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Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)

Mgawadere, Florence ORCID: https://orcid.org/0000-0003-3341-9118, Unkels, Regine and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2016) 'Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)'. BJOG: An International Journal of Obstetrics & Gynaecology, Vol 123, Issue 10, pp. 1647-1653.

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Abstract

Objective
To compare methodology used to assign cause of and factors contributing to maternal death.

Design
Reproductive Age Mortality Study.

Setting
Malawi.

Population
Maternal deaths among women of reproductive age.

Methods
We compared cause of death as assigned by a facility-based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (ICD-10) cause classification for deaths during pregnancy, childbirth and the puerperium (ICD-MM) and a computer-based probabilistic program (InterVA-4).

Main outcome measures
Number and cause of maternal deaths.

Results
The majority of maternal deaths occurred at a health facility (94/151; 62.3%). The estimated maternal mortality ratio was 363 per 100 000 live births (95% CI 307–425). There was poor agreement between cause of death assigned by a facility-based maternal death review team and an expert panel (κ = 0.37, 86 maternal deaths). The review team considered 36% of maternal deaths to be indirect and caused by non-obstetric complications (ICD-MM Group 7) whereas the expert panel considered only 17.4% to be indirect maternal deaths with 33.7% due to obstetric haemorrhage (ICD-MM Group 3). The review team incorrectly assigned a contributing condition rather than cause of death in up to 15.1% of cases. Agreement between the expert panel and InterVA-4 regarding cause of death was good (κ = 0.66, 151 maternal deaths). However, contributing conditions are not identified by InterVA-4.

Conclusions
Training in the use of ICD-MM is needed for healthcare providers conducting maternal death reviews to be able to correctly assign underlying cause of death and contributing factors. Such information can help to identify what improvements in quality of care are needed.

Tweetable abstract
For maternal deaths assigning cause of death is best done by an expert panel and helps to identify where quality of care needs to be improved.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
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 Complications > WQ 240 Pregnancy complications (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1111/1471-0528.13969
Depositing User: Jessica Jones
Date Deposited: 16 May 2016 08:56
Last Modified: 06 Feb 2018 13:12
URI: https://archive.lstmed.ac.uk/id/eprint/5887

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