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BJOG. 2018 Aug;125(9):1137-1143. doi: 10.1111/1471-0528.15011. Epub 2018 May 21.

A prospective cause of death classification system for maternal deaths in low and middle-income countries: results from the Global Network Maternal Newborn Health Registry.

Author information

1
Aga Khan University, Karachi, Pakistan.
2
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
3
RTI International, Durham, NC, USA.
4
Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
5
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
6
University Teaching Hospital, Lusaka, Zambia.
7
University of Alabama at Birmingham, Birmingham, AL, USA.
8
INCAP, Guatemala City, Guatemala.
9
University of Colorado, School of Medicine, Denver, CO, USA.
10
KLE University's JN Medical College, Belagavi, India.
11
Thomas Jefferson University, Philadelphia, PA, USA.
12
Lata Medical Research Foundation, Nagpur, India.
13
Boston University, Boston, MA, USA.
14
Moi University, Eldoret, Kenya.
15
Indiana University, Indianapolis, IN, USA.
16
NICHD, Rockville, MD, USA.
17
Columbia University School of Medicine, New York, NY, USA.

Abstract

OBJECTIVE:

To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology.

DESIGN:

A population-based, prospective observational study.

SETTING:

Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia.

POPULATION:

All deaths among pregnant women resident in the study sites from 2014 to December 2016.

METHODS:

For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD.

MAIN OUTCOME MEASURES:

Assigned causes of maternal mortality.

RESULTS:

Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy.

CONCLUSIONS:

The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions.

TWEETABLE ABSTRACT:

An algorithmic system for determining maternal cause of death in low-resource settings is described.

KEYWORDS:

Cause of death; classification; low- and middle-income countries; maternal mortality

PMID:
29094456
DOI:
10.1111/1471-0528.15011

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