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<<   作成日時 : 2010/04/13 20:19   >>

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 最新のデータによると、妊産婦死亡は1980年の約50万から2008年の35万以下にまで低下した。中国などは著しい改善があったが、米国などでは驚くほどの増加がみられた。英国では極めて低いが、過去20年間低下がみられない。安全な出産は国際的な目標であるが、いくつかの国ではその改善が遅れている。最新の研究はシアトルのワシントン大のチームによる181カ国の調査研究データである。
 世界の妊産婦死亡は1980年の526,300から2008年の342,900の下がったと概算された。2008年のすべての妊産婦死亡の半分以上がほんの6か国 - インド、パキスタン、ナイジェリア、アフガニスタン、エチオピア、コンゴ民主共和国からでている。しかし、中国、エジプト、エクアドル、ボリビアを含めいくつかの国は、母体死亡率の上の国際的な目標を達成に向けて重要な進歩がみられた。
 最も驚くべきことの一つは、米国での10万出生あたりの妊産婦死亡が1990年から2008年にかけて12から17へと増加したことである。英国では1980-1990の間で低下しその後横ばいでありほとんどの西ヨーロッパ諸国が同じ傾向にある。10万出生あたりの死亡率は英国で8、ドイツ・スペインは7、フランスは10である。
 英国での低下傾向が見られないことに懸念を表明している。妊産婦の健康状態の悪化と高齢出産の増加が原因の可能性がある。
 ランセットの編集者は、国連の発表との大きな違いがあるという。20年間の努力の成果だろうともいう。
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開発途上国の妊産婦死亡率は100年前の英国と同程度
http://kurie.at.webry.info/201003/article_10.html
国連のミレニアム開発目標(MDGs)/中間点
http://kurie.at.webry.info/200712/article_19.html
母体死亡への対策急務 年50万人の妊娠出産時死亡
http://kurie.at.webry.info/200710/article_33.html
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Page last updated at 16:26 GMT, Monday, 12 April 2010 17:26 UK
Maternal deaths 'fall worldwide'
By Helen Briggs
Health reporter, BBC News
http://news.bbc.co.uk/2/hi/health/8616250.stm

画像A doctor examines a pregnant woman in Nepal. File photo
Progress in reducing maternal deaths has been slow

Maternal deaths have fallen worldwide, from about half a million a year in 1980 to less than 350,000 in 2008, according to new data.

Countries such as China are making significant progress but there have been surprising increases in others, including the US, say researchers.

UK deaths are very low, but have not fallen in the past 20 years, the study, published in the Lancet, found.

Making childbirth safe for all women has long been an international goal.

But progress in some countries has been slow.

In the latest study, a team led by the University of Washington in Seattle, looked at data from thousands of observations of maternal deaths for 181 countries between 1980 and 2008.


Two decades of concerted campaigning by those dedicated to maternal health is working
Dr Richard Horton, Lancet Editor

They estimated there were 342,900 maternal deaths worldwide in 2008, down from 526,300 in 1980.

More than half of all maternal deaths were in only six countries in 2008 - India, Pakistan, Nigeria, Afghanistan, Ethiopia, and the Democratic Republic of the Congo.

But some countries - including China, Egypt, Ecuador and Bolivia - had made significant progress towards achieving international goals on maternal mortality.

Lead author Dr Christopher Murray said: "There are still too many mothers dying worldwide, but now we have a greater reason for optimism than has generally been perceived."

He said finding out why a country such as Egypt has had "such enormous success in driving down the number of women dying from pregnancy-related causes could enable us to export that success to countries that have been lagging behind".

Mixed progress

The picture in high-income countries is less clear. One of the most surprising findings was an increase in the number of expectant mothers dying in the US, from 12 in every 100,000 live births in 1990, to 17 in 2008.

The authors say the trend can be explained in part by changes in the way maternal deaths are recorded in the US.

In the UK, maternal mortality rates fell between 1980 and 1990, and then levelled off - which reflects the trend in most western European countries.

The rate per 100,000 live births in the UK is eight, with Germany and Spain at seven, and France at 10.

Commenting on the statistics, Cathy Warwick, General Secretary of the Royal College of Midwives, said it was clear that around the world needless deaths can be avoided.

But she expressed concern that the UK rate - although very low - is not falling.

She added: "It is possible that this is due to increasing levels of ill health amongst pregnant women and possibly to greater numbers of older women giving birth."

Lancet editor Dr Richard Horton said there was a dramatic difference between the latest estimates and those last reported by the UN.

He added: "Two decades of concerted campaigning by those dedicated to maternal health is working.

"Even greater investment in that work is likely to deliver even greater benefits. Women have long delivered for society, and, slowly, society is at last delivering for women. This is a moment to celebrate - and accelerate."

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The Lancet, Early Online Publication, 12 April 2010
doi:10.1016/S0140-6736(10)60518-1

Maternal mortality for 181 countries, 1980―2008: a systematic analysis of progress towards Millennium Development Goal

Margaret C Hogan MSc a b, Kyle J Foreman AB a, Mohsen Naghavi MD a, Stephanie Y Ahn BA a, Mengru Wang BA a, Susanna M Makela BS a, Prof Alan D Lopez PhD c, Prof Rafael Lozano MD a, Prof Christopher JL Murray MD a Corresponding AuthorEmail Address

Summary
Background
Maternal mortality remains a major challenge to health systems worldwide. Reliable information about the rates and trends in maternal mortality is essential for resource mobilisation, and for planning and assessment of progress towards Millennium Development Goal 5 (MDG 5), the target for which is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. We assessed levels and trends in maternal mortality for 181 countries.
Methods
We constructed a database of 2651 observations of maternal mortality for 181 countries for 1980―2008, from vital registration data, censuses, surveys, and verbal autopsy studies. We used robust analytical methods to generate estimates of maternal deaths and the MMR for each year between 1980 and 2008. We explored the sensitivity of our data to model specification and show the out-of-sample predictive validity of our methods.
Findings
We estimated that there were 342 900 (uncertainty interval 302 100―394 300) maternal deaths worldwide in 2008, down from 526 300 (446 400―629 600) in 1980. The global MMR decreased from 422 (358―505) in 1980 to 320 (272―388) in 1990, and was 251 (221―289) per 100 000 livebirths in 2008. The yearly rate of decline of the global MMR since 1990 was 1?3% (1?0―1?5). During 1990―2008, rates of yearly decline in the MMR varied between countries, from 8?8% (8?7―14?1) in the Maldives to an increase of 5?5% (5?2―5?6) in Zimbabwe. More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo). In the absence of HIV, there would have been 281 500 (243 900―327 900) maternal deaths worldwide in 2008.
Interpretation
Substantial, albeit varied, progress has been made towards MDG 5. Although only 23 countries are on track to achieve a 75% decrease in MMR by 2015, countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress.
Funding
Bill & Melinda Gates Foundation.

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