[Surveillance system of maternal mortality in the Tunis region]

In the framework of a national strategy of reduction of the maternal mortality rate. Tunisia has set up a follow up system of maternal deaths occurring in public facilities to analyse their causes, the levels of deficiency and to propose solutions for preventing them. This note aims at describing the system, its results, its efficiency and its limitations in the Tunis region for the years 1999 and 2000. The results show a maternal mortality rate estimated at 80 for 100,000 births in public facilities of the region: the main causes being haemorrhage (42.1%) followed by infection (13.2%). The proportion of avoidable deaths is 87%:74% possibly avoidable and 13% certainly avoidable, factors related to women behaviour have also contributed to 45% of cases. The system flows are however intricated, and related to organization: an underestimation of risk by the patient (33%), an inadequate watch during the postpartum period (25%), a late hospitalisation (22%) and not enough reanimation equipment. Nevertheless, this control system has achieved part of its objective by starting up a quality approach to obstetrical cares and by warning health professionals such as obstetricians, anaesthetists, blood banks in charge, hospital managers and other medical teams. The limitations of the system are tied to the follow up of the real implementation of recommendations stated in reports at a local as well as central levels.