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: 7.28). 02/2008; 6:12. DOI: 10.1186/1741-7015-6-12
Source: PubMed

ABSTRACT 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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    • "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 · 1.56 Impact Factor
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    • "However, because maternal mortality is a relatively rare event, even the largest of these surveys cannot accurately estimate maternal mortality at the subnational level and may not provide information on location of death [14]. Some studies have used expensive techniques such as surveys on reproductive-age mortality and case finding [14] [15] [16] [17]. Model-based approaches have also been used to obtain subnational estimates in Bangladesh [14], and some countries are including questions on maternal mortality in their national censuses. "
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    ABSTRACT: Objective To review national data on HIV and malaria as causes of maternal death and to determine the importance of looking at maternal mortality at a subnational level in Mozambique. Methods Three national data surveys were used to document HIV and malaria as causes of maternal mortality and to assess HIV and malaria prevention services for pregnant women. Data were collected between 2007 and 2011, and included population-level verbal autopsy data and household survey data. Results Verbal autopsy data indicated that 18.2% of maternal deaths were due to HIV and 23.1% were due to malaria. Only 19.6% of recently pregnant women received at least two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment, and only 42.3% of pregnant women were sleeping under an insecticide-treated net. Only 37.5% of recently pregnant women had been counseled, tested, and received an HIV test result. Coverage of prevention services varied substantially by province. Conclusion Triangulation of information on cause of death and coverage of interventions can enable appropriate targeting of maternal health interventions. Such information could also help countries in Sub-Saharan Africa to recognize and take action against malaria and HIV in an effort to decrease maternal mortality.
    International Journal of Gynecology & Obstetrics 06/2014; DOI:10.1016/j.ijgo.2014.05.002 · 1.56 Impact Factor
    • "All methods for determining, the number of maternal deaths are influenced by two major errors: Identification of deaths and determining the relevance of the cause of death to pregnancy.[1] In the present study, dependency between the databases existed only in identification of deaths. "
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    ABSTRACT: Background: Maternal mortality ratio (MMR) is one of the main indicators of the millennium development goals and its accurate estimation is very important for the countries concerned. The objective of this study is to evaluate the applicability of capture-recapture (CRC) as an analytical method to estimate MMR in countries. Methods: We used the CRC method to estimate MMR in Iran for 2004 and 2005, using two data sources: The maternal mortality surveillance system and the National Death Registry (NDR). Because the data registry contains errors, we defined three levels of matching criteria to enable matching of cases between the two systems. Increasing the matching level makes the matching criteria less conservative. Because NDR data were missing or incomplete for some provinces, we calculated estimates for two conditions: With and without missing/incomplete data. Results: According to the CRC method, MMR in 2004 and 2005 were 33 and 25 in the best-case scenarios respectively and 86 and 59 in the worst-case scenarios respectively. These estimates are closer to the ones reported by United Nations Agencies published in 2010, 38 and Hogan's study, 30 in 100,000 live births in 2005. Conclusions: The MMR estimation by CRC method is slightly different from the international studies. CRC can be considered as a cost-effective method, in comparison with cross-sectional studies or improvement of vital registration systems, which are both costly and difficult. However, to achieve accurate estimates of MMR with CRC method and decrease the uncertainty we need to have valid databases and the absence of such capacities will limit the applicability of this method in developing countries with poor quality health databases.
    International journal of preventive medicine 05/2014; 5(5):624-31.
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