An analysis of the determinants of maternal mortality in sub-Saharan Africa.
OBJECTIVE
To establish what population characteristics affect the high maternal mortality rate in the sub-Saharan Africa region and to propose possible solutions to reduce this rate.


METHODS
This study is a secondary analysis of existing data sources from the World Bank, the World Health Organization (WHO), as well as direct and indirect sources from UNAIDS, the United Nations, Demographic and Health Surveys (DHS), Macro International, and national statistical offices. Instead of looking at continentwide or individual nation models, it develops a regional model. Sociodemographic population variables are used as independent variables to predict the dependent variable, maternal mortality. Additionally, a new country-specific political stability independent variable is introduced into the model. Data from 28 sub-Saharan African countries are used. Bivariate correlations are used to establish associations among the variables, whereas cross-tabulations, using Kendall's tau-c values, and regression lines are used to establish impacts.


RESULTS
In the sub-Saharan Africa region, births attended by skilled health personnel and life expectancy at birth strongly correlate with maternal mortality. Gross national product (GNP) per capita and health expenditure per capita also have strong association with maternal mortality.


CONCLUSIONS
The availability of skilled delivery personnel, life expectancy, national economic wealth, and health expenditure per capita predict the maternal mortality rate of a country. Based on these findings, it is recommended that structural arrangements be made to train skilled health personnel to take care of maternal health problems. In view of the high cost of training physicians, middle-level health personnel may offer an affordable alternative to handle emergency obstetrical cases to address the shortage of physicians. In addition, the allocation of adequate resources to the health sector could improve maternal mortality. The economic wealth of a country and life expectancy at birth are less modifiable through short-term specific interventions. Additionally, it is recommended that country-specific interventions are needed to correct the problem of lack of critical data for analysis.
Buor
Daniel
D
Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. danielburo@yahoo.com
Bream
Kent
K
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000401:mortality* / Q000592:standards; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D015233:Models, Statistical; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016387:Women's Health