Abstract
BackgroundIndonesia’s national health information systems collect data on maternal deaths but the completeness of reporting is questionable, making it difficult to design appropriate interventions. This study examines the completeness of maternal death reporting by the district health office (DHO) system in Banten Province.MethodWe used a nested-control study design to compare data on maternal deaths in 2016 from the DHO reporting system and the MADE-IN/MADE-FOR method in two districts and one municipality in Banten Province, with the aim of identifying and characterizing missed deaths in the DHO reporting system. The capture-recapture method was used to assess the magnitude of underreporting of maternal deaths by both systems.ResultsA total of 169 maternal deaths were reported in the MADE-IN/MADE-FOR study for calendar year 2016 in the three study areas. The DHO system reported 105 maternal deaths for the same period, of which 90 cases were found in both data sources. Capture-recapture analyses suggest that the MADE-IN/MADE-FOR approach identified 92% (95% CI: 87%–95%) of all maternal deaths, while the DHO system captured 57% (95% CI: 50%–64%) of all maternal deaths. Deaths of women who resided in urban areas had four times higher odds (OR 4.3, 95% CI: 1.52–12.3) of being missed by the DHO system compared to deaths among women who lived in rural or remote areas after adjusting for other covariates.ConclusionThe DHO reporting system missed approximately half of the maternal deaths in the 3 study areas, suggesting that the DHO system is likely to grossly underestimate the maternal mortality ratio. The DHO reporting system needs to be improved to capture and characterize all maternal deaths.
Highlights
The World Health Organization (WHO) defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes [1].” Over the past two decades, the number of maternal deaths and the maternal mortality ratio (MMR) have declined globally, but in Indonesia the MMR remains high [2,3]
Capture-recapture analyses suggest that the MADE-IN/MADE-FOR approach identified 92% of all maternal deaths, while the district health office (DHO) system captured 57% of all maternal deaths
Cases were defined as maternal deaths that were not captured by the DHO reporting system, and controls were defined as deaths that were captured by the DHO reporting system
Summary
The World Health Organization (WHO) defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes [1].” Over the past two decades, the number of maternal deaths and the maternal mortality ratio (MMR) have declined globally, but in Indonesia the MMR remains high (more than 300 maternal deaths per 100,000 live births) [2,3]. Over the past two decades, the number of maternal deaths and the maternal mortality ratio (MMR) have declined globally, but in Indonesia the MMR remains high (more than 300 maternal deaths per 100,000 live births) [2,3]. The maternal mortality ratio is one of the key indicators for tracking global Sustainable Development Goal number 3 but its measurement is difficult in settings where the vital registration system is weak, as it is in Indonesia. Local information on the occurrence, timing and causes of maternal death, as well as key contributing factors, is vital to guide the design and implementation of program interventions to reduce maternal mortality in a specific context. Indonesia’s national health information systems collect data on maternal deaths but the completeness of reporting is questionable, making it difficult to design appropriate interventions. This study examines the completeness of maternal death reporting by the district health office (DHO) system in Banten Province.
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