GMatH Pseudocode
Model Inputs \(\rightarrow\) GMatH Pseudocode
//Simulate each country - all parameters are country-specific
//Initialize population trends for each country
Initialize population projections //(see Appendix A.1.1.2: Population Projections)
Initialize education projections //(see Appendix A.1.1.5 Education Projections)
//Initialize individual-level characteristics at model startup
For each woman:
Assign subgroup (urban/rural location + education level) | Birth year
Assign age of sexual debut | Subgroup //(see Appendix A.1.3.1 Age of Sexual Debut)
Assign age of menopause //(see Appendix A.1.2.9 Menopause)
Assign hemoglobin latent variable //~Norm(0,1) (see Appendix A.1.2.10 Anemia)
Assign desired number of children | Subgroup, Year /*(see Appendix A.1.3.3
Desired Number of Children)*/
Initialize current living children | Subgroup, Age, Year /*(see Appendix A.1.3.2
Number of Living Children)*/
Initialize history of previous miscarriages | Current living children
//~Pois(0.2*numLivingKids) assume 20% risk of historic miscarriage
//Simulate population going forward
for(t=0; t<numCycles; t++){ //monthly cycle length
Add incoming females to population //(see Appendix A.1.1.2: Population Projections)
for(w=0; w<numWomen; w++){ //For each woman currently in the population
Risk background mortality | Age, Year (remove risk of maternal deaths)
//(see Appendices A.1.1.3: Lifetables, A.1.5.7 Indirect Maternal Deaths)
Risk indirect maternal mortality (ages 15-49) | Year
(remove accidental/incidental deaths)
/*(see Appendices A.1.5.7 Indirect Maternal Deaths,
A.1.1.4 Proportion of Deaths due to Injury)*/
Risk incidence of late maternal event (if >2 months and <=1 year of last delivery)
//(see Appendix A.1.5.6 Late Maternal Deaths)
if(lateEvent==true){ //has late maternal event
simulateReferral() //Simulate facility referral, see function below
Risk late maternal death | Site, Quality, Year /*(see Appendices A.1.5.6
Late Maternal Deaths,
A.1.4.6 Quality of Care)*/
}
If woman died, simulate if reported | Site, Year /*(see Appendix A.1.4.7
Maternal Death Underreporting)*/
if alive{
Risk child mortality for each living child | Age, Sex, Year
//(see Appendix A.1.1.3 Lifetables)
//check for sexual debut (see Appendix 1.3.1 Age of Sexual Debut)
if(sexuallyActive==false & curAge>=ageAtSexualDebut){
sexuallyActive=true
assignContraception() /*Assign contraception status + method,
see function below*/
}
//check for menopause (see Appendix A.1.2.9 Menopause)
if(menopause==false & curAge>=ageAtMenopause){
menopause=true
}
//If fecund (sexually active, not currently pregnant, pre-menopausal)
if(pregnant==false & sexuallyActive==true & menopause==false){
//risk pregnancy
updateContraception() //Update contraception status, see function below
Update breastfeeding (LAM) status | Time since delivery, # living infants
//(see Appendix A.1.3.10 Breastfeeding)
Risk conception | Age, LAM, Contraception method(subgroup)
/*(see Appendices A.1.2.1 Natural Fecundity/Fertility,
A.1.2.8 Lactational Amenorrhea (LAM),
A.1.3.6 Contraception Failure Rates)*/
if(conception==true){ //becomes pregnant
Assign ANC visits | Subgroup, Year /*(see Appendix A.1.4.1
Antenatal Care)*/
Assign anemia (Hb) | Subgroup, Year, ANC /*(see Appendix A.1.2.10
Anemia*/
Simulate number of fetuses | Maternal age /*(see Appendix A.1.2.3
Twinning Rates)*/
Assign sex for each fetus /(see Appendix A.1.2.2 Sex Ratio - Primary)
//Pre-draw pregnancy outcome and time to event
Simulate risk of elective abortion if unwanted pregnancy |
Subgroup, Year, Fetus sex, Secondary sex ratio(Subgroup,Year)
//(see Appendices A.1.3.8 Abortion, A.1.3.9 Sex Ratio - Secondary)
/*risk ectopic pregnancy, miscarriage, stillbirth
(estimates are conditional on no induced abortion)*/
if(abortion==false){
/*Note: Ectopic pregnancy, miscarriage, and stillbirth are
modelled as mutually exclusive events*/
Simulate risk of ectopic pregnancy |
Maternal age, History of ectopic pregnancy /*(see Appendix
A.1.2.5 Ectopic Pregnancy)*/
Simulate risk of miscarriage |
Maternal age, History of miscarriage /*(see Appendix A.1.2.4
Miscarriage)*/
Simulate risk of antepartum stillbirth | Maternal age, Fetus sex
//(see Appendix A.1.2.6 Stillbirths)
Draw time to event //(see Appendix A.1.2.7 Month of Delivery)
}
}
//if currently pregnant and time for pregnancy outcome
if(pregnant==true & t==eventTime){
//pregnancy loss
if(outcome=='abortion'){ /*elective abortion (see Appendix A.1.3.8
Abortion)*/
Simulate abortion type ('safe'/'unsafe') | Subgroup, Year
Risk maternal death | Abortion type, Anemia
If woman survives, risk infertility | Abortion type
}
else if(outcome=='miscarriage'){ /*miscarriage (see Appendix A.1.2.4
Miscarriage)*/
Update miscarriage history
}
else if(outcome=='ectopic'){ /*ectopic pregnancy (see Appendix A.1.2.5
Ectopic Pregnancy)*/
Risk rupture
if(rupture){
simulateReferral() /*Simulate facility referral,
see function below*/
Risk maternal death |
Site, Treatment Availability(Year)+Efficacy, Quality(Year)
/*(see Appendices A.1.6.5 Management of Ectopic Pregnancy,
A.1.4.6 Quality of Care)*/
}
}
//pregnancy is carried to delivery
if(outcome=='delivery'){
Simulate starting delivery site | Subgroup, Year
//(see Appendix A.1.4.2 Starting Delivery Site)
Simulate elective c-section | Subgroup, Year
//(see Appendix A.1.6.1 Elective Caesarean Section)
//risk delivery complications
/*Preeclampsia/Eclampsia (see Appendix A.1.5.1
Preeclampsia/Eclampsia)*/
if(electiveCSection==false){
Risk PE/E incidence | Maternal age, Severe anemia,
Multiple gestation, History of PE/E
if(hasComplication){
simulateReferral() /*Simulate facility referral,
see function below*/
Risk maternal death | Severity, Site,
Treatment Availability(Year)+Efficacy, Quality(Year)
/*(see Appendices A.1.6.6 Hypertension Management,
A.1.4.6 Quality of Care)*/
if(alive){ //woman survives
Risk morbidity (subsequent infertility)
Risk intrapartum stillbirth
}
}
}
//Obstructed labour (see Appendix A.1.5.2 Obstructed Labor)
if(alive==true & electiveCSection==false){
Risk OL incidence | Maternal Age,
Partograph Availability(Year)+Efficacy, Quality(Year)
//(see Appendices A.1.6.3 Partograph, A.1.4.6 Quality of Care)
if(hasComplication){
simulateReferral() /*Simulate facility referral,
see function below*/
Risk maternal death | Severity, Site,
Treatment Availability(Year)+Efficacy, Quality(Year)
/*(see Appendices A.1.6.7 Assisted Delivery,
A.1.4.6 Quality of Care)*/
if(alive){ //woman survives
Risk morbidity (fistula, assume subsequent infertility)
Risk intrapartum stillbirth
}
}
}
//Other direct (see Appendix A.1.5.5 Other Direct Complications)
if(alive==true){
Risk other direct incidence
if(hasComplication){
simulateReferral() /*Simulate facility referral,
see function below*/
Risk maternal death | Site, Quality(Year)
//(see Appendix A.1.4.6 Quality of Care)
}
}
/*Postpartum hemorrhage (see Appendix A.1.5.3
Postpartum Hemorrhage)*/
if(alive==true & electiveCSection==false){
Risk PPH incidence |
Active Management Availability(Year)+Efficacy, Quality(Year)
/*(see Appendices A.1.6.2 Active Management of Labor,
A.1.4.6 Quality of Care)*/
if(hasComplication){
simulateReferral() /*Simulate facility referral,
see function below*/
Risk maternal death | Severity, Anemia, Site,
Treatment Availability(Year)+Efficacy, Quality(Year)
/*(see Appendices A.1.2.10 Anemia,
A.1.6.8 Hemorrhage Treatment,
A.1.4.6 Quality of Care)*/
if(alive){ //woman survives
Risk morbidity (assume subsequent infertility)
Simulate hemoglobin loss
}
}
}
//Sepsis (see Appendix A.1.5.4 Sepsis)
if(alive==true){
Risk sepsis incidence | C-section,
Clean Delivery Availability(Year)+Efficacy, Quality(Year)
//(see Appendix A.1.6.4 Clean delivery, A.1.4.6 Quality of Care)
if(hasComplication){
simulateReferral() /*Simulate facility referral,
see function below*/
Risk maternal death | Severity, Anemia, Site,
Treatment Availability(Year)+Efficacy, Quality(Year)
/*(see Appendices A.1.2.10 Anemia, A.1.6.9 Antibiotics,
A.1.4.6 Quality of Care)*/
if(alive){ //woman survives
Risk morbidity (secondary infertility)
}
}
}
if(woman is alive & fetus(es) is/are alive){
Record birth(s)
Add new infant child(ren)
Simulate breastfeeding status (exclusive/non-exclusive)
and duration //(see Appendix A.1.3.10 Breastfeeding)
}
}
if(alive==false){ //woman died
Simulate if maternal death is reported | Site, Year
//(see Appendix A.1.4.7 Maternal Death Underreporting)
}
else{ //woman is alive
assignContraception() /*Assign contraception status + method,
see function below*/
}
} //end pregnancy outcome
} //end if fecund
} //end if alive
} //end woman loop
} //end cycle loop
//Simulates referral to a healthcare facility
function simulateReferral(){
Simulate recognition | Site, Complication (type+severity), Subgroup, ANC (home only)
//(see Appendices A.1.4.3 Recognition/Referral, A.1.4.1 Antenatal Care)
if(recognized){
Simulate transport availability | Site, Subgroup /*(see Appendix A.1.4.4
Transportation)*/
if(transportAvailable){
Simulate referral site | Current site, Subgroup /*(see Appendix A.1.4.5
Referral Facility)*/
Update current site
}
}
}
//Assigns contraception status and method
function assignContraception(){
if(numCurrentChildren < numDesiredChildren){ //spacing
Draw spacing intention | Subgroup, Age, Year //(see Appendix A.1.3.4 Unmet Need)
if(desiresBirthSoon){
No need for contraception (no method assigned)
}
else{ //wants to space children
Check if spacing need is met | Subgroup, Age, Year /*(see Appendix A.1.3.4
Unmet Need)*/
if(needMet){
Assign contraception method | Subgroup, Spacing, Year
//(see Appendix A.1.3.5 Contraception Method Mix)
Assign intended duration of use | Method, Subgroup
//(see Appendix A.1.3.7 Method Duration of Use)
}
else{ //unmet need
No method assigned
}
}
}
else{ //limiting (met or exceeded desired number of children)
Check if limited need is met | Subgroup, Age, Year /*(see Appendix A.1.3.4
Unmet Need)*/
if(needMet){
Assign contraception method | Subgroup, Limiting, Year
//(see Appendix A.1.3.5 Contraception Method Mix)
Assume indefinite use of method
}
else{ //unmet need
No method assigned
}
}
}
//Updates contraception status
function updateContraception(){
if(usingContraception & timeUse==duration){ //check if duration of use has elapsed
Simulate if woman discontinues all methods or switches to another method
//(see Appendix A.1.3.7 Method Duration of Use)
if(switchesMethods){
Assign new contraception method | Subgroup, Spacing, Year
//(see Appendix A.1.3.5 Contraception Method Mix)
Assign new intended duration of use | Method, Subgroup
//(see Appendix A.1.3.7 Method Duration of Use)
}
else{
Discontinues all methods (no method assigned)
}
}
}
GMatH (Global Maternal Health) Model - Last updated: 28 November 2022
© Copyright 2020-2022 Zachary J. Ward
zward@hsph.harvard.edu