Indirect cost of maternal deaths in the WHO African Region in 2010

BMC Pregnancy and Childbirth

Rosenabi Deborah Karimi Muthuri¹  Juliet Nabyonga Orem³  Germano Mwige Mwabu²  Joses Muthuri Kirigia⁴ 

[1] Department of Psychology, School of Social Sciences and Humanities, United States International University, Nairobi, Kenya;School of Economics, University of Nairobi, Nairobi, Kenya;Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo;Research, Publications and Library Services Programme, Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo

关键词: Loss in non-health GDP;    Indirect costs;    Maternal mortality;    African Region;   

Others  :  1125559
DOI  :  10.1186/1471-2393-14-299

 received in 2014-05-13, accepted in 2014-08-26,  发布年份 2014

【 摘 要 】

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.

Conclusion

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.

【 授权许可】

   
2014 Kirigia et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Hogan CM, Foreman K, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJL: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010, 375:1609-1623.
• [2]WHO, UNICEF, UNFPA and The World Bank: Trends in Maternal Mortality: 1990 to 2010. Geneva: WHO; 2012.
• [3]WHO: The global burden of disease: updated projections. Geneva: WHO; 2008. http://www.who.int/healthinfo/global_burden_disease/en/ webcite
• [4]WHO: World Health Statistics 2013. Geneva: WHO; 2013.
• [5]United Nations: Millennium Declaration. New York: UN; 2000.
• [6]Sambo LG, Kirigia JM, Nabyonga J: Health financing in the African Region: 2000–2009 data analysis. Int Arch Med 2013, 6:10. URL: http://www.intarchmed.com/content/6/1/10 webcite
• [7]Schaferhoff M, Schrade C, Yamey G: Financing maternal and child health - what are the limitations in estimating donor flows and resource needs? PLoS Med 2010, 7(7):1-6.
• [8]WHO/AFRO: Women’s health in the WHO African region: a call for action. WHO Regional Committee resolution AFR/RC58/R1. Brazzaville: WHO/AFRO; 2008.
• [9]Kirigia JM, Oluwole D, Mwabu GM, Gatwiri D, Kainyu LH: Effects of maternal mortality on gross domestic product (GDP) in the WHO African Region. Afr J Health Sci 2005, 12(3–4):1-10.
• [10]WHO/AFRO: Addressing the challenge of women’s health in Africa. Report of the Commission on Women’s Health in the African Region. Brazzaville: WHO/AFRO; 2012.
• [11]WHO: WHO guide to identifying the economic consequences of disease and injury. Geneva: WHO; 2009.
• [12]Fischer S, Mohr P, Rogers C: Macroeconomics. Johannesburg: Heinemann Publishers; 1996.
• [13]Grossman M: On the concept of health capital and the demand for health. J Polit Econ 1972, 80(2):223-255.
• [14]Chisholm D, Stanciole A, Edejer TTT, Evans DB: Economic impact of disease and injury: counting what matters. Br Med J 2010, 340:583-586.
• [15]Murray CJL: Rethinking DALYs. In The global burden of disease. Edited by Murray CJL, Lopez AD. Geneva: WHO; 1996:1-89. Chapter 1
• [16]Dempsey M: Decline in tuberculosis. The death rate fails to tell the entire story. Am Rev Tuberc 1947, 56:157-16417.
• [17]Feachem RGA, Kjellstrom T, Murray CJL, Over M, Phillips MA: The health of adults in the developing world. New York: Oxford University Press; 1992.
• [18]WHO: WHO methods and data sources for global burden of disease estimates 2000–2011. Geneva: WHO; 2013.
• [19]Murray CJL, Evans DB: Health systems performance assessment debates, methods and empiricisms. Geneva: WHO; 2003.
• [20]Kirigia JM: Economic evaluation of public health problems in sub-Saharan Africa. Nairobi: University of Nairobi Press; 2009.
• [21]The World Bank: Database. http://data.worldbank.org/about/country-classifications/country-and-lending-groups#Lower_middle_income webcite Accessed on 10 February 2014, 14h10
• [22]WHO: Life tables for WHO member states. http://www.who.int/gho/mortality_burden_disease/life_tables/life_tables/en/ webcite Accessed on 28 October 2013, 16h25
• [23]WHO: Disease and injury regional estimates for 2004. Geneva: WHO; 2013. http://www.who.int/healthinfo/global_burden_disease/en/ webcite
• [24]Drummond M: Cost-of-illness studies: a major headache? Pharmacoeconomics 1992, 2:1-4.
• [25]Wiseman V, Mooney G: Burden of disease illness estimates for priority setting: a debate revisited. Health Policy 1998, 43:243-251.
• [26]Wiseman V, Mooney G: Burden of disease and priority setting. Health Econ 2000, 9:369-372.
• [27]Shiell A, Gerard K, Donaldson C: Cost of illness studies: an aid to decision-making? Health Policy 1987, 8:317-323.
• [28]Rice DP: Estimating the cost of illness. Am J Public Health 1967, 57:424-440.
• [29]Ternent L, McNamee P, Newlands D, Belemsaga D, Gbangou A, Cross S: Willingness to pay for maternal health outcomes: are women willing to pay more than men? Appl Health Econ Health Policy 2010, 8(2):99-109.
• [30]Onwujekwe OE, Fox-Rushby J, Hanson K: Inter-rater and test-retest reliability of three contingent valuation questions formats in South-East Nigeria. Health Econ 2005, 14(5):529-536.
• [31]Kirigia JM, Sambo LG, Kainyu LH: Willingness to pay for schistosomiasis-related health outcomes in Kenya. Afr J Health Sci 2000, 7(3–4):55-67.
• [32]Morrison GC, Gyldmark M: Appraising the use of contingent valuation. Health Econ 1992, 1:233-243.
• [33]UNDP: Human Development Report 2010 – The real wealth of nations: pathways to human development. New York: UNDP; 2010.
• [34]Godlee F, Pakenham-Walsh N, Ncayiyana D, Cohen B, Packer A: Can we achieve health information for all by 2015? Lancet 2004, 364(9430):295-300.
• [35]United Nations: Report of the Office of the United Nations High Commissioner for Human Rights on preventable maternal mortality and morbidity and human rights. New York: UN; 2010.
• [36]Adam T, Lim SS, Mehta S, Bhutta ZA, Fogstad H, Mathai M, Zupan J, Darmstadt GL: Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. Br Med J 2005, 331:1107. URL: http://www.bmj.com/content/331/7525/1107 webcite
• [37]Pathmanathan I, Liljestrand J, Martins JM, Rajapaksa LC, Lissner C, de Silva A, Selvaraju S, Singh PJ: Investing in maternal health: learning from Malaysia and Sri Lanka. Washington, D.C: The World Bank; 2003.
• [38]Department for International Development: Reducing maternal deaths: evidence and action. A strategy for DFID. London: United Kingdom Department for International Development [DFID]; 2004.
• [39]Yadav H: A review of maternal mortality in Malaysia. IeJSME 2012, 6(Suppl 1):S142-S151.
• [40]Ahmed S, Li Q, Liu L, Tsui AO: Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet 2012, 380:111-125.
• [41]Bhutta ZA, Black RE: Global maternal, newborn, and child health – so near and yet so far. N Engl J Med 2013, 369(23):2226-2235.
• [42]WHO: Packages of interventions for family planning, safe abortion care, maternal, newborn and child health. Geneva: WHO; 2010.
• [43]WHO: Saving mothers’ lives. Geneva: WHO; 2014.
• [44]Commission on Information and Accountability for Women’s and Children’s health: Keeping promises, measuring results. Geneva: WHO; 2011.
• [45]Independent Expert Review Group (iERG): Every Woman, Every Child: from commitments to action. Geneva: WHO; 2012.
• [46]iERG: Every Woman, Every Child: strengthening equity and dignity through health. Geneva: WHO; 2013.
• [47]Ki-Moon B: Global strategy for women’s and children’s health. New York: UN; 2010.
• [48]African Union (AU): Protocol to the African Charter on human and peoples’s rights on the rights of women in Africa. Adopted by the 2nd Ordinary Session of the Assembly of the Union, Maputo, 11 July 2003. Addis Ababa: AU; 2003.
• [49]Sambo LG, Kirigia JM, Ki-zerbo G: Perceptions and viewpoints on proceedings of the Fifteenth Assembly of Heads of State and Government of the African Union Debate on Maternal, Newborn and Child Health and Development, 25–27 July 2010, Kampala, Uganda. BMC Proc 2011, 5(Suppl 5):S1. URL: http://www.biomedcentral.com/1753-6561/5/S5/S1 webcite
• [50]WHO/AFRO: Road map for accelerating the attainment of the millennium development goals relating to maternal and newborn health in Africa. Brazzaville: WHO/AFRO; 2004.
• [51]WHO: Monitoring of the achievement of the health-related Millennium Development Goals. Geneva: WHO; 2010. WHA 63.15
• [52]WHO: Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva: WHO; 2012. WHA65.6
• [53]WHO: Implementation of the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health. Geneva: WHO; 2012. WHA65.7
• [54]WHO: Implementation of the recommendations of the United Nations Commission on Life-Saving Commodities for Women and Children. Geneva: WHO; 2013. WHA66.7
• [55]United Nations Human Right Council: Preventable maternal mortality and morbidity and human rights. New York: UN; 2009. Resolution A/HRC/11/L.16/Rev.1
• [56]United Nations Human Right Council: Preventable maternal mortality and morbidity and human rights. New York: UN; 2012. Resolution A/HRC/21/L.10
• [57]United Nations General Assembly: Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality. New York: UN; 2012. Resolution A/HRC/21/22
• [58]United Nations General Assembly: Practices in adopting a human rights-based approach to eliminate preventable maternal morbidity and mortality. New York: UN; 2011. Resolution A/HRC/18/27
• [59]United Nations Economic and Social Council: Eliminating preventable maternal mortality and morbidity through empowerment of women. New York: UN; 2010. Resolution E/CN.6/2010/L.6
• [60]United Nations: Keeping the promise: united to achieve the Millennium Development Goals. New York: UN; 2010. Resolution A/RES/65/1 adopted by the General Assembly on 22 September 2010
• [61]United Nations: Follow-up to the Fourth World Conference on Women and full implementation of the Beijing Declaration and Platform for Action and the outcome of the twenty-third special session of the General Assembly. New York: UN; 2009. United Nations General Assembly Resolution A/RES/63/159 adopted on 18 December 2008
• [62]United Nations: Convention on elimination of all forms of discrimination against women. New York: UN; 1979. UN Treaties Series, Vol. 1249, P. 13