روند علل مرگ مادران در ايران و ساير كشورهاي منطقه در طول سالهاي 2016-1990

Trends in the Causes of Maternal Mortality in Iran and other Countries in the Region During the Years 1990 – 2016

: ﺷﻨﺎﺧﺖ ﻋﻠﻞ ﻣﺮگ ﻣﺎدران و ﻓﺮاواﻧﯽ و روﻧﺪ ﻫﺮ ﯾﮏ از آﻧﻬﺎ در ﻃﻮل زﻣﺎن اوﻟﯿﻦ ﮔﺎم ﻣﻬﻢ ﺑﺮاي ﺳﯿﺎﺳﺘﮕﺬاري در ﻧﻈﺎم ﺳﻼﻣﺖ در راﺳﺘﺎي ﮐﺎﻫﺶ ﻣﺮگ ﻣﺎدران ﻣﯽ ﺑﺎﺷﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ ﻣﻘﺎﯾﺴﻪ اي روﻧﺪ ﻋﻠﻞ ﻣﺮگ ﻣﺎدران در اﯾﺮان ﺑﺎ ﺳﺎﯾﺮ ﮐﺸﻮرﻫﺎي ﻣﻨﻄﻘﻪ ﺷﺎﻣﻞ 30 ﮐﺸﻮر اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روشﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻃﻮﻟﯽ ﮐﻪ از ﻧﻮع ﮐﻮﻫﻮرت ﺗﺎرﯾﺨﯽ ﻣﯽ ﺑﺎﺷﺪ، روﻧﺪ ﻋﻠﻞ ﻣﺮگ ﻣﺎدران ﺑﯿﻦ ﺳﺎﻟﻬﺎي 1990 ﺗﺎ 2016 ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺖ. داده ﻫﺎي ﻣﻄﺎﻟﻌﻪ از ﺳﺎﯾﺖ ﺑﺎر ﺟﻬﺎﻧﯽ ﺑﯿﻤﺎرﯾﻬﺎ )GBD( ﮔﺮدآوري ﺷﺪ و ﺗﺤﻠﯿﻞ ﺛﺎﻧﻮﯾﻪ ﺑﺮ روي آﻧﻬﺎ ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮﻧﻬﺎي رﮔﺮﺳﯿﻮﻧﯽ ﺧﻄﯽ ﭼﻨﺪ ﺳﻄﺤﯽ اﻧﺠﺎم ﺷﺪ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ، زﻣﺎن"، ﻣﺘﻐﯿﺮ ﻣﺴﺘﻘﻞ و درﺻﺪ ﻋﻠﻞ ﻣﺮگ"، ﻣﺘﻐﯿﺮ واﺑﺴﺘﻪ ﻣﯽ ﺑﺎﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: از ﺑﯿﻦ ﻋﻠﻞ ﻣﺴﺘﻘﯿﻢ ﻣﺮگ، ﺧﻮﻧﺮﯾﺰي، ﺑﺎ وﺟﻮد داﺷﺘﻦ روﻧﺪ ﮐﺎﻫﺸﯽ ﻣﻌﻨﯽ دار، ﺑﺎ ﺿﺮﯾﺐ 0/28 ﻣﻬﻤﺘﺮﯾﻦ ﻋﻠﺖ ﻣﺮگ ﻣﺎدران در اﯾﺮان ﺑﻮده اﺳﺖp<0.001, 0/25, -0/31- =CI ﺳﺎﯾﺮ ﻋﻠﻞ ﻣﺴﺘﻘﯿﻢ ﻣﺮگ ﺷﺎﻣﻞ ﻓﺸﺎر ﺧﻮن، ﻋﻔﻮﻧﺖ، ﺳﻘﻂ و ﺣﺎﻣﻠﮕﯽ ﺧﺎرج رﺣﻤﯽ، اﻧﺴﺪاد زاﯾﻤﺎن و ﭘﺎرﮔﯽ رﺣﻢ و ﻣﺮگ ﺑﻌﻠﺖ ﺗﺎﺧﯿﺮات ﻧﯿﺰ در ﻃﻮل دوره ﺳﺎﻟﯿﺎﻧﻪ ﻫﻤﮕﯽ روﻧﺪ ﮐﺎﻫﺸﯽ ﻣﻌﻨﯽ داري ﺑﺎ ﺿﺮاﯾﺐ رﮔﺮﺳﯿﻮﻧﯽ ﺑﻪ ﺗﺮﺗﯿﺐ 0/15 ،0/16 ،0/17، 0/13 و 0/02 داﺷﺘﻪ اﻧﺪ )0/001

Understanding the causes and frequency of maternal mortality and their occurrence over time is the first important step in policymaking to reduce maternal mortality. The purpose of this study was to compare the trends in the causes of maternal mortality in Iran and other countries in the region including 30 countries. METHODS In this longitudinal, retrospective cohort study, the trends in causes of maternal mortality between 1990 and 2016 were evaluated. The study data were collected from the Global Burden of Disease Study (GBD) website and a secondary analysis was performed using Multilevel Linear Regression Models. In this study, "time" is the independent variable and "percentage of causes of death" is the dependent variable. FINDINGS Among the direct causes of death, hemorrhage, despite a significant decreasing trend, was the most important cause of maternal mortality in Iran with a coefficient of 0.28 (CI = -0.25, -0.31, p<0.001). Other direct causes of death, including hypertension, infection, abortion and ectopic pregnancy, labor obstruction, and uterine rupture and death due to delays, all showed a significant decreasing trend during the annual period with regression coefficients of 0.17, 0.16, 0.15, 0.13, and 0.02, respectively (p<0.001). After hemorrhage, indirect causes and deaths due to other reasons were respectively ranked as second and third causes. The trends in almost all causes of death in Iran have declined significantly over this period compared to other countries in the region. CONCLUSION The results of the study showed that the trends in all causes of maternal mortality has decreased significantly in Iran over the past 26 years, but this decline was lower compared to other countries in the region.