Abouchadi Saloua, Zhang Wei-Hong, De Brouwere Vincent
Ecole Nationale de Santé Publique (ENSP), Rabat, Morocco.
School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
PLoS One. 2018 Jan 31;13(1):e0188070. doi: 10.1371/journal.pone.0188070. eCollection 2018.
To assess the reliability of maternal deaths surveillance system (MDSS) and to determine the factors that influence its completeness in one region of Morocco.
We conducted a retrospective survey in "Gharb Chrarda Bni Hssen" region (GCBH) between January the 1st, 2013 and September the 30th, 2014 using multiple sources approach. All deaths of women of reproductive age (WRA) were investigated using certificates with medical cause, medical records and interviews with household members and relatives to ascertain a pregnancy-related or maternal death. An External Expert Committee reviewed the information collected to assign a cause for each death. Our results were compared to those reported in the same period by the MDSS.
Our study identified 690 deaths of WRA and 69 maternal deaths of which 34.8% occurred outside health facilities. The MDSS recorded during the study period 538 deaths of WRA and 29 maternal deaths (including only one outside health facility) representing respectively an underreporting of 22.0% and 58.0%. Late maternal deaths represented 11.4% of all deaths of women with a registered pregnancy within 12 months prior to the death, while the MDSS identified none. The maternal mortality ratio (MMR) was estimated at 103, approximately 2.5 times higher than that reported in the MDSS.
Our study has shown weaknesses in the current notification system for maternal deaths in the region of GCBH. Therefore, more attention must be given to the regional committees in charge of auditing the cases and defining actions to be implemented to prevent further maternal deaths.
评估孕产妇死亡监测系统（MDSS）的可靠性，并确定影响摩洛哥某一地区该系统完整性的因素。
我们于2013年1月1日至2014年9月30日期间，在“加尔卜·沙拉尔达·布尼·赫森”地区（GCBH）采用多源方法进行了一项回顾性调查。对所有育龄妇女（WRA）的死亡情况进行调查，使用医疗死因证明文件、病历，并与家庭成员及亲属进行访谈，以确定是否为与妊娠相关或孕产妇死亡。一个外部专家委员会对收集到的信息进行审查，以确定每例死亡的原因。我们将研究结果与MDSS同期报告的结果进行比较。
我们的研究共确定了690例育龄妇女死亡，其中69例为孕产妇死亡；34.8%的孕产妇死亡发生在医疗机构之外。在研究期间，MDSS记录了538例育龄妇女死亡和29例孕产妇死亡（其中仅1例发生在医疗机构之外），漏报率分别为22.0%和58.0%。晚期孕产妇死亡占死亡前12个月内有妊娠登记的所有妇女死亡人数的11.4%，而MDSS未识别出任何晚期孕产妇死亡病例。孕产妇死亡率（MMR）估计为103，约为MDSS报告数字的2.5倍。
我们的研究表明，GCBH地区目前的孕产妇死亡通报系统存在缺陷。因此，必须更加关注负责审核病例并确定为预防更多孕产妇死亡而应采取行动的地区委员会。
