title: Magnitude of maternal and neonatal mortality in Tanzania: A systematic review.
abstract: BACKGROUND
  Maternal and neonatal mortality remains a serious challenge in Tanzania. Progress is tracked through maternal mortality ratios (MMR) and neonatal mortality rates (NMR), yet robust national data on these outcomes is difficult and expensive to ascertain, and mask wide variation.
  
  
  METHODS
  We searched EMBASE, MEDLINE, Popline, and EBSCO online databases, basing search terms on ("maternal" OR "neonatal") AND ("mortality" OR "cause of death") AND "Tanzania."
  
  
  METHODS
  Nationally representative or population representative from the subnational context were eligible, providing NMR, MMR, or numbers of maternal deaths or early neonatal deaths or neonatal deaths and live births.
  
  
  METHODS
  Data were extracted on study context, time period, number of deaths and live births, definition of maternal and neonatal death, study design, and completeness and representativeness of data. NMR and MMR were extracted or calculated and study quality was assessed. Nationally representative data were compared with modelled national data from international agencies.
  
  
  RESULTS
  2107 records were screened yielding 21 maternal mortality and 15 neonatal mortality datasets. There were high mortality levels with wide subnational MMR and NMR variation. National survey data differed from the modelled estimates, with wide uncertainty ranges.
  
  
  CONCLUSIONS
  Subnational data quality was generally poor with no observable trends and geographical clustering across several regions. Combined MMR and NMR reporting is uncommon. Modelled national estimates lack precision and are complex to interpret. Results suggest that aggregate national data are inadequate for policy generation and progress monitoring. We recommend strengthening of vital registration and Health Management Information Systems with complementary use of process indicators, for improved monitoring of, and accountability for maternal and newborn health.
authors.affiliation: The London School of Hygiene and Tropical Medicine, London, UK; Evidence for Action Tanzania, Dar es Salaam, Tanzania. Electronic address: Corinne.armstrong@lshtm.ac.uk.
authors.forename: Corinne E
authors.initials: CE
authors.lastname: Armstrong
authors.affiliation: Evidence for Action Tanzania, Dar es Salaam, Tanzania.
authors.forename: Moke
authors.initials: M
authors.lastname: Magoma
authors.affiliation: The London School of Hygiene and Tropical Medicine, London, UK; Evidence for Action Tanzania, Dar es Salaam, Tanzania.
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
mesh_terms: D000068598:Data Accuracy; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D050498:Live Birth; D008428:Maternal Mortality / Q000639:trends*; D011247:Pregnancy; D013636:Tanzania
keywords: Maternal mortality; Millennium Development Goal; Modelled estimates; Neonatal mortality; Process indicators; Tanzania