Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study.

Reuben Musarandega,Stephen Peter Munjanja,Rhoderick Machekano,Robert Pattinson,Claudia Marotta

doi:10.1371/journal.pone.0252106

Reuben Musarandega, Stephen Peter Munjanja + Show 3 more

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https://doi.org/10.1371/journal.pone.0252106

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Abstract

Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe-an SSA country. In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007-2008 and 2018-2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007-2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.

Highlights

World Health Organization (WHO) defines maternal death as the death of a woman while pregnant, giving birth 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]
This study will determine changes in maternal mortality ratios (MMR) and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007–2008, remains a significant cause of maternal deaths in Zimbabwe
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO)

Summary

Introduction

WHO defines maternal death as the death of a woman while pregnant, giving birth 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]. In 2017, there were an estimated 295,000 maternal deaths globally, 196,000 (66%) of which occurred in Sub-Saharan Africa (SSA), primarily due to avoidable causes [3]. Sustainable Development Goal (SDG) 3.1 aims to reduce the average global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100,000 live births by 2030. Countries with a 2010 baseline above 420 should not have an MMR greater than 140 maternal deaths per 100,000 live births [6, 7]. Attaining the SDG 3.1.1 global target by 2030 is a mammoth task for SSA countries such as Zimbabwe, where the MMR is estimated above 400 maternal deaths per 100,000 live births [8,9,10]. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe—an SSA country

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