maternal mortality sri lanka strategies for improving maternal mortality estimates in asia_lozano_110210_ihme

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Institute for Health Metrics and Evaluation - University of Washington

The document outlines lessons learned and strategies for improving measurement of maternal mortality. Key strategies discussed include increasing completeness of vital registration systems, reducing misclassification of causes of death, introducing nationwide verbal autopsy programs, and shortening the time between data collection and analysis. The document also notes progress made in reducing global maternal deaths but indicates this progress would have been greater without HIV/AIDS.

Lessons learned and strategies for improvement November 2, 2010 Rafael Lozano Professor of Global Health

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- The document discusses improving the measurement of maternal mortality rates (MMR) in Mexico by implementing a passive identification system to more accurately count maternal deaths. - This led to the addition of over 1,000 previously uncounted maternal deaths being added to official statistics. - While initially controversial, it empowered neglected health areas and improved transparency, credibility, and the culture of health information over the long-term.

maternal mortality sri lanka maternal mortality in asia_lozano_110210_ihme

Institute for Health Metrics and Evaluation - University of Washington

This document outlines a regional analysis of maternal mortality in Asia, including trends in the maternal mortality ratio (MMR) across regions and country-specific results. It notes that three major Asian countries are among the top contributors to global maternal deaths and that declining fertility rates, growing GDP, increased skilled birth attendance coverage, and greater maternal education have likely all contributed to observed declines in the MMR in Asia. An interactive online tool is referenced for tracking changes in maternal deaths across regions and viewing multiple health indicators over time.

Maternal mortality estimates: global progress on levels and trends

Institute for Health Metrics and Evaluation - University of Washington

maternal mortality sri lanka global mortality landscape_murray_110110_ihme

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The document discusses methods and results for estimating global mortality, including maternal mortality. It describes using multiple data sources and statistical modeling to estimate mortality rates for countries lacking complete vital registration systems. Key findings include a 34% reduction in under-five mortality from 1990-2008, with declines seen in most regions. Maternal mortality declined from 342,900 deaths in 2008, though progress has been uneven across countries and hampered by HIV in some areas.

maternal mortality sri lanka validating maternal mortality estimates_murray_1...

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The document discusses validating maternal mortality estimates through predictive validity testing. It proposes holding out portions of observational data and using a model fit to the remaining data to predict the held-out portions. This allows evaluating how well the model predicts gaps in time, out-of-time predictions, and countries with no data. The document also discusses accounting for different sources of uncertainty in estimates, including sampling uncertainty, parameter uncertainty from the model stages, and remaining systematic variation not explained by the model. It summarizes the WHO's 2010 maternal mortality estimation approach using civil registration, survey, and study data grouped by availability and type.

Maternal mortality for 181 countries

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This document analyzes global maternal mortality rates from 1980-2008 using improved statistical methods. It finds that the global maternal mortality ratio declined from 380 maternal deaths per 100,000 live births in 1980 to 342,900 deaths in 2008. However, progress was uneven, with over 50% of maternal deaths occurring in just 6 countries. Improving measurement of maternal mortality through better vital registration systems and repeated collection of household survey data could help accelerate progress towards reducing maternal mortality.

maternal mortality sri lanka intro_murray_11012010_ihme

Institute for Health Metrics and Evaluation - University of Washington

The document outlines the vision, mission, principles, and organizational structure of the Institute for Health Metrics and Evaluation (IHME). The vision is to provide high quality population health information to improve health globally. The mission is to answer three key questions about populations' health problems, how societies address them, and what can be done in the future. The IHME works according to principles of excellence, relevance, independence, comparability, comprehensibility, coherence, efficiency, transparency, collaboration, consultation, and dialogue. It has four program areas and recruits and trains the next generation of health leaders through various programs. Research is organized across multiple teams focused on topics like mortality, health systems performance, and innovative measurement. The board consists of

maternal mortality sri lanka the importance of maternal mortality measurement...

Institute for Health Metrics and Evaluation - University of Washington

The document discusses a workshop on measuring maternal mortality. The objectives of the workshop were to discuss maternal mortality trends in Asia, compare estimates from WHO and IHME, define methods to improve estimates, and discuss next steps. It provides background on definitions of maternal deaths, metrics for measurement like maternal mortality ratio, and obstacles to accurate measurement like misclassification of causes of death in places without proper death certification.

This document discusses estimating maternal mortality rates using statistical models. It outlines selecting dependent variables, processing input data from sources that provide the proportion of maternal deaths by age group, and choosing a regression model form. Key factors considered for the model are fertility, GDP, education, neonatal mortality, and HIV prevalence. A counterfactual scenario is proposed to estimate maternal mortality without the effect of HIV.

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Institute for Health Metrics and Evaluation - University of Washington

This document discusses different data sources that can be used to measure maternal mortality rates, including vital registration data, household survey data, sibling history data from surveys, and peer-reviewed studies using methods like verbal autopsies. It outlines some issues with data sources like miscoding and underreporting of deaths. The document also describes methods used to process and correct the raw data, like redistributing garbage codes and applying weights to survey data to address survivor bias.

maternal mortality sri lanka estimating maternal mortality ii_lozano_110210_ihme

Institute for Health Metrics and Evaluation - University of Washington

This document discusses outlier detection and modeling approaches for estimating maternal mortality rates. It outlines detecting and removing outliers by examining residuals from regression models, relationships between outcomes and covariates, and summary maternal mortality measures. It then discusses using spatial-temporal regression to capture systematic variation not explained by linear models, by running local regressions on residuals from the first stage weighted by geographic, time, and age proximity. This allows smoothing residual differences over countries and time to improve predictions.

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Vital Records: Vital input for population health measurement

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The document discusses vital records and their importance as inputs for measuring population health through studies like the Global Burden of Disease. It describes how the Institute for Health Metrics and Evaluation uses vital registration data from over 130 countries, along with other sources, to measure mortality trends and causes of death globally. Challenges with obtaining and standardizing vital records data are addressed, such as accounting for garbage codes, and opportunities for future collaboration on analyzing vital records at subnational levels in countries like the United States are presented.

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1. Maternal and child mortality in the United States has increased in recent decades according to findings from the GBD 2013 study, unlike trends in other developed nations which have seen continued declines. 2. The reasons for rising mortality in the US are unclear but may be related to increasing rates of non-communicable diseases and comorbidities among women of reproductive age as well as declining health insurance coverage and access to care. 3. While congenital birth defects have decreased substantially in the US, rates of neonatal disorders and injuries continue to outpace declines in other countries, driving higher rates of child mortality overall.

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This review summarizes the key limitations of using verbal autopsies to measure malaria mortality at the population level. The main limitations identified are the low sensitivity and specificity of existing verbal autopsy tools in determining malaria as the cause of death. There is also a lack of standardization in how verbal autopsies are implemented and analyzed across studies. Additional challenges include small sample sizes and potential for recall bias. The review concludes there is an urgent need to improve verbal autopsy methods to provide more accurate estimates of malaria mortality and track progress of malaria control goals.

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The document summarizes the results of a baseline study conducted as part of the Salud Mesoamérica Initiative, which aims to improve health indicators in Central American and Mexican countries. Key findings from household and health facility surveys in multiple countries are presented. Dried blood spot samples were also collected and tested to estimate measles immunization coverage, identifying gaps between reported vaccination and presence of antibodies. Health facility characteristics associated with discrepancies included lack of internet access and inconsistent receipt of requested vaccine supplies. The study highlights opportunities to strengthen vaccination programs and better measure coverage through biomarkers.

Quality of under-5 mortality statistics in Yucatán, Mexico (Spanish)

Institute for Health Metrics and Evaluation - University of Washington

Este estudio evaluó la calidad de la información sobre mortalidad infantil en Yucatán, México entre 2015-2016. El análisis encontró que el sistema de registros vitales mostró buena calidad general pero con problemas en la certificación de causas de muerte, especialmente para neonatos. La concordancia entre registros médicos y estadísticas vitales varió según la causa. La Universidad de Yucatán diseñará intervenciones para mejorar la certificación de muertes infantiles.

Under-5 mortality and healthcare in Yucatán – 2017 Results dissemination work...

Institute for Health Metrics and Evaluation - University of Washington

The first phase of the “Under-5 Child Health and Mortality Statistics Project” sough to strengthen the evidence and understanding of key factors related to under-5 mortality in Yucatán, Mexico using Verbal Autopsy data collection tools with an added battery on search for care processes for U5 deaths which occurred in Yucatán during 2015-2016, and the triangulation of Verbal Autopsy reports with data from vital registration systems and medical records. This presentation, presented to stakeholders at a results dissemination workshop in October 2017 in Mérida, Yucatán, provides an overview of the project and summarizes key results and learnings from the research.

Under-5 mortality and healthcare in Yucatán – 2021 Results dissemination work...

Institute for Health Metrics and Evaluation - University of Washington

The second phase of the “Under-5 Child Health and Mortality Statistics Project” sough to strengthen the evidence and understanding of key factors related to under-5 mortality in Yucatán, Mexico through the implementation and evaluation of both community and facility-based interventions, aimed at improving recognition of alarm signs among mothers and caretakers for common causes of death in children and improving the quality of cause of death certification for deaths of children under 5, respectively. This presentation, presented virtually to stakeholders at a results dissemination workshop in January 2021, provides an overview of the project and summarizes key results and learnings from the research.

The Global Fund Prospective Country Evaluation

Institute for Health Metrics and Evaluation - University of Washington

Prospective Country Evaluation 2019 Synthesis Findings

Institute for Health Metrics and Evaluation - University of Washington

The Prospective Country Evaluation is an embedded mixed-methods evaluation platform designed to examine the Global Fund business model, investments and contribution to disease program outcomes and impact in eight countries. Findings were synthesized across the 8 countries to provide timely and actionable recommendations to support program improvements and accelerate progress towards the objectives of the Global Fund 2017-2022 Strategy.

Global Burden of Disease (GBD) 2017 study findings

Institute for Health Metrics and Evaluation - University of Washington

Expected Human Capital: Key themes and talking points

Institute for Health Metrics and Evaluation - University of Washington

Expected human capital is a measure that combines education levels, functional health, and learning to assess a population's economic productivity. It is defined as the attributes of a population that contribute to economic growth through technology development and adoption. Expected human capital is calculated for each country by applying age-specific rates of education, health, and learning to demographic data. Higher expected human capital is correlated with higher GDP. Since 1990, many countries have improved their expected human capital through gains in education and health, leading to faster economic growth. Finland currently has the highest expected human capital while Niger, South Sudan and Chad have the lowest.

Global Health Financing

Institute for Health Metrics and Evaluation - University of Washington

Salud Mesoamérica 2015 Initiative: Select results from the first operation me...

Institute for Health Metrics and Evaluation - University of Washington

Chronic diseases and their risk factors in the Kingdom of Saudi Arabia

Institute for Health Metrics and Evaluation - University of Washington

Understanding the costs of and constraints to health service delivery in Ghana

Institute for Health Metrics and Evaluation - University of Washington

The document provides an overview of the ABCE (Access, Bottlenecks, Costs, and Equity) project in Ghana which collected primary data from 240 health facilities across the country. Key findings include that while facility personnel and capacity have increased in recent years, availability of diagnostic testing and human resources vary substantially between facility types. The study also found opportunities to improve efficiency and increase service outputs given current resource levels. Results of the ABCE project can help inform health policy in Ghana by identifying areas of strength and those needing further development in the country's health system.

ABCE: Understanding the costs of and constraints to health service delivery ...

Institute for Health Metrics and Evaluation - University of Washington

The document summarizes key findings from the ABCE (Access, Bottlenecks, Costs, and Equity) research project in Zambia. The project assessed facility capacity, service provision, patient perspectives, efficiency, and costs of health care delivery. It found gaps in capacity across facility types, with shortages of equipment, staff, and stock-outs of medicines and vaccines. It also found potential for improved efficiency, with the average facility using only 42% of resources. Costs per patient visit varied by facility and service type.

ABCE: Understanding the costs of and constraints to health service delivery ...

Institute for Health Metrics and Evaluation - University of Washington

The document provides an overview of the Access, Bottlenecks, Costs, and Equity (ABCE) research project in Uganda. The project collected data from 247 health facilities and over 3,900 patient interviews between 2012-2013. Key findings include: gaps between reported and functional service capacity at facilities, especially for non-HIV services; high availability of HIV/AIDS services but lower availability for non-communicable diseases; and efficiency scores varied widely both across and within facility platforms, indicating potential for expanded service provision.

ABCE: Understanding the Costs of and Constraints to Health Service Delivery ...

Institute for Health Metrics and Evaluation - University of Washington

The ABCE project in Kenya collected data from 254 health facilities and over 4,200 patient exit interviews from 2012. Key findings include: - Primary care facilities reported providing services but often lacked full capacity, especially in rural areas. Equipment, staffing, and diagnostic capacities were often inadequate. - Patients generally paid some fees but amounts varied. Over 75% of public health center patients paid 20 KSH or less. - Efficiency scores averaged 41% and generally declined with lower levels of care. Significant potential existed to increase service production given resources. - Costs per patient visit varied by facility and output, with outpatient visits generally the lowest cost.

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