DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175849

Reproductive age mortality survey: a tool to determine level of underreporting of maternal mortality

Sonika Badalia, Anupam Parashar, D. S. Dhadwal, Deepak Sharma

Abstract


Background: For achieving sustainable development goals, tracking all maternal deaths without missing any is a crucial step. Underreporting of maternal deaths is an issue especially in developing countries like India. Objectives of this study were to estimate maternal deaths using Reproductive Age Mortality Survey (RAMOS) methodology in a district of North India and to study medical causes responsible for maternal deaths.

Methods: A Reproductive Age Mortality Study (RAMOS) was carried out in a district of North India for the period 2009 to 2012. Records of female deaths in the reproductive age group were reviewed using multiple sources and verbal autopsy was conducted. Maternal deaths thus identified were compared with the officially reported maternal deaths for the same period for finding out the under reporting. Verbal autopsy was conducted to find out causes of maternal deaths.

Results: A total of 16 women were identified as maternal deaths using RAMOS methodology. The officially reported maternal deaths were 8, thus under reporting of 100%. The 16 maternal deaths consisted of 14 (87.5%) direct maternal deaths and 2 (12.5%) indirect maternal deaths. One or the other form of delay was recognized in 8 of 16 maternal deaths. There was delay in recognizing the warning signs for urgent health care requirement (first delay) in 4 of 16 maternal deaths. There was delay on part of health facility to diagnose the complication and act appropriately (third delay) in 4 cases.

Conclusions: It is concluded that the reporting system for maternal deaths need to be strengthened. Health workers should be adequately trained on reporting maternal death cases. On this foundation verbal autopsy should be conducted for all the reported deaths of women of reproductive age group to know the circumstances leading to maternal deaths.

 


Keywords


Maternal deaths, Reproductive age mortality survey, Underreporting

Full Text:

PDF

References


World Health Organization: Trends in Maternal Mortality: 1990 to 2008 Estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva. 2010

RAMOS. Available at http://www.who.int/reproductivehealth/topics/monitoring/measuring_mmr.pdf. Accessed 24th April 2016.

Abouzahr C. In: Critical issues in safe motherhood. Geneva, WHO; 1999:110-134.

Estimates of maternal mortality ratios in India and its states: a pilot study. Available at www.icmr.nic.in/final/Final%20Pilot%20Report.pdf Cited 17 February 2016.

Zakariah AY, Alexander S, Roosmalen JV. Reproductive age mortality survey (RAMOS) in Accra, Ghana. Reproductive Health. 2009;6:7.

Bouvier-Colle MH, Varnoux N, Costes P, Hatton F. Reasons for the underreporting of maternal mortality in France, as indicated by a survey of all deaths among women of childbearing age. Int J Epidemiol. 1991;20:717-21.

Schuitemaker NWE, van Roosmalen J, Dekker GA, van Dongen PWJ, van Geijn HP, Bennebroek Gravenhorst J: Underreporting of maternal mortality in The Netherlands. Obstet Gynecol. 1997;90:78-82.

Das R, Biswas S, Mukherjee A. Maternal mortality at a teaching hospital of rural India: a retrospective study. Int J Biomed Advance Res. 2014;5:114-7.

Dogra P, Gupta KB. A study of maternal mortality at a tertiary institute. Obs Gynae Today. 2009;115:58-60.

Purandare N, Singh A, Upadhyae S, Saraogi RM. Maternal mortality at a referral centre: a five year study. J Obstet Gynaecol India. 2007;57:248-50.

Priya N, Verma A, Verma S. Maternal mortality: ten years retrospective study. J Med Educ Res. 2010;12:134-6.

Singh R, Sinha N, Bhattacharyya K, Ram R. Pattern of maternal mortality in a tertiary care hospital of Patna, Bihar. Indian J Community Med. 2009;34:73-4.

Paul B, Mohpatra B, Kar K. Maternal deaths in a tertiary health care centre of Odisha: an in-depth study supplemented by verbal autopsy. Indian J Community Med. 2011;36:213-6.

Qomariyah SN, Ambruoso L. Indonesia: extending verbal autopsy to examine social and medical causes of maternal mortality. Impact briefing note: November 2008. Avalaible at http://r4d.dfid.gov.uk/PDF/Outputs/Immpact/IndonesiaBriefingNote.pdf. Cited 5th May 2016.

McDonagh M. Is antenatal care effective in reducing maternal morbidity and mortality? Health Policy Plan. 1996;11(1):1-15.