TABLE 6.

Changes in District-Wide Numbers of Maternal Deaths and Maternal Mortality Ratios (per 100,000 Live Births) in Uganda and Zambia SMGL-Supported Districts, by Cause and Timing of Death

	Uganda				Zambia
	Baseline	Endline	% Change	Sig. Level^a	Baseline	Endline	% Change	Sig. Level^a
Number of maternal deaths	342	222	N/A	N/A	200	135	N/A	N/A
Total MMR^b^,^c	452	255	−44	***	480	284	−41	***
Cause of death (MMRs)^d
Direct obstetric causes	382	195	−49	***	364	220	−40	***
Obstetric hemorrhage	128	70	−45	***	131	45	−66	***
Obstructed labor (including uterine rupture)	71	46	−36	**	44	6	−87	**
Preeclampsia/eclampsia	58	29	−51	***	36	22	−39	NS
Puerperal infection/sepsis	33	21	−37	NS	29	42	+44	NS
Abortion-related	42	14	−67	***	66	64	−2	NS
Other direct obstetric causes	49	16	−67	***	58	42	−28	NS
Indirect obstetric causes	70	60	−15	NS	116	64	−45	NS
Timing of death (MMRs)^e
Antepartum	66	53	−20	NS	109	59	−46	NS
Intrapartum and immediate postpartum (up to 24 hours)	224	62	−72	***	196	106	−46	**
>24 hours–42 days postpartum	161	140	−13	NS	175	120	−31	NS

Abbreviations: MMR, maternal mortality ratio; P/F, parity/fertility; Sig., significance.
↵a Asterisks indicate significance level of the difference between baseline and 2016 MMRs, using a z statistic to calculate the P value of the difference, as follows: ***P<.01, **P<.05, NS = not significant. N/A = not applicable.
↵b Uganda MMRs are direct estimates for the baseline (June 2011–May 2012) and endline (2016): baseline MMR=342 maternal deaths/75,675 live births*100,000; 2016 MMR=222 maternal deaths/87,094 live births*100,000.
↵c Zambia MMRs are adjusted estimates using General Growth Balance method for compensating underreporting of all deaths to WRA in the previous 12 months and applying the proportion of deaths among WRA that are due to maternal causes to derive maternal deaths; population live births were adjusted using P/F ratios estimated from the lifetime fertility of women of reproductive age. Adjusted baseline MMR=200 maternal deaths/41,665 live births; adjusted endline MMR=135/47,509 live births.
↵d Uganda cause-specific MMRs are direct estimates using population maternal deaths of a specific cause divided by total number of population live births. Zambia cause-specific MMRs are adjusted estimates using General Growth Balance method for adjusting all deaths to WRA and applying the proportion of deaths among WRA that are due to maternal causes to derive maternal deaths; crude percent distribution by cause is applied to the adjusted maternal deaths to derive adjusted cause-specific MMRs.
↵e Uganda time-of-death MMRs are direct estimates using population maternal deaths while pregnant (antepartum), during delivery or first 24 hours postpartum, and up to 42 days postpartum divided by total number of population live births. Zambia MMRs are adjusted estimates using General Growth Balance method for adjusting all deaths to WRA and applying the proportion of deaths among WRA that are due to maternal causes to derive maternal death; crude percent distribution by timing of death is applied to the adjusted maternal deaths to derive adjusted cause-specific MMRs.