Abstract
Background: The fifth Millennium Development Goal (MDG-5) aimed to improve maternal health, targeting a maternal mortality ratio (MMR) reduction of 75% between 1990 and 2015. The objective of this study was to identify all maternal deaths in Suriname, determine the extent of underreporting, estimate the reduction, audit the maternal deaths and assess underlying causes and substandard care factors. Methods: A reproductive age mortality survey was conducted in Suriname (South-American upper-middle income country) between 2010 and 2014 to identify all maternal deaths in the country. MMR was compared to vital statistics and a previous confidential enquiry from 1991 to 1993 with a MMR 226. A maternal mortality committee audited the maternal deaths and identified underlying causes and substandard care factors. Results: In the study period 65 maternal deaths were identified in 50,051 live births, indicating a MMR of 130 per 100.000 live births and implicating a 42% reduction of maternal deaths in the past 25 years. Vital registration indicated a MMR of 96, which marks underreporting of 26%. Maternal deaths mostly occurred in the urban hospitals (84%) and the causes were classified as direct (63%), indirect (32%) or unspecified (5%). Major underlying causes were obstetric and non-obstetric sepsis (27%) and haemorrhage (20%). Substandard care factors (95%) were mostly health professional related (80%) due to delay in diagnosis (59%), delay or wrong treatment (78%) or inadequate monitoring (59%). Substandard care factors most likely led to death in 47% of the cases. Conclusion: Despite the reduction in maternal mortality, Suriname did not reach MDG-5 in 2015. Steps to reach the Sustainable Development Goal in 2030 (MMR ≤ 70 per 100.000 live births) and eliminate preventable deaths include improving data surveillance, installing a maternal death review committee, and implementing national guidelines for prevention and management of major complications of pregnancy, childbirth and puerperium.
| Original language | English |
|---|---|
| Article number | 275 |
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | BMC Pregnancy and Childbirth |
| Volume | 17 |
| DOIs | |
| Publication status | Published - 29 Aug 2017 |
Funding
The authors wish to thank the Ministry of Health of Suriname, the Bureau of Public Health and the Central Bureau of Civil Registration for their support, as well as the hospital boards of all hospitals, Regional Health Services and Medical Mission for making this study possible. V. Jairam and other employees of the archives and students are acknowledged for helping collect the data. The authors would like to thank the obstetricians (G. Essed, P. Goerdin, R. Charles, R. Tjon Kon Fat, H. Karansingh, R. Tjon A Fat, L. Olmtak, M. Sietaram, O. Ramkhelawan, K. Ramkhelawan, S. Mohan, M. Dipoikromo), gynaecology residents (F. Rigters and S. Cornelisse), internal medicine specialists (K. Waldring, S. Vreden, A. Niekoop, J. Adhin, P. Issa and A. Punwasi), anaesthesiologists (M. Tjon Sie Fat, D. Nahar), neurologist (S. de Jong) and midwives (M. Fitz Jim, S. Abente, S. Holband, A. Naarden, J. Kloppenburg) for their valuable participation in the analysis of the cases. J. Brown (MD) and B. Jacod (MD, PhD) are acknowledged for their guidance in the analysis and advisory role in the first stages of the writing process.
Keywords
- Maternal mortality
- Middle-income country
- Mmr
- RAMoS
- Suriname
- Underreporting
