Abstract
BackgroundAssessing the feasibility of conducting a prospective Reproductive Age Mortality Survey (RAMOS) study in the low-income setting of Mangochi District, Malawi to obtain cotemporaneous estimates of the number, cause of and conditions associated with maternal deaths (MD) in all women of reproductive age (WRA) (n = 207 688).MethodsMD among all deaths of WRA were identified using the ICD-10 definition. Cause of death and contributing conditions identified by a panel of experts using the classification system for deaths during pregnancy, childbirth and puerperium (ICD-MM).ResultsOut of 424 deaths of WRA, 151 were MD giving a Maternal Mortality Ratio (MMR) of 363 per 100,000 live births (95 % CI: 307–425). Only 86 MD had been reported via existing reporting mechanisms representing an underreporting of 43 %. The majority of MD (62.3 %) occurred in a health facility and were the result of direct obstetric causes (74.8 %) with obstetric haemorrhage as the leading cause (35.8 %), followed by pregnancy-related infections (19.4 %), hypertensive disorders (16.8 %) and pregnancy with abortive outcome (13.2 %). Malaria was the most frequently identified indirect cause (9.9 %). Contributing conditions were more frequently identified when both verbal autopsy and facility-based death review had taken place and included obstructed labour (28.5 %), anaemia (12.6 %) and positive HIV status (4.0 %).ConclusionThe high number of MD that occur at health facility level, cause of death and contributing conditions reflect deficiencies in the quality of care at health facility level. A RAMOS is feasible in low- and middle-income settings and provides contemporaneous estimates of MMR.
Highlights
Assessing the feasibility of conducting a prospective Reproductive Age Mortality Survey (RAMOS) study in the low-income setting of Mangochi District, Malawi to obtain cotemporaneous estimates of the number, cause of and conditions associated with maternal deaths (MD) in all women of reproductive age (WRA) (n = 207 688)
Reducing maternal mortality (MM) is one of the priority goals on the international agenda – the target for Millenium Development Goal (MDG) 5a was to reduce the Maternal Mortality Ratio (MMR) by three quarters between 1990 and 2015 and recently this target has been reset to a global target of less than 70 maternal deaths per 100,000 live births by 2030 [2, 3]
This study identified an additional 8 MD which had occurred at facility level which had not previously been reported and which had occurred in wards other than the maternity ward
Summary
Assessing the feasibility of conducting a prospective Reproductive Age Mortality Survey (RAMOS) study in the low-income setting of Mangochi District, Malawi to obtain cotemporaneous estimates of the number, cause of and conditions associated with maternal deaths (MD) in all women of reproductive age (WRA) (n = 207 688). The vast majority (99 %) occur in low- and middle-income countries, predominantly in sub-Saharan Africa and South Asia [1]. Malawi, situated in sub-Saharan Africa, is one of the fifteen sub-Saharan countries with the highest MMR (above 500 per 100,000 live births) [1]. As in most other low- and middle-income countries, there is no functioning birth and death registration system and the number of maternal deaths that occur per year is not precisely known.
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