Post on 24-May-2015
description
Maternal Mortality Ratio Estimates Region of the Americas
Geneva, Jan 2011
Fatima Marinho, MD, PhD
Coordinator of Information and Health Analysis
Pan American Health
Organizationmarinhof@paho.org
MMR. Estimation for the Americas
• Completeness adjustments• The use of the correction factor (CF) of 1.5 and the generalized
application for VR data is problematic.• For those countries with better registration systems (e.g. Canada,
Uruguay, Cuba, Chile) CF causes an artificial increase in MMR and benefits the ones with less quality of vital registration (e g. Guatemala, Belize and Suriname).
• The CF of 1.5 has been applied over 18 years (1990-2008) without any consideration that many countries in this region have improved their vital registration system, especially since 2000. The CF should decrease over time.
• This is the case of Uruguay, Argentina and Mexico. It is very hard to accept the inconsistency between the latest 2005 WHO estimate and the new one, e.g Mexico. In the latter publication, Mexico’s important progress has been started in 2002 and was recognized by WHO while this time it was not considered.
Results• When we compare the results for the countries in the Americas, we
find some inconsistencies. We expect the MMR to be lower for some countries than for others and vice-versa. For some countries, the estimates underestimate or overestimate the MMR.
• The statistics model shows a strong tendency to decrease the MMR of those countries which began with high MMR in 1990 (Bolivia and Haiti) and a steady decrease tendency in those which presents initial lower MMR (Puerto Rico). It might suggest that the model could be better adjusted to reflect the differences in the trends among those countries.
• Haiti’s MMR is low; probably due to the HIV prevalence adjustment• We also consider Suriname MMR very low.• We do not agree that the following countries Argentina, Canada,
Chile, Costa Rica, Cuba, Chile, Mexico, Uruguay, and USA have to be corrected by CF 1.5.
• We expect that the MMR of Argentina, Brazil, Venezuela and Mexico are more proximate.
RMM. Países del GRUPO 1.
0
10
20
30
40
50
60
70
IHME PAHO WHO UNICEF UNFPA WB
CHI URUCUB COR
MMR Comparison of different sources
RMM. Países del GRUPO 2.
0
50
100
150
200
250
IHME PAHO WHO UNICEF UNFPA WB
PANARGVENCOLMEXELSBRADOR
RMM. Países del GRUPO 3.
0
50
100
150
200
250
300
IHME PAHO WHO UNICEF UNFPA WB
NICECUPARGUTPERHON
RMM. Haití y Bolivia.
0
100
200
300
400
500
600
700
800
900
1000
IHME PAHO WHO UNICEF UNFPA WB
BOLHAI
RMM for Suriname
SUR. MMR Estimations.
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
200.0
IHME
Lower MMR
Upper MMR
PAHO
WHO UNICEF UNFPAWB
Thank you!
Merci! Gracias! Obrigada!