title: Indirect cost of maternal deaths in the WHO African Region in 2010.
abstract: BACKGROUND
  An estimated 147,741 maternal deaths occurred in 2010 in 45 of the 47 countries in the African Region of the World Health Organization (WHO). The objective of this study was to estimate the indirect cost of maternal deaths in the Region to provide data for use in advocacy for increased domestic and external investment in multisectoral policy interventions to curb maternal mortality.
  
  
  METHODS
  This study used the cost-of-illness method to estimate the indirect cost of maternal mortality, i.e. the loss in non-health gross domestic product (GDP) attributable to maternal deaths. Estimates on maternal mortality for 2010 from Trends in maternal mortality: 1990 to 2010 published by WHO, UNICEF, UNFPA and the World Bank were used in these calculations. Values for future non-health GDP lost were converted into their present values by applying a 3% discount rate. One-way sensitivity analysis at 5% and 10% discount rates assessed the impact on non-health GDP loss. Indirect cost analysis was undertaken for the countries, categorized under three income groups. Group 1 consisted of nine high and upper middle income countries, Group 2 of 12 lower middle income countries, and Group 3 of 26 low income countries. Estimates for Seychelles in Group 1 and South Sudan in Group 3 were not provided in the source used.
  
  
  RESULTS
  The 147,741 maternal deaths that occurred in 45 countries in the African Region in 2010 resulted in a total non-health GDP loss of Int$ 4.5 billion (PPP). About 24.5% of the loss was in Group 1 countries, 44.9% in Group 2 countries and 30.6% in Group 3 countries. This translated into losses in non-health GDP of Int$ 139,219, Int$ 35,440 and Int$ 16,397 per maternal death, respectively, for the three groups. Using discount rates of 5% and 10% reduced the total non-health GDP loss by 19.1% and 47.7%, respectively.
  
  
  CONCLUSIONS
  Maternal mortality is responsible for a noteworthy level of non-health GDP loss among the countries in the African Region. There is urgent need, therefore, to increase domestic and external investment to scale up coverage of existing cost-effective, multisectoral women's health interventions to reduce maternal morbidity and mortality.
authors.affiliation: Research, Publications and Library Services Programme, Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo. kirigiaj@afro.who.int.
authors.forename: Joses Muthuri
authors.initials: JM
authors.lastname: Kirigia
authors.forename: Germano Mwige
authors.initials: GM
authors.lastname: Mwabu
authors.forename: Juliet Nabyonga
authors.initials: JN
authors.lastname: Orem
authors.forename: Rosenabi Deborah Karimi
authors.initials: RD
authors.lastname: Muthuri
mesh_terms: D000349:Africa; D017281:Cost of Illness; D003365:Costs and Cost Analysis / Q000191:economics*; D005260:Female; D059066:Gross Domestic Product / Q000706:statistics & numerical data*; D006801:Humans; D008428:Maternal Mortality; D018803:Models, Economic