Implementing a maternal mortality surveillance system in Morocco – challenges and opportunities

Abstract

Abstractobjective To describe the development of the maternal death surveillance system (MDSS) in Morocco and discuss the initial results.method The nationwide MDSS was implemented in 2009 with the involvement of health professionals and local authorities. It comprises (i) notification of all deaths of women of reproductive age (from 15 to 49 years); (ii) a preliminary survey to identify pregnancy-related deaths; (iii) a confidential enquiry into all pregnancy-related deaths. The information thus obtained describes socio-demographic characteristics of the women, their obstetric and medical history, the mode of delivery, its follow-up and the medical cause of death.results From 1st of January 2009 to 31st of December 2009, 3814 deaths of women of reproductive age were recorded, and a total of 436 pregnancy-related deaths were identified, with 73.4% of those occurring in health facilities. Among the 313 reviewed records, 80.8% were direct obstetric deaths, and 13.5% were classified as indirect. Haemorrhage was the first direct obstetric cause of death (33%). Heart disease was the main indirect obstetric cause of death (39% of indirect causes).conclusion The Moroccan MDSS is a powerful tool for understanding the causes and circumstances of maternal deaths. However, challenges remain regarding the full coverage of the system, the decentralisation of the data entry and analysis and the completeness of medical records.

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health

“…Anaemia was the most common indirect cause of SMO in this current analysis. This is in accordance with other reports from developing countries; however, cardiac disease was the leading indirect cause of MD from developed countries …”

“…A very recent report from India including 39 704 live births and 120 MDs showed that 27.5% of MDs were the result of indirect causes, with anaemia and jaundice being the two most common causes . The maternal death surveillance system (MDSS) in Morocco, including 313 reviewed records, found that 13.5% were classified as indirect cause, and that heart disease was the main indirect cause of death . A hospital‐based review of maternal mortality in Ghana of 30 269 live births and 322 MDs indicated that 22.4% were from indirect causes, and that infection and sickle cell disease accounted for 61.1% of indirect causes .…”

“…This is in accordance with other reports from developing countries; 3,4,15 however, cardiac disease was the leading indirect cause of MD from developed countries. [5][6][7][8]14,16 HIV/AIDS is an increasing contributor of indirect as well as direct causes of MDs in many countries, especially in sub-Saharan Africa. 9,[17][18][19] The most common causes of MD among women with HIV were AIDS, pneumonia, tuberculosis, and meningitis.…”

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

“…Maternal mortality surveillance studies such as confidential enquiry have showed that late maternal death is non-trivial in even low-resource settings34,59 and can account for up to 40% of maternal deaths in high-income settings 60. A contemporary linkage study in Mexico found that 18% of maternal deaths are missed when the definition is truncated at 42 days’ post partum 61.…”

“…This change had the effect of substantially increasing the size of our analytical dataset with respect to time and geography. Late maternal death data from the causes-of-death database were limited to those location years where at least 0·5% of all maternal deaths in raw vital registration data files were coded to late maternal deaths as this was the lowest proportion reported in any surveillance studies 34. Only 39 countries met these criteria with variable times in which they began coding late maternal deaths.…”