Measuring maternal mortality using a Reproductive Age Mortality Study (RAMOS)

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Maternal deaths (MD) in low-income settings are often underestimated.
• Assessing the feasibility of a Reproductive Age Mortality Survey (RAMOS) in Mangochi District, Malawi.
• Focus on women of reproductive age (WRA) with a total population of 207,688.

Purpose of the Study:

• To obtain contemporaneous estimates of maternal deaths (MD) in women of reproductive age (WRA).
• To determine the causes and associated conditions of maternal deaths.
• To assess the feasibility of implementing a RAMOS study in a low-income country.

Main Methods:

• Maternal deaths (MD) identified using ICD-10 definition among all deaths of WRA.
• Cause of death and contributing conditions classified by expert panel using ICD-MM.
• Data collection involved verbal autopsy and facility-based death review.

Main Results:

• Maternal Mortality Ratio (MMR) was 363 per 100,000 live births (151 MD out of 424 WRA deaths).
• Significant underreporting: 43% of MD were missed by existing mechanisms.
• Most MD (62.3%) occurred in health facilities, often due to direct obstetric causes like hemorrhage (35.8%) and infections (19.4%).

Conclusions:

• RAMOS is feasible in low- and middle-income settings for accurate MMR estimation.
• High in-facility MD rates suggest deficiencies in healthcare quality.
• Obstetric hemorrhage, infections, hypertensive disorders, and abortive outcomes are leading causes of maternal mortality.