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  • Title: [Maternal mortality in Central America. The basis for national programs on epidemiologic surveillance].
    Author: Kestler E.
    Journal: Rev Latinoam Perinatol; 1989; 9(4):167-77. PubMed ID: 12316763.
    Abstract:
    Although maternal mortality rates worldwide have declined dramatically over the past several decades, maternal mortality rates in developing countries are considered a public health problem. The true rates of maternal mortality are unknown and frequently underestimated. Data from the UN annual demographic report show that only 4 Central American countries met the requirements for publication of their maternal mortality rates. 1984 rates ranged from the high of 75.6/100,000 live births in Guatemala to the low of 22.4/100,000 in Costa Rica. The principal or only source of maternal mortality data in Central American countries is vital statistics reported by official organizations. Difficulties in reporting and collecting this information and the fact that vital statistics were not developed for study of maternal mortality make them a poor source of data. Death certificates do not include the final cause of death. Review of death certificates of fertile-aged women and combining other sources of data such as clinical histories or autopsy reports with the vital statistics are techniques for improving the registration of maternal deaths. A national system of epidemiologic surveillance of maternal mortality has the advantage of obtaining information from multiple sources, including the press, private physicians, midwives, hospital obstetrics and gynecology departments, health centers and posts, family planning clinics, private hospitals, maternal mortality committees, families, and the local and national vital statistics. A national level surveillance program should be recognized as the coordinator of activities in this area, and the systems of data collection, analysis, and use of the results should be easily adaptable, inexpensive, simple, and able to motivate. An outline of steps to be followed in organizing and developing a system of surveillance is included in this work, beginning with establishing the objectives and determining what data are needed and ending with identifying requisites for future development. The data should include the pregnancy outcome, type of delivery, gestational age, type of anesthesia used, medications given before death, and other factors that could have contributed to the death. Since there are no universally accepted scientific definitions or usages for causes or rates of maternal death, each national surveillance program must review and attempt to standardize its definitions. Definitions proposed by the maternal division of the US Centers for Disease Control are discussed in this article, including deaths associated with or related to pregnancy, maternal mortality rates and ratios, and specific mortality rates during pregnancy. Such a national surveillance program can help detect misclassified maternal deaths and clarify risk factors so that national level priorities and strategies can be developed to combat maternal deaths.
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