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

Mgawadere, Florence ORCID: https://orcid.org/0000-0003-3341-9118, Unkels, Regine, Adegoke, Adetoro and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2016) 'Measuring maternal mortality using a Reproductive Age Mortality Study (RAMOS)'. BMC Pregnancy and Childbirth, Vol 16, p. 2941.

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Abstract

Background
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).

Methods
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).

Results
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 %).

Conclusion
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.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General) WQ Obstetrics > Labor > WQ 330 Complications of labor
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12884-016-1084-8
Depositing User:	Caroline Hercod
Date Deposited:	29 Sep 2016 11:17
Last Modified:	07 Jun 2022 11:10
URI:	https://archive.lstmed.ac.uk/id/eprint/6219

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