Mapping maternal mortality rate via spatial zero-inflated models for count data: A case study of facility-based maternal deaths from Mozambique

PLoS One. 2018 Nov 9;13(11):e0202186. doi: 10.1371/journal.pone.0202186. eCollection 2018.

Abstract

Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with overdispersion and clustered counts when analyzing data on maternal deaths and related risk factors within health facilities in Mozambique. This paper aims at providing additional insights over previous analyses and presents an extension of such models to account for spatial variation in a disease mapping framework of facility-based maternal mortality in Mozambique.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Maternal Mortality*
  • Models, Biological*
  • Mozambique / epidemiology
  • Pregnancy
  • Pregnancy Complications / mortality*

Grants and funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article. The present study received financial support from Universidade Eduardo Mondlane (UEM)/Vlaamse Interuniversitaire Raad (VLIR-UOS) DESAFIO Program. The authors would also like to acknowledge the Ministry of Health of Mozambique (MISAU) for providing the data.