title: Maternal mortality estimation at the subnational level: a model-based method with an application to Bangladesh.
abstract: OBJECTIVE
  To provide a model-based method of estimating maternal mortality at the subnational level and illustrate its use in estimating maternal mortality rates (MMrates) and maternal mortality ratios (MMRs) in all 64 districts of Bangladesh.
  
  
  METHODS
  Knowing that mortality is more pronounced among the poorer segments of a population, in rural areas and in areas with poor availability and utilization of maternal care, we used an empirical Bayesian prediction method to estimate maternal mortality at the subnational level from the spatial distribution of such factors.
  
  
  RESULTS
  MMRs varied significantly by district in Bangladesh, from 158 maternal deaths per 100,000 live births at Dhaka district to 782 in the northern coastal regions. Maternal mortality was consistently higher in the eastern and northern regions, which are known to be culturally conservative and to have poor transportation systems.
  
  
  CONCLUSIONS
  Bangladesh has made noteworthy strides in reducing maternal mortality since 1990, even though the utilization of skilled birth attendants has increased very little. However, several areas still show alarmingly high maternal mortality figures and need to be prioritized and targeted by health administrators and policy-makers.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA. sahmed@jhsph.edu
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hill
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D001499:Bayes Theorem; D006801:Humans; D008428:Maternal Mortality; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors