Kim Shin Y, Rochat Roger, Rajaratnam Abel, Digirolamo Ann
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
J Biosoc Sci. 2009 Mar;41(2):195-205. doi: 10.1017/S0021932008003064. Epub 2008 Oct 16.
Health systems in developing countries infrequently implement and evaluate maternal death surveillance. This study identified under-reported and misclassified maternal deaths among women of reproductive age between 1999 and 2004 in a rural service unit in Vellore, India. In-depth interviews, semi-structured interviews and structured questionnaires were used to identify maternal deaths known to health care providers and community leaders who regularly come in contact with pregnant women. Eighteen under-reported and misclassified cases--or 50% of maternal deaths--were reported. These included 29% of abortion-related and 7% of domestic violence-related deaths. Based on this study's fieldwork, the existing death surveillance system detected 100% of the maternal deaths reported by hospital staff; however, it missed most maternal deaths reported by community workers. The latter are more likely than deaths reported by hospital workers to result from abortion and family violence. The existing surveillance system should be augmented with a community-based death surveillance system. This comprehensive approach identified twice as many maternal deaths than previously recorded and could be applied in other settings. Appropriate public health interventions should be initiated to prevent maternal deaths in this community.
发展中国家的卫生系统很少实施和评估孕产妇死亡监测。本研究确定了1999年至2004年印度韦洛尔一个农村服务单位中育龄妇女中报告不足和分类错误的孕产妇死亡情况。通过深入访谈、半结构化访谈和结构化问卷，来确定医疗保健提供者以及经常接触孕妇的社区领袖所知晓的孕产妇死亡情况。共报告了18例报告不足和分类错误的病例，占孕产妇死亡病例的50%。其中包括29%与流产相关的死亡病例和7%与家庭暴力相关的死亡病例。基于本研究的实地调查，现有的死亡监测系统检测出了医院工作人员报告的100%的孕产妇死亡病例；然而，它遗漏了社区工作者报告的大多数孕产妇死亡病例。后者比医院工作人员报告的死亡病例更有可能由流产和家庭暴力导致。现有的监测系统应通过基于社区的死亡监测系统加以补充。这种综合方法识别出的孕产妇死亡病例数量是之前记录的两倍，并且可应用于其他环境。应启动适当的公共卫生干预措施，以预防该社区的孕产妇死亡。
