Measuring maternal mortality using a Reproductive Age Mortality Study (RAMOS)

• Published in: BMC pregnancy and childbirth 2016-09, Vol.16 (1), p.291-291, Article 291
• Main Authors: Mgawadere, Florence, Unkels, Regine, Adegoke, Adetoro, van den Broek, Nynke
• Format: Article
• Language: English
• Subjects: Age; Births; Censuses; Estimates; Health facilities; Health surveys; Immunization; Low income groups; Maternal mortality; Newborn babies; Obstetrics; Registration; Vaccines; Womens health
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-016-1084-8

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). MD 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). Out 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 %). The 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.