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We used data on household deaths collected in the census to estimate the lifetime risk of pregnancy-related death among females in Zambia. Using all-cause age-specific death rates, we generated female life tables for 74 districts and estimated person-years of exposure to all-cause mortality at each age. We then applied age-specific pregnancy-related mortality rates to the person-years of exposure to obtain estimates of adult lifetime risk that took account of competing causes of death.
We used the ArcGIS software to analyse clustering and the spatial distribution of risk. A female aged 15 in Zambia had a 3. At district level, the lifetime risk ranged from 1. Clustering of high-risk districts was found in Western province while clustering of low risk districts was found in Lusaka and Muchinga provinces. The level of adult lifetime risk was more positively associated with pregnancy-related mortality than with fertility.
Females in Zambia have a high lifetime risk of pregnancy-related death overall but this risk varies greatly across the different districts of the country. The observed diversity is larger than when merely studying differences between provinces and is only weakly linked to differences in fertility levels.
The identification of districts with varying levels of risk should enable evidence-based and focused delivery of maternal health services in districts where risk of death from maternal causes is greatest. Studies show that the main direct obstetric causes of maternal deaths are haemorrhage, hypertensive disorders of pregnancy, sepsis and complications of abortion Ronsmans et al. Although many women die annually from maternal causes, such deaths are preventable with known interventions Campbell and Graham ; Ronsmans et al.
To reduce maternal mortality, interventions must be focused in areas where women face the greatest risk Ronsmans et al. The level of maternal mortality in a population is considered to be a result of a combination of the risk of death during pregnancy or childbirth and the level of fertility World Health Organisation et al. The adult lifetime risk ALTR of maternal mortality is therefore an important indicator of the reproductive health status of the population as it measures the cumulative loss of adult female life due to maternal causes Wilmoth While the maternal mortality ratio MMRatio is an important indicator of the current magnitude of mortality due to maternal causes, the ALTR gives an indication of the number of deaths that could potentially be averted Graham et al.