Bayesian multilevel model on maternal mortality in Ethiopia

Abstract

Introduction: Maternal mortality is one of the socio-economic problems and widely considered a serious indicator of the quality of a health. As UNICEF report in 2016 the global MMR declined by 44% during the MDG era, which indicate that, the annual reduction of 2.3% between 1990 and 2015. Maternal mortality is significantly affecting the county of low resources especially sub-Saharan country and the distributions of the death are different from county to country and also from region to region. Ethiopia is considered to be one of the top six subSaharan countries with severe maternal mortality. The objective of this study was to investigate the effects of the Demographic and Socio-economic determinant factors of maternal mortality in Ethiopia using Bayesian multilevel model. Data and Method: Data from the 2016 Ethiopia Demographic and Health Survey indicated that the sample of women (15-49) was (n=15683) in Ethiopia. However, due to some women were not eligible under some covariates, the sample size with full information of maternal mortality for all covariates was (n=10103). The Bayesian multilevel Logistic regression model was used to explore the major risk factors and regional variations in maternal mortality in Ethiopia. To determine the posterior marginal, the MCMC methods with non-informative priors have been applied. The DIC model selection criteria were used to select the appropriate model. Results: The analysis result revealed that out of the 10103 number of women’s considered in the analysis, 145(1.43%) mothers were died due to pregnancy, while 9958 (98.67%) were not.. Using model selection criteria Bayesian multilevel logistic regression of random coefficient model was found to be appropriate. Thus, with this model, Age of mother, marital status, number of living children, wealth index and Educational level are found to be the significant determinants of maternal mortality in Ethiopia. The study indicated that there was within and between regional variations in maternal mortality. Conclusions: The major significant factors affecting maternal mortality are: mother’s education level, wealth index, number of children, marital status and age of mothers. It also revealed that there is a contribution of those major factors to maternal mortality variations among regional states. The Bayesian multilevel random coefficient model is the appropriate model.