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Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification

Owolabi, Helen, Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605, Bar-Zeev, Sarah, Adaji, Sunday, Kachale, Fanny and Van Den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2014) 'Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification'. BJOG An International Journal of Obstetrics and Gynaecology, Vol 121, Issue S4, pp. 95-101.

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Abstract

Maternal death review (MDR) is an accepted process that is implemented across Malawi and ‘underlying cause of death’ is assigned by healthcare providers using a standard MDR form. Mixed-methods approach. Key informant interviews with eight stakeholders involved in MDR. Secondary analysis of MDR forms for 54 maternal deaths. Comparison of assigned cause of death by healthcare providers conducting MDR at health facility level with cause assigned by researchers using the International Classification of Diseases Maternal Mortality (ICD-MM) classification. MDR teams, analysts and policymakers reported facing challenges in completing the forms, analysing and using information. The concepts of underlying (primary) and contributing (secondary) causes of death are often misunderstood. Healthcare providers using only MDR forms reported cause of death as non-obstetric complications in 39.6% and pregnancy-related infection in 11.3% of cases. For 30.2% of cases, no clear clinical cause of death was recorded. The most commonly assigned underlying cause of death using ICD-MM was obstetric haemorrhage (32.1%), non-obstetric complications (24.5%) and pregnancy-related infection (22.6%). There was poor agreement between cause(s) of maternal death assigned by healthcare providers in the field and trained researchers using the new ICD-MM classification (κ statistic; 0.219). The majority of cases could be reclassified using the ICD-MM and this provided a more specific cause of death. A more structured and user-friendly MDR form is required. Accurate classification of cause of death is important. Dissemination of, and training in the use of the new ICD-MM classification system will be helpful to healthcare providers conducting MDR in Malawi.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 26.5 Informatics. Health informatics
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1111/1471-0528.12998
Depositing User: Caroline Hercod
Date Deposited: 08 Oct 2014 09:52
Last Modified: 06 Feb 2018 13:07
URI: http://archive.lstmed.ac.uk/id/eprint/4462

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