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- Title
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.
- Authors
Pasha, O.; McClure, E. M.; Saleem, S.; Tikmani, S. S.; Lokangaka, A.; Tshefu, A.; Bose, C. L.; Bauserman, M.; Mwenechanya, M.; Chomba, E.; Carlo, W. A.; Garces, A. L.; Figueroa, L.; Hambidge, K. M.; Krebs, N. F.; Goudar, S.; Kodkany, B. S.; Dhaded, S.; Derman, R. J.; Patel, A.
- Abstract
<bold>Objective: </bold>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.<bold>Design: </bold>A population-based, prospective observational study.<bold>Setting: </bold>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.<bold>Population: </bold>All deaths among pregnant women resident in the study sites from 2014 to December 2016.<bold>Methods: </bold>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.<bold>Main Outcome Measures: </bold>Assigned causes of maternal mortality.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Tweetable Abstract: </bold>An algorithmic system for determining maternal cause of death in low-resource settings is described.
- Subjects
CONGO (Democratic Republic); GUATEMALA; INDIA; KENYA; PAKISTAN; ZAMBIA; MATERNAL mortality; MIDDLE-income countries; CAUSE of death statistics; DEATH rate; PREGNANT women; STATISTICS on Black people; CAUSES of death; DEVELOPING countries; INCOME; LONGITUDINAL method; PREGNANCY complications; RESEARCH funding; WHITE people; WORLD health; ACQUISITION of data
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2018, Vol 125, Issue 9, p1137
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.15011