Affette M McCaw-Binns1, Jasneth A Mullings2, Yvette Holder3. 1. Department of Community Health and Psychiatry, University of the West Indies, Kingston, Jamaica. Electronic address: affette.mccawbinns@uwimona.edu.jm. 2. Office of the Dean, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica. 3. International Biostatistics and Information Services, Castries, Saint Lucia.
Abstract
OBJECTIVE: To identify why vital registration under-reports maternal deaths in Jamaica. METHODS: A cross-sectional study was undertaken to identify all maternal deaths (during pregnancy or ≤42 days after pregnancy ended) occurring in 2008. Data sources included vital registration, hospital records, forensic pathology records, and an independent maternal mortality surveillance system. Potential cases were cross-referenced to registered live births and stillbirths, and hospital records to confirm pregnancy status, when the pregnancy ended, and registration. Medical certificates were inspected for certification, transcription, and coding errors. Maternal mortality ratios (MMRs) for registered and/or unregistered deaths were calculated. RESULTS: Of 50 maternal deaths identified, 10 (20%) were unregistered. Eight unregistered deaths were coroners' cases. Among 40 registered deaths, pregnancy was undocumented in 4 (10%). Among the other 36, 24 (67%) had been misclassified (59% direct and 89% indirect deaths). Therefore, only 12 (30%) registered maternal deaths had been coded as maternal deaths, yielding an MMR of 28.3 per 100 000 live births (95% confidence interval [CI] 12.3-48.3), which was 76% lower than the actual MMR of 117.8 (95% CI 85.2-150.4). CONCLUSION: Under-reporting of maternal deaths in Jamaica in 2008 was attributable to delayed registration of coroners' cases and misclassification. Timely registration of coroners' cases and training of nosologists to recognize and code maternal deaths is needed.
OBJECTIVE: To identify why vital registration under-reports maternal deaths in Jamaica. METHODS: A cross-sectional study was undertaken to identify all maternal deaths (during pregnancy or ≤42 days after pregnancy ended) occurring in 2008. Data sources included vital registration, hospital records, forensic pathology records, and an independent maternal mortality surveillance system. Potential cases were cross-referenced to registered live births and stillbirths, and hospital records to confirm pregnancy status, when the pregnancy ended, and registration. Medical certificates were inspected for certification, transcription, and coding errors. Maternal mortality ratios (MMRs) for registered and/or unregistered deaths were calculated. RESULTS: Of 50 maternal deaths identified, 10 (20%) were unregistered. Eight unregistered deaths were coroners' cases. Among 40 registered deaths, pregnancy was undocumented in 4 (10%). Among the other 36, 24 (67%) had been misclassified (59% direct and 89% indirect deaths). Therefore, only 12 (30%) registered maternal deaths had been coded as maternal deaths, yielding an MMR of 28.3 per 100 000 live births (95% confidence interval [CI] 12.3-48.3), which was 76% lower than the actual MMR of 117.8 (95% CI 85.2-150.4). CONCLUSION: Under-reporting of maternal deaths in Jamaica in 2008 was attributable to delayed registration of coroners' cases and misclassification. Timely registration of coroners' cases and training of nosologists to recognize and code maternal deaths is needed.
Authors: Lachmi R Kodan; Kim J C Verschueren; Affette M McCaw-Binns; Ray Tjon Kon Fat; Joyce L Browne; Marcus J Rijken; Kitty W M Bloemenkamp Journal: Reprod Health Date: 2021-02-19 Impact factor: 3.223
Authors: Federico G de Cosio; Safia S Jiwani; Antonio Sanhueza; Patricia N Soliz; Francisco Becerra-Posada; Marcos A Espinal Journal: PLoS One Date: 2016-09-14 Impact factor: 3.240