Doctoral Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Obstetrics and Gynecology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
BMC Pregnancy Childbirth. 2021 May 17;21(1):380. doi: 10.1186/s12884-021-03840-3.
Maternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality. To support MDR, an adequate MDR instrument is required to accurately identify the underlying causes of maternal deaths. We conducted a systematic review and meta-analysis to determine the reliability of maternal death instruments for conducting the MDR process.
Three databases: PubMed, ProQuest and EBSCO were systematically searched to identify related research articles published between January 2004 and July 2019. The review and meta-analysis involved identification of measurement tools to conduct MDR in all or part of maternal audit. Eligibiliy and quality of studies were evaluated using the Modified Quality Appraisal of Diagnostic Reliability (QAREL) Checklist: Reliability Studies.
Overall, 242 articles were identified. Six articles examining the instrument used for MDR in 4 countries (4 articles on verbal autopsy (VA) and 2 articles on facility-based MDR) were included. None of studies identified reliability in evaluation instruments assessing maternal audit cycle as a comprehensive approach. The pooled kappa for the MDR instruments was 0.72 (95%CI:0.43-0.99; p < 0.001) with considerable heterogeneity (I = 96.19%; p < 0.001). Subgroup analysis of MDR instruments showed pooled kappa in VA of 0.89 (95%CI:0.52-1.25) and facility-based MDR of 0.48 (95%CI:0.15-0.82). Meta-regression analysis tended to show the high heterogeneity was likely associated with sample sizes, regions, and year of publications.
The MDR instruments appear feasible. Variation of the instruments suggest the need for judicious selection of MDR instruments by considering the study population and assessment during the target periods.
孕产妇死亡评审（MDR）可以协助制定预防策略，以降低孕产妇死亡率。为了支持 MDR，需要有一个足够的 MDR 工具来准确识别孕产妇死亡的根本原因。我们进行了系统回顾和荟萃分析，以确定用于进行 MDR 过程的孕产妇死亡工具的可靠性。
我们系统地检索了三个数据库：PubMed、ProQuest 和 EBSCO，以确定 2004 年 1 月至 2019 年 7 月期间发表的相关研究文章。该综述和荟萃分析涉及确定用于在全部或部分孕产妇审核中进行 MDR 的测量工具。使用修改后的诊断可靠性质量评估（QAREL）清单：可靠性研究评估研究的合格性和质量。
总共确定了 242 篇文章。纳入了 4 个国家的 6 篇文章，这些文章探讨了用于 MDR 的工具（4 篇关于死因推断（VA）和 2 篇关于基于机构的 MDR）。没有研究确定评估孕产妇审核周期的综合方法的评估工具的可靠性。MDR 工具的汇总 Kappa 值为 0.72（95%CI：0.43-0.99；p<0.001），存在较大的异质性（I=96.19%；p<0.001）。MDR 工具的亚组分析显示，VA 的汇总 Kappa 值为 0.89（95%CI：0.52-1.25），基于机构的 MDR 的汇总 Kappa 值为 0.48（95%CI：0.15-0.82）。元回归分析表明，高异质性可能与样本量、地区和发表年份有关。
MDR 工具似乎是可行的。工具的变化表明，需要根据研究人群和目标期间的评估情况，明智地选择 MDR 工具。
