaNational Institute of Public Health, Cuernavaca, Mexico.
Mohammad Ali SahraianMS Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Joshua A SalomonHarvard University, Boston, MA, USA.
Uchechukwu SampsonVanderbilt University, Nashville, TN, USA.
Itamar S SantosUniversity of São Paulo, São Paulo, Brazil.
Monika SawhneyMarshall University, Huntington, WV, USA.
Felix SayinzogaMinistry of Health, Kigali, Rwanda.
Ione J C SchneiderFederal University of Santa Catarina, Florianópolis, Brazil.
Austin SchumacherInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
David C SchwebelUniversity of Alabama at Birmingham, Birmingham, AL, USA.
Soraya SeedatStellenbosch University, Cape Town, South Africa.
Sadaf G SepanlouDigestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Edson E Servan-MoriNational Institute of Public Health, Cuernavaca, Mexico.
Marina Shakh-NazarovaNational Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia.
Sara SheikhbahaeiEndocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Kenji ShibuyaUniversity of Tokyo, Tokyo, Japan.
Hwashin Hyun ShinHealth Canada, Ottawa, ON, Canada.
Ivy ShiueHeriot-Watt University, Edinburgh, UK.
Inga Dora SigfusdottirReykjavik University, Reykjavik, Iceland.
Donald H SilberbergUniversity of Pennsylvania, Philadelphia, PA, USA.
Andrea P SilvaInstituto Nacional de Epidemiología Dr Juan H Jara, Mar del Plata, Buenos Aires, Argentina.
Jasvinder A SinghUniversity of Alabama at Birmingham, Birmingham, AL, USA.
Vegard SkirbekkNorwegian Institute of Public Health, Oslo, Norway.
Karen SliwaHatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Cape Town, South Africa.
Sergey S SoshnikovFederal Research Institute for Health Organisation and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia.
Luciano A SposatoDepartment of Clinical Neurological Sciences, Western University, London, ON, Canada.
Chandrashekhar T SreeramareddyUniversity Tunku Abdul Rahman, Kajang, Malaysia.
Konstantinos StroumpoulisHellenic Centre for Disease Control and Prevention (KEELPNO) Greece, Athens, Greece.
Lela SturuaNational Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia.
Bryan L SykesDepartment of Criminology, Law and Society (and Sociology), University of California Irvine, Irvine, CA, USA.
Karen M TabbUniversity of Illinois, Chicago, IL, USA.
Roberto Tchio TalongwaMinistry of Public Health, Yaounde, Cameroon.
Feng TanNational Institute of Occupational Health and Poison Control, Beijing, China.
Carolina Maria TeixeiraDepartamento de Saúde Pública, ARS Norte IP, Porto, Portugal.
Eric Yeboah TenkorangMemorial University, St John's, NL, Canada.
Abdullah Sulieman TerkawiDepartment of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
Andrew L Thorne-LymanThe Earth Institute, Columbia University, New York, NY, USA.
David L TirschwellDepartment of Neurology, Seattle, WA, USA.
Jeffrey A TowbinCincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA.
Bach X TranJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Miltiadis TsilimbarisDepartment of Medicine, University of Crete, Heraklion, Greece.
Uche S UchenduDepartment of Veterans Affairs, Washington, DC, USA.
Kingsley N UkwajaDepartment of Internal Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Nigeria.
Eduardo A UndurragaBrandeis University, Waltham, MA, USA.
Selen Begüm UzunMinistry of Health, Ankara, Turkey.
Andrew J VallelyThe Kirby Institute, Sydney, NSW, Australia.
Coen H van GoolNational Institute for Public Health and the Environment, Bilthoven, Netherlands.
Tommi J VasankariUKK Institute for Health Promotion Research, Tampere, Finland.
Monica S VavilalaUniversity of Washington, Seattle, WA, USA.
N VenketasubramanianNeuroscience Centre, Raffles Hospital, Singapore.
Salvador VillalpandoNational Institute of Public Health, Cuernavaca, Mexico.
Francesco S ViolanteUniversity of Bologna, Bologna, Italy.
Vasiliy Victorovich VlassovHigher School of Economics, Moscow, Russia.
Theo VosInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Stephen WallerUniformed Services University of Health Sciences, Bethesda, MD, USA.
Haidong WangInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Linhong WangNational Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China.
XiaoRong WangShandong University Affiliated Jinan Central Hospital, Jinan, China.
Yanping WangNational Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China.
Scott WeichenthalHealth Canada, Ottawa, ON, Canada.
Elisabete WeiderpassDepartment of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
Robert G WeintraubUniversity of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
Ronny WestermanPhilipps-University Marburg, Marburg, Germany.
James D WilkinsonUniversity of Miami, Miami, FL, USA.
Solomon Meseret WoldeyohannesInstitute of Public Health, University of Gondar, Gondar, Ethiopia.
John Q WongAteneo School of Medicine and Public Health, City of Pasig, Manila, Philippines.
Muluemebet Abera WordofaJimma University, Jimma, Ethiopia.
Gelin XuNanjing University School of Medicine, Jinling Hospital, Nanjing, China.
Yang C YangUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Yuichiro YanoDivision of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
Gokalp Kadri YenturGeneral Directorate of Health Research, Ankara, Turkey.
Paul YipUniversity of Hong Kong, Hong Kong Special Administrative Region, China.
Naohiro YonemotoNational Centre of Neurology and Psychiatry, Kodaira, Japan.
Seok-Jun YoonKorea University, Seoul, South Korea.
Mustafa Z YounisJackson State University, Jackson, MS, USA.
Chuanhua YuDepartment of Epidemiology and Biostatistics, Global Health Institute, School of Public Health, Wuhan University, Wuhan, China.
Kim Yun JinTCM Medical Tk, Nusajaya, Johor Bahru, Malaysia.
Maysaa El Sayed ZakiMansoura Faculty of Medicine, Mansoura, Egypt.
Yong ZhaoChongqing Medical University, Chongqing, China.
Yingfeng ZhengZhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China.
Maigeng ZhouNational Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China.
Jun ZhuNational Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China.
Xiao Nong ZouCancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Alan D LopezUniversity of Melbourne, Melbourne, VIC, Australia.
Mohsen NaghaviInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Christopher J L MurrayInstitute for Health Metrics and Evaluation, Seattle, WA, USA.
Rafael LozanoInstitute for Health Metrics and Evaluation, Seattle, WA, USA; National Institute of Public Health, Cuernavaca, Mexico.

Funding

Mayo Clinic Center for Translational Science ActivitiesUL1TR000135 · NCATS · MAYO CLINIC ROCHESTER · PI KHOSLA, SUNDEEP · 2012 to 2015
$41.2M
Research Services CoreP2CHD050924 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI KAREN B GUZZO · 2015 to 2026
$9.6M
Department of Health CDF-2013-06-012Medical Research Council G1100684Medical Research Council MC_U147585824Medical Research Council MC_UP_A620_1014Medical Research Council MC_UU_12011/1Medical Research Council MR/L003120/1NCATS NIH HHS UL1 TR000135NICHD NIH HHS P2C HD050924Wellcome Trust 095066Wellcome Trust 099876
6 · The paper itself

Abstract

backgroundThe 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.

methodsWe used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.

findings292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.

interpretationGlobal rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.

fundingBill & Melinda Gates Foundation.

Indexed as

Age DistributionCause of DeathFemaleGlobal HealthHIV InfectionsHumansMaternal MortalityModels, StatisticalOrganizational ObjectivesPregnancyPregnancy Complications, InfectiousRisk FactorsSocioeconomic FactorsTime Factors

Identifiers

PMID24797575
PMCPMC4255481

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