Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.

Processes of change in the transition to adulthood

 A re-conceptualisation of the risk process was an outcome of this research, from which a positioning theory of crime was developed to explain more comprehensively the causal mechanisms by which risk effects are exerted and conduce to offending behaviour.

Perceptions of change in office space design: redesigning Barwon Water’s office environment

In early 2015 Barwon Water received State government funding to rationalise and renovate its various Geelong-based administrative offices into one complex. Integral to the renovations is a new green-star retrofit of the existing Ryrie Street complex by GHD Woodhead. The project will consolidate all of Barwon Water’s offices onto one site, increase floor space, provide a new ‘green’ atrium, and adopt an open plan layout. Having set a new strategic direction, Barwon Water is now undergoing a wholesale cultural and operational change in order to realise these strategic objectives. Aspirations for workplace design have been identified as: environmentally sustainable; foster innovation and creativity; establish connections; improve communication and collaboration; provide efficient space for effective work; flexibility over time; welcoming and connected to the community; healthy; and, up to date technology. This paper investigates Barwon Water staff perceptions and apprehensions of this prospective consolidation, particularly the proposed open plan office environment. While most research in this topic is informed by an immediate pre-design workshop of staff needs, this research provides a longitudinal perspective of human perceptions about work place environment change and a review of how changes in office environment synergistically align to architectural responses and changes in corporate strategies.