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

作者：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; Hibberd P L; Esamai F; Tenge C; Liechty E A; Moore J L; Wallace D D; Koso Thomas M; Miodovnik M; Goldenberg R L

来源：BJOG: An International Journal of Obstetrics and Gynaecology , 2018, 125(9): 1137-1143.

DOI：10.1111/1471-0528.15011

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

ObjectiveTo 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.
DesignA population-based, prospective observational study.
SettingSeven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia.
PopulationAll deaths among pregnant women resident in the study sites from 2014 to December 2016.
MethodsFor 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 DiseaseMaternal 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 measuresAssigned causes of maternal mortality.
ResultsAmong 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.
ConclusionsThe 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 abstractAn algorithmic system for determining maternal cause of death in low-resource settings is described.
Tweetable abstract An algorithmic system for determining maternal cause of death in low-resource settings is described.

• 出版日期2018-8