Abstract
Reducing maternal mortality is a key focus of development strategies and one of the indicators used to measure progress towards achieving the Sustainable Development Goals. In the absence of medical certification of the cause of deaths that occur in the community, verbal autopsy (VA) methods are the only available means to assess levels and trends of maternal deaths that occur outside health facilities. The 2016 World Health Organization VA Instrument facilitates the identification of eight specific causes of maternal death, yet maternal deaths are often unsupervised, leading to sparse and generally poor symptom reporting to inform a reliable diagnosis using VAs. There is little research evidence to support the reliable identification of specific causes of maternal death in the context of routine VAs. We recommend that routine VAs are only used to capture the event of a maternal death and that more detailed follow-up interviews are used to identify the specific causes.
Highlights
The World Health Organization recommends the use of verbal autopsy (VA) methods to measure maternal mortality in countries without adequate medical certification of the cause of death, in part to enable them to monitor progress towards the Sustainable Development Goal of reducing the global maternal mortality ratio to less than 70 per 100,000 live births [1, 2]
We suggest that, in order to reliably describe the distribution of maternal causes in a population using VAs, a two-step process is required, involving (1) the identification of a maternal death using VAs and (2) the collection of detailed data by dedicated interviewers in a follow-up enquiry involving family and community collaboration
Our field experience regarding the ability of a VA interview and automated diagnostic algorithm to reliably distinguish between specific causes of maternal death, along with our interpretation of the very limited evidence, suggests that countries should be very cautious when assuming that VA methods designed for routine application are, inherently, sufficiently reliable to do so
Summary
The World Health Organization recommends the use of verbal autopsy (VA) methods to measure maternal mortality in countries without adequate medical certification of the cause of death, in part to enable them to monitor progress towards the Sustainable Development Goal of reducing the global maternal mortality ratio to less than 70 per 100,000 live births [1, 2]. * Correspondence: alan.lopez@unimelb.edu.au 1School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia Full list of author information is available at the end of the article assignment of cause of death for specific diseases for research purposes [4].
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