From: Linda Asante-Agyei, GNA Special Correspondent, Seattle, Washington, USA, Courtesy IHME/Ghana's Ministry of Health

Seattle, US, March 14, GNA - A recent study conducted on Trends in 93Maternal Mortality: 1990 to 2008" has shown a decline in Maternal Mortality Ratio (MMR) globally.

The trend is a good sign of attaining the Millennium Development Goal (MDG) 5 of reducing the maternal mortality ratio by three-quarters by 2015.

With only four years left until the 2015 deadline to achieve the MDGs, closer examination of maternal mortality levels is needed to inform planning of reproductive health programmes and guide advocacy efforts and research at the national level.

Dr John Wilmoth, Associate Professor of the University of California, Berkeley, said this at the opening of a four-day Global Health Metrics and Evaluation Conference, in Seattle, US. Speaking on the topic: 93Measuring Maternal Mortality," he said the research presented the global maternal mortality data for 2008 as well as data for the years 1990, 1995, 2000 and 2005 using a revised methodology.

The maternal mortality rate was released in September 2010 to provide an input to the United Nations General Assembly on progress towards achieving the MDGs. Estimates by the World Health Organisation, UN Population Fund, UN Children's Fund and the World Bank showed that developing countries continued to account for 99 per cent of all maternal deaths with sub-Saharan Africa and South Asia accounting for 87 per cent of the global figure.

Eleven countries - Ethiopia, Nigeria, Sudan, Kenya, India, Democratic Republic of Congo, Afghanistan, Indonesia, Pakistan and the United Republic of Tanzania 96 had 65 per cent of all maternal deaths in 2008.

The conference, the first of its kind, on the theme: 93Global Health Metrics and Evaluation: Controversies, Innovation, Accountability," is being attended by more than 600 researchers, policy makers and global health leaders from around the world, who would be sharing ground breaking advances in health measurements. The conference will highlight innovative methods, latest debates in measurements, and translation of data to inform effective policy for improved population health.

It is co-hosted by the Institute for Health Metrics and Evaluation, The Lancet, the London School of Hygiene and Tropical Medicine, the Harvard School of Public Health and the University Of Queensland School Of Population Health. The conference aims at fostering greater exchange of ideals, collaboration and intellectual innovation. It is also to help bridge traditional disciplinary boundaries by demonstrating the force and potential of multi disciplinary intellectual endeavours in population health.

Topics being treated include non-communicable diseases, malaria, priority setting and health inequalities. Dr Wilmoth explained that previously, it was a challenge to assess the extent of progress towards the MDG5 due to the lack of reliable and accurate data on maternal mortality, particularly in developing country settings where maternal mortality was very high. He said all these became possible because countries were given the opportunity to review their estimates, data sources and methods to obtain additional primary sources that may not have been previously reported or used.

This enabled them to build mutual understanding of the strengths and weaknesses of available data and ensure broader ownership of the results. Dr Wilmoth said during the period of under study, 1990-2008, sub-Saharan Africa recorded the highest of 640 maternal deaths per 100,000 live births in 2008.

"During this period, 147 countries experienced a decline in maternal mortality rate out of which 90 showed a decline of 40 per cent or more. It was only two countries that did not record (decline) in maternal mortality ratio," he added.

Dr Wilmoth explained that overall, an estimated 42,000 deaths were due to HIV and AIDS among pregnant women in 2008 whilst about half of those were assumed to be maternal. "The contribution of HIV and AIDS was the highest in sub-Saharan Africa where nine per cent of all maternal deaths were due to HIV and AIDS.

"Without these deaths, the maternal mortality in sub-Saharan Africa would have been 580 deaths per 100,000 live births instead of the 640." He said there was the need to assess and ensure that MDG 5 was achieve= d. In an interview with the Ghana News Agency, Dr Wilmoth said Ghana was among the 85 countries that lacked good and complete registration data but had data available. Answering whether MDG 5 was achievable, Dr Wilmoth said though there had been a slow progress in proving maternal health, there was the need to improve country-led health plans, have comprehensive, integrated package of essential interventions and services, strengthen health systems, build the capacity of the health workforce and have a co-ordinated research and innovation. "Fulfilling these commitments in line with the elements of the Global Strategy for Women's and Children's Health should help advance progress in maternal health now that we have only four years to reach 2015," he added.

Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation, who opened the conference called on countries to translate data into cost effective policies for the improvement of population health.

"At a crucial time like this when global health funding may drop for the first time in two decades, we need to engage in measuring health and evaluating impact and share knowledge to improve health," he said.

Dr Murray said when data are missing, researchers turn to make the best of available sources and using multiple sources to fill in the gaps created.

He explained that the cause of death data came from several sources with varying formats and different cause lists. These included vital registration systems, censuses, verbal autopsies, hospital records, mortuaries and disease surveillance systems. Dr Murray said there was the need to generate one comprehensive cause of death database with standardised cause lists and age formats and then improve cause of deaths assignments. He called for data preparation process to achieve greater comparability across data sources, facilitate the analysis of trends in causes of death, and provide further evidence to evaluate theories of epidemiological transition.