From Passive Surveillance to Response: Suriname's Steady Efforts to Implement Maternal Death Surveillance and Response (MDSR)

Kodan, Lachmi R.; Verschueren, Kim J.C.; Boerstra, Geertje E.; Gajadien, Inder; Mohamed, Robert S.; Olmtak, Lily D.; Mohan, Satish R.; Bloemenkamp, Kitty W. M.

doi:10.21203/rs.3.rs-35174/v1

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…While MNM-tools register the number of severe maternal outcomes, an audit is necessary to reveal the actual ‘lessons to be learned’ [ 39 ]. Recommendations can be formed through these ‘lessons learned’, which encourage targeted action and response (eg, guideline updates, enabling policies and legislation, conduct research to fulfil knowledge gaps).…”

Section: Discussionmentioning

confidence: 99%

“…Recommendations can be formed through these ‘lessons learned’, which encourage targeted action and response (eg, guideline updates, enabling policies and legislation, conduct research to fulfil knowledge gaps). This cycle of continuous evaluation, ‘maternal death and near-miss surveillance and response’, is essential in the elimination of preventable severe maternal outcomes and deserves a more prominent place in MNM studies [ 39 - 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname

Verschueren¹,

Kodan²,

Paidin³

et al. 2020

Journal of Global Health

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Background Maternal near-miss (MNM) is an important maternal health quality-of-care indicator. To facilitate comparison between countries, the World Health Organization (WHO) developed the “MNM-tool”. However, several low- and middle-income countries have proposed adaptations to prevent underreporting, ie, Namibian and Sub-Sahara African (SSA)-criteria. This study aims to assess MNM and associated factors in middle-income country Suriname by applying the three different MNM tools. Methods A nationwide prospective population-based cohort study was conducted using the Suriname Obstetric Surveillance System (SurOSS). We included women with MNM-criteria defined by WHO-, Namibian- and SSA-tools during one year (March 2017-February 2018) and used hospital births (86% of total) as a reference group. Results There were 9114 hospital live births in Suriname in the one-year study period. SurOSS identified 71 women with WHO-MNM (8/1000 live births, mortality-index 12%), 118 with Namibian-MNM (13/1000 live births, mortality-index 8%), and 242 with SSA-MNM (27/1000 live births, mortality-index 4%). Namibian- and SSA-tools identified all women with WHO-criteria. Blood transfusion thresholds and eclampsia explained the majority of differences in MNM prevalence. Eclampsia was not considered a WHO-MNM in 80% (n = 35/44) of cases. Nevertheless, mortality-index for MNM with hypertensive disorders was 17% and the most frequent underlying cause of maternal deaths (n = 4/10, 40%) and MNM (n = 24/71, 34%). Women of advanced age and maroon ethnicity had twice the odds of WHO-MNM (respectively adjusted odds ratio (aOR) = 2.6, 95% confidence interval (CI) = 1.4-4.8 and aOR = 2.0, 95% CI = 1.2-3.6). The stillbirths rate among women with WHO-MNM was 193/1000births, with six times higher odds than women without MNM (aOR = 6.8, 95%CI = 3.0-15.8). While the prevalence and mortality-index differ between the three MNM tools, the underlying causes of and factors associated with MNM were comparable. Conclusions The MNM ratio in Suriname is comparable to other countries in the region. The WHO-tool underestimates the prevalence of MNM (high mortality-index), while the adapted tools may overestimate MNM and compromise global comparability. Contextualized MNM-criteria per obstetric transition stage may improve comparability and reduce underreporting. While MNM studies facilitate international comparison, audit will remain necessary to identify shortfalls in quality-of-care and improve maternal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname

Verschueren¹,

Kodan²,

Paidin³

et al. 2020

Journal of Global Health

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“…When death occurs, the attending physician in Suriname has an obligation to complete a death certi cate documenting the causes and circumstances of the death. The Bureau of Public Health codes the cause of death using ICD-10 [3,17]. A national MDR committee was established to audit and classify the pregnancy-related cases.…”

Section: Settingsmentioning

confidence: 99%

Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by physicians, national and international maternal death review committees

Kodan

Verschueren

McCaw-Binns

et al. 2020

Preprint

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Background Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. Methods The classification of pregnancy-related deaths in Suriname during 2010-2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement.Results Out of the 89 cases certified by attending physicians, 47% (n=42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n=16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n=11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ=0.53) and underlying cause group (κ=0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ=0.69 vs κ=0.63) was better than between the Surinamese and the Netherlands MDR committees (κ=0.48 vs κ=0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ=0.85) and obstetric hemorrhage (κ=0.74) and fair for unspecified (κ=0.29) and other direct causes (κ=0.32). Conclusions Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.

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Midwives experiences in the practice of maternal death audits in Burkina Faso: A qualitative study

Idrissa¹,

Bationo²,

Dieudonne³

et al. 2022

Int. J. Nurs. Midwifery

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From Passive Surveillance to Response: Suriname's Steady Efforts to Implement Maternal Death Surveillance and Response (MDSR)

Cited by 3 publications

References 11 publications

Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname

Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname

Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by physicians, national and international maternal death review committees

Midwives experiences in the practice of maternal death audits in Burkina Faso: A qualitative study

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