Indicator 3.1.1 Maternal mortality ratio

Goal 3: Ensure healthy lives and promote well-being for all at all ages

Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

Indicator 3.1.1: Maternal Mortality Ratio By Sex, Age, Employment Status And Geographical Location (Urban/Rural)

November 2021

3.1.2: Proportion of births attended by skilled health personnel

Uganda Bureau of Statistics (UBOS)

Uganda Bureau of Statistics (UBOS)

Johnstone Galande

Department of Demography and Social Statistics

Senior Demographer

+256 782 789787

P.O Box 7186, Kampala

galandej1@gmail.com

Definition:

The Maternal Mortality Ratio (MMR) is defined as The number of women who die as a result of pregnancy and childbirth related complications (maternal deaths during pregnancy, childbirth and within six weeks after childbirth) per 100,000 live births in a given period. Maternal deaths: The number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of a pregnancy, irrespective of the duration and site of the pregnancy, expressed per 100,000 live births, for a specified time period.

Concepts:

Maternal death: The death of a woman while pregnant or within 42 days of termination of a pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management (from direct or indirect obstetric death), but not from accidental or incidental causes. Pregnancy-related death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.

Ratio

Maternal death in ICD-10

The Uganda Demography and Health Survey (UDHS)

Sample Design:

The sample design for the 2016 UDHS used the sampling frame from the Uganda National Population and Housing Census (NPHC 2014). The census frame is a complete list of all census Enumeration Areas (EAs) created for the 2014 NPHC. In Uganda, an EA is a geographic area that covers an average of about 130 households. At the time of the NPHC, Uganda was divided administratively into 112 districts, which were grouped for this survey into 15 regions. The sample for the 2016 UDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the 15 sub regions. Estimates are also presented for three special areas: the Lake Victoria islands, the mountainous districts, and greater Kampala. The 2016 UDHS sample was stratified and selected in two stages. In the first stage, 697 EAs were selected from the 2014 NPHC, 162 EAs in urban areas and 535 in rural areas. Households constituted the second stage of sampling. A listing of households was compiled in each of the 696 accessible selected EAs from April to October 2016. To minimize the task of household listing, each large EA (that is to say more than 300 households) selected for the 2016 UDHS was segmented. Only one segment was selected for the survey with probability proportional to segment size, and the household listing was conducted only in the selected segment. Out of the 20,880 selected households (30 households per EA), 18,506 women aged 15-49 were successfully interviewed. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In one-third of the sampled households, all men age 15-54, including both usual residents and visitors who stayed in the household the night before the interview, were eligible for individual interviews.

Recruitment and Training:

UBOS recruited and trained field staff to serve as supervisors, CAPI managers, interviewers, health technicians, and reserve interviewers for the main fieldwork. Health technicians were trained separately from interviewers. A two-day field practice was organized to provide trainees with additional hands-on practice before the actual fieldwork. Prior to the main field work, a pre-test was conducted and best practices were adopted.

Questionnaires:

Four questionnaires were used for the 2016 UDHS: The Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Uganda. Input was solicited from all stakeholders such as; Government Ministries and Agencies, Non-governmental Organizations, and Development partners. After the finalization of the questionnaires in English, they were then translated into eight major local languages. The Household, Woman’s, and Man’s Questionnaires were programmed into a computer-assisted personal interviewing (CAPI) application for data collection purposes.

Data collection:

Data collection was conducted by 21 field teams, each consisting of one team leader, one field data Manager, three female interviewers, one male interviewer, one health technician, and a driver. The health technicians were responsible for anthropometric measurements, blood sample collection for Hemoglobin and malaria testing, and DBS specimen collection for vitamin A testing. The, interviewers used tablets to record all questionnaire responses during the interviews. The tablets were equipped with Bluetooth technology to enable remote electronic transfer of files, such as assignments from the team supervisor to the interviewers, individual questionnaires among survey team members, and completed questionnaires from interviewers to team supervisors.

Every 5 years

2022

Uganda Bureau of Statistics

Uganda Bureau of Statistics and ICF

The Uganda Bureau of Statistics (UBOS) Act, 1998 provides for the development and maintenance of a National Statistical System (NSS) to ensure collection, analysis and publication of integrated, relevant, reliable and timely statistical information. It established the Bureau as the coordinating, monitoring and supervisory body for the National Statistical System.

MMR is one of the indicators indicators which measures the level of human and social development. It particularly reveals women’s’ overall status, access to health care and the responsiveness of the health care system to their reproductive health needs.

Estimates based on the sibling method depend on respondent recall. Despite this concern, in the absence of vital registration data, DHS maternal mortality estimates may be the only reliable sources of these data.

MMR is computed using the direct sister hood method. The maternal mortality ratio was calculated by dividing the age-standardized maternal mortality rate for women age 15-49 in the 7 years preceding the survey by the general fertility rate (GFR) for the same time period. The number of maternal deaths per 1,000 women age 15-49. Maternal mortality rates by 5-year age groups are calculated by dividing the number of maternal deaths to female siblings of respondents in each age group by the total person-years of exposure of the sisters to the risk of dying in that age group during the 7 years preceding the survey. The number of deaths is the number of sisters reported as having died in the 7 years preceding the survey either during pregnancy or delivery, or in the 42 days following the delivery, by their age group at the time of death. Deaths due to accident or violence are excluded. The person-years of exposure in each age group are calculated for both surviving and dead sisters based on their reported current age (living sisters) or age at death and years since death (dead sisters).

A wide consultative process is undertaken to compile, assess and validate data on the indicator. The consultation process solicited feedback directly from other Government Agencies responsible for official statistics, on the compilation of the indicators, including the data sources used, and the application of internationally agreed definitions, classification and methodologies to the data from that source. The results of this Indicator consultation are reviewed by Ministry of Health (MOH), International agencies and other stakeholders.

None

1. The survey implementation is overseen by a technical working Group which is constituted using a multi sectorial approach. 2. The survey report is reviewed by an experienced team at Management level who are in most cases Directors or Heads of departments and key stakeholders from Makerere School of Public Health, Molecular Laboratory of Makerere University School of Health Sciences, Ministry of Health and later reviewed by consultants.

The UDHS goes through several stages before production and sharing of the final findings. During the Survey implementation. i. ii. Consultative user needs assessment meetings are held with all key stakeholders. ICF International provided consultants to oversee the UDHS iii. The survey and sampling design generated using scientific methods as recommended by the Census and Survey Rules and Regulations. iv. The questionnaire development for different categories of the Target respondents were adapted to reflect the population and health issues relevant to Uganda. (Man’s Questionnaire, Woman’s questionnaire, Biomarker questionnaire and Field worker questionnaire. This follows a multi-stakeholder approach and pretesting helps to establish the relevancy and adequacy of the questions to be used. v. Survey staff are trained on the survey tools and the survey CAPI system before deployment to the field. vi. Senior Supervision is conducted during data collection to ensure that quality data is collected. vii. Debriefing meetings are organized with survey staff at agreed intervals to discuss the field challenges. viii. Field Data editing, Secondary data cleaning and coding is undertaken before analysis and report writing

Before dissemination, the report is reviewed and quality assured by a professional team in the National Statistical System. Quality Control is addressed at all levels during Survey implementation.

Data Availability Data Available Every 5 years.

Time Series 2016

Disaggregation: National

Not applicable

Uganda Demographic and Health Survey 2016 [FR333] (ubos.org) maternal mortality – levels and trends 2000-2017: http://mmr2017.srhr.org. https://dhsprogram.com/