Measuring maternal mortality: An overview of opportunities and options for developing countries

Department of Obstetrics and Gynaecology, University of Aberdeen, UK.
BMC Medicine (Impact Factor: 7.25). 02/2008; 6(1):12. DOI: 10.1186/1741-7015-6-12
Source: PubMed


There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015.
Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts.
There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates.
Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act.

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    • "It is also known that women who live in countries where abortion has been legalized still patronize unskilled persons for termination of unplanned pregnancies because of other reasons including religion and social issues.[7] Getting accurate data for abortions and worse unsafe abortions is challenging as many countries still have very weak Data collection and Monitoring and Evaluation (M/E) systems.[8] All over the world, women experience unplanned pregnancies and after intense consideration of their health, future and finances, they often choose to terminate such unwanted pregnancies. "
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    ABSTRACT: Context: Unsafe abortions remain a significant cause of maternal mortality and morbidity in Nigeria. They increase the burden on the already stretched health systems with majority coming in as emergencies and contribute to maternal morbidity and mortality. It is important to ascertain these contributions in order to prevent them. Objectives: This study aims at reviewing the contributions of unsafe abortions to gynaecological emergencies, the pattern of terminations and complications, as well as morbidity and mortality among women in Jos University Teaching Hospital (JUTH). Methodology: The 120 cases of unsafe abortions managed from January 2001 to December 2005 at the Jos University Teaching Hospital were reviewed. Information was retrieved from patients’ case notes in the various gynaecological units as well as daily ward reports and analyzed using EPI Info statistical software version 3.3. Results: Induced abortions contributed 4.8% of the 2,495 gynaecological emergencies and 12.64% maternal deaths; with the maternal mortality ratio being 891/100,000 live births. The age range was 14 – 45 years, with the majority 33% (40) being adolescents. Singles contributed 70.8% (85), married 26.7 %( 32), and separated/divorced 2.5 % (3). Parity range was 0 – 10, with 66.4% being nulliparous and 21.1% grand-multipara. At presentation, 26 (21.7%) denied termination of pregnancy. Modal gestational age was 13 weeks. Surgical termination occurred in 75 (62.8%) of patients. There were 51 abortions (42.5%) procured at private clinics and 28 (23.1%) at chemists and homes. Most of the patients 60.8% (73) were first timers. Most of the complications of induced abortion occurred in the first week and were mainly: incomplete abortion, septicemia, uterine perforation, acute renal failure, pelvic abscess and tetanus. Uterine evacuation was done for 47.8%, laparotomy for 17.5% and blood transfusion for 23.3% of the patients. Days on admission ranged from 0 – 64 days. The case fatality rate was 11.2% with 30.8%of the deaths attributed to the use of herbal concoctions. Conclusion: The morbidity and mortality from unsafe abortions remains high. Adolescents contribute high numbers warranting programs for adolescent reproductive health services and improved contraceptive utilization.
    06/2015; 6(6):402-411. DOI:10.7439/ijbr.v6i6.2114
    • "Via the DS method, women provide mortality information for all their sisters. It is widely used to establish PRMRs via large household surveys because it provides population-representative data, generates a recent estimate, and is easily included in multipurpose surveys [7] [8] [9]. With the HH method, household heads report on deaths occurring within their household. "
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    ABSTRACT: To compare sociodemographic and pregnancy characteristics of pregnancy-related deaths identified by the direct sisterhood and the verbal autopsy with household mortality (HHVA) methods. Nationally representative data for 1997-2001 were obtained from the household, verbal autopsy, and women's questionnaires of the Bangladesh Maternal Health Services and Maternal Mortality Services Survey, 2001. Sociodemographic and pregnancy characteristics were compared for maternal deaths identified by the two methods. Characteristics of deceased women were reported directly with HHVA, but extrapolated in the direct sisterhood method using the reporting sister as proxy. Overall, 201 pregnancy-related deaths were identified via HHVA and 388 through DS reporting. There were no significant differences between reporting sister characteristics and deceased women's characteristics in educational attainment, working status, husband's educational attainment, and spouse educational parity. However, timing of death relative to pregnancy phase, number of previous live births, and years since death did differ (P<0.05). The sociodemographic characteristics of women with pregnancy-related deaths identified via the two methods were similar. However, some pregnancy characteristics differed significantly, suggesting that different policy interventions are required. Before considering using sister proxy characteristics to target services, issues responsible for these differences should be resolved, and generalizability of evaluated indicators must be considered. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
    International Journal of Gynecology & Obstetrics 02/2015; 129(3). DOI:10.1016/j.ijgo.2014.12.003 · 1.54 Impact Factor
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    • "Supported sites might have underreported deaths, because investigation requires extra work and (despite assurances to the contrary) providers and administrators may feel defensive or apprehensive about an audit. Related reviews have shown that, although maternal death audit is becoming more common in some low-income countries, facility-level data may underestimate the number of deaths [19] [20]. "
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    ABSTRACT: Objective To describe the mortality risk associated with surgical treatment of female genital fistula and the contributory and contextual factors. Methods In a descriptive study, confidential inquiries and clinical audits were conducted at 14 fistula repair sites in seven resource-poor countries between January 2005 and March 2013. Data collection included interviews with key personnel involved in the clinical management of the deceased, and a review of hospital records and patient files following an audit protocol. Results Overall, 26 060 fistula repairs were performed at 44 sites located in 13 countries; 30 deaths were reported in this period. Twenty-one deaths were attributable to surgery, yielding a case fatality of 0.08 per 100 procedures. The cause of death in nearly half of the cases was various manifestations of sepsis and inflammation. Conclusion The case fatality rate for fistula repair surgery in resource-poor countries was in the same range as that for comparable gynecologic operations in high-resource settings. Clinical and systemic issues to be addressed to reduce the case fatality rate include improvement of perioperative care and follow-up, assuring prudent referral or deferral of difficult cases, and maintaining better records.
    International Journal of Gynecology & Obstetrics 08/2014; 126(2). DOI:10.1016/j.ijgo.2014.02.015 · 1.54 Impact Factor
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