1. 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
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Pasha O, McClure EM, Saleem S, Tikmani SS, Lokangaka A, Tshefu A, Bose CL, Bauserman M, Mwenechanya M, Chomba E, Carlo WA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Goudar S, Kodkany BS, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Tenge C, Liechty EA, Moore JL, Wallace DD, Koso-Thomas M, Miodovnik M, and Goldenberg RL
- Subjects
- Black People statistics & numerical data, Democratic Republic of the Congo epidemiology, Developing Countries, Female, Guatemala epidemiology, Humans, Income, India epidemiology, Kenya epidemiology, Maternal Death etiology, Maternal Mortality, Pakistan epidemiology, Pregnancy, Prospective Studies, Registries, White People statistics & numerical data, Zambia epidemiology, Cause of Death, Global Health statistics & numerical data, Maternal Death classification, Pregnancy Complications mortality
- 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., (© 2017 Royal College of Obstetricians and Gynaecologists.)
- Published
- 2018
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