Tej Dellagi Rafla, Bougatef Souha, Ben Salah Fayçal, Ben Mansour Nadia, Gzara Ahlem, Gritli Ibtissem, Ben Romdhane H, Rachdi M T
Tunis Med. 2014 Aug-Sep;92(8-9):560-6.
Tunisia has investigated maternal mortality in 2010 to determine maternal mortality ratio (MMR) nationally and regionally, in addition to the indentifying main causes of this mortality.
Describe methodology of this study and its principal findings in the region of Tunis and discuss the national maternal mortality strategy.
This is a Ramos study (Reproductive Ag Mortality Studies) that consists on identifying maternal deaths from reproductive age group (RAG) women deaths. We started by the a rehearsal and targeting of (RAG) women deaths , then we investigated a next of kin person of the decedent women by verbal autopsy, thereafter we identified maternal deaths to be confidentially investigated to judge the potential avoidability of the death. The study took place in 2010, it was carried out by 5 couples of investigators supervised by a coordinator doctor.
A total of 200 deaths of (RAG) women were found in Tunis, 7 deaths among them were maternal deaths, that corresponds to an MMR of 41/100000 live births. The mean age of the deceased women was 35 years. The main causes of maternal deaths were hemorrhage (3/7), thrombo-embolic diseases (2 times for7) and HELLP syndrome (1/7). Four of a total of 4 deaths (3 deaths were not marked), were avoidable. The majority of late women had a satisfying educational level, 4 of 7 had financial autonomy. All of them had pregnancy monitoring, 5 times of 7 in university hospital. All the childbirth were medically assisted, Caesarean section was carried in 6 of 7 cases. Nationally, the MMR was estimated to 44.8/100 000 LB, that to say a decrease of 35% compared to 1993. The decrease was significant for all the regions of the country, except the great Tunis where opposite trend was recorded. This could be more likely related to quality of care rather than socio-economic conditions seeing that social determinants in Tunis are favorable. In fact, the Tunisian maternal mortality strategy had essentially focused on the monitoring system of maternal deaths rather than the quality of care improvement interventions, results were disappointing due to the lack of institutional engagement. The achievement of the OMD5 objectives is compromised, due to socio-economic constraint especially in certain regions, poor governance and lack of engagement of ministry of health in reducing maternal mortality.
Tunisian maternal mortality strategy should be revised and adapted to regional context, also should includ multisectoral interventions. Priority would be given to quality of care improvement, by launching the experience of care setting accreditation in one hand, and in the other improving partnership between different levels of care.
突尼斯于2010年对孕产妇死亡率进行了调查，以确定全国及各地区的孕产妇死亡率，并找出导致这种死亡的主要原因。
描述本研究在突尼斯地区的方法及其主要发现，并讨论国家孕产妇死亡战略。
这是一项拉莫斯研究（生殖年龄组孕产妇死亡研究），包括从生殖年龄组（RAG）女性死亡中识别孕产妇死亡。我们首先对（RAG）女性死亡进行预演和定位，然后通过口头尸检对死者女性的近亲进行调查，此后我们确定孕产妇死亡病例进行保密调查，以判断死亡的潜在可避免性。该研究于2010年进行，由5对调查人员在一名协调医生的监督下开展。
在突尼斯共发现200例（RAG）女性死亡，其中7例为孕产妇死亡，孕产妇死亡率为41/100000活产。死亡女性的平均年龄为35岁。孕产妇死亡的主要原因是出血（3/7）、血栓栓塞性疾病（2/7）和HELLP综合征（1/7）。总共4例死亡中有4例（3例未标明）是可避免的。大多数晚期孕产妇教育水平令人满意，7例中有4例有经济自主权。她们都接受了孕期监测，7例中有5例在大学医院。所有分娩均得到医疗协助，7例中有6例进行了剖宫产。在全国范围内，估计孕产妇死亡率为44.8/100000活产，也就是说与1993年相比下降了35%。除大突尼斯地区出现相反趋势外，该国所有地区的下降都很显著。鉴于突尼斯的社会决定因素有利，这更可能与医疗质量而非社会经济状况有关。事实上，突尼斯的孕产妇死亡战略主要侧重于孕产妇死亡监测系统，而不是改善医疗质量的干预措施，由于缺乏机构参与，结果令人失望。由于社会经济限制，特别是在某些地区，治理不善以及卫生部在降低孕产妇死亡率方面缺乏参与，千年发展目标5的实现受到了影响。
突尼斯的孕产妇死亡战略应进行修订并适应当地情况，还应包括多部门干预措施。应优先提高医疗质量，一方面开展医疗机构认证试点，另一方面改善不同医疗层面之间的合作关系。
