Table 2.
Overview of 47 included maternal mortality reports
| Country | LIC/l‐MIC/u‐MIC | MMR | Period | Cardiac MD/total MD | Proportion cardiac MD (%) | cMMR | OFD included | Review at facility level | Review central level | Case review by |
|---|---|---|---|---|---|---|---|---|---|---|
| Bangladesh | LIC | 479† | 1996–1997 | 291/7086 | 4.1% | 19.7 | Yes | Research team | None | Recent medical graduates |
| Ethiopia | LIC | 523† | 2008 | 14/633 | 2.2% | 11.6 | Yes | MD notification form | None | Staff at facility |
| Ghana, Upper West reg. | LIC | 325† | 2009 | 0/47 | 0.0% | 0.0 | if reported | MD notification form | Audit of complete file | Panel, expertise unclear |
| Ghana, Accra reg* | LIC | 467† | 2002 | 3/178 | 1.7% | 7.9 | Yes | None | Audit of complete file | Panel with O&G specialist |
| Malawi | LIC | 629† | 2008–2012 | **/1433 | N/A | N/A | No | Facility audit | CEMD, audit of complete file | Panel with O&G specialist |
| Malawi, Central reg.* | LIC | 648† | 2007 | 1/43 | 2.3% | 15.1 | No | Facility audit | None | Staff at facility |
| Nepal, 8 reg. | LIC | 229‡ | 2008–2009 | 11/160 | 6.9% | 15.7 | Yes | Facility audit | None | Staff at facility |
| Rwanda | LIC | 381† | 2009–2013 | 23/987 | 2.3% | 8.9 | No | Facility audit | None | Staff at facility |
| Tanzania, Arusha reg. | LIC | 961† | 1995–1996 | **/45 | /A | N/A | Yes | None | Audit of complete file | Panel with O&G specialist |
| Zimbabwe | LIC | 725‡ | 2006 | 16/364 | 4.4% | 31.9 | Yes | MD notification form | Review of MD notification forms | Staff at facility |
| Egypt, Dakahlia reg. | l‐MIC | 71‡ | 2004–2005 | 15/171 | 8.8% | 6.3 | Yes | MD notification form | Audit of complete file | Panel, expertise unclear |
| Egypt* | l‐MIC | 84‡ | 2000 | 45/580 | 7.8% | 6.5 | Yes | None | Audit of complete file | Panel with O&G and non‐O&G specialists |
| El Salvador | l‐MIC | 50‡ | 2011 | 4/64 | 6.3% | 3.2 | Yes | MD notification form | Audit of complete file | Panel, expertise unclear |
| Guatemala, ‘dep. of Guatemala’ | l‐MIC | 156‡ | 1993–1996 | 2/435 | 0.5% | 0.7 | Yes | None | Audit of complete file | Data clerk |
| India, Kerala reg. | l‐MIC | 29¶ | 2004–2009 | 32/501 | 6.4% | 1.9 | No | MD notification form | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Jamaica* | l‐MIC | 95‡ | 1998–2003 | 12/232 | 5.2% | 4.9 | Yes | None | Audit of complete file | Panel, expertise unclear |
| Jamaica | l‐MIC | 96‡ | 1993–1995 | 3/141 | 2.1% | 2.1 | Yes | None | Audit of complete file | Panel, expertise unclear |
| Jordan | l‐MIC | 19‡ | 2007–2008 | 8/76 | 10.5% | 2.0 | Yes | None | Audit of complete file | Panel, expertise unclear |
| Moldova* | l‐MIC | 34† | 2009–2013 | 2/49 | 4.1% | 1.4 | No | MD notification form | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Moldova | l‐MIC | 39† | 2006–2008 | 0/29 | 0.0% | 0.0 | No | MD notification form | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Morocco, 6 priority reg. | l‐MIC | 121‡ | 2015 | 7/152 | 4.6% | 5.6 | Yes | MD notification form | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Morocco* | l‐MIC | 153† | 2009 | 16/303 | 5.3% | 8.1 | If reported | MD notification form | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Pakistan, Sindh reg. | l‐MIC | 279‡ | 2006–2008 | 3/72 | 4.2% | 11.6 | Yes | MD notification form | None | Staff at facility |
| Russia, St. Petersburg | l‐MIC | 43‡ | 1992–2003 | 12/179 | 6.7% | 2.9 | Yes | Facility audit | None | Research team with O&G specialist |
| Sri Lanka* | l‐MIC | 34‡ | 2015 | 28/113 | 24.8% | 8.4 | Yes | District audit | Audit of complete file | Panel with O&G and non‐O&G specialists |
| Sri Lanka | l‐MIC | 32‡ | 2014 | 16/112 | 14.3% | 4.6 | Yes | District audit | Audit of complete file | Panel with O&G and non‐O&G specialists |
| Sudan | l‐MIC | 349† | 2010 | **/898 | N/A | N/A | If reported | MD notification form | Review of MD notification forms | Panel, expertise unclear |
| Swaziland | l‐MIC | 586† | 2000–2001 | 2/43 | 4.7% | 27.3 | No | None | Audit of complete file | Panel, expertise unclear |
| Botswana | u‐MIC | 129† | 2015 | 2/73 | 2.7% | 3.5 | Unknown | Unclear | National statistics | Unknown |
| Botswana* | u‐MIC | 169† | 2010 | 7/55 | 12.7% | 21.5 | Yes | MD notification form | Audit of complete file | Panel, expertise unclear |
| China, Wuhan reg. | u‐MIC | 14,5‡ | 2001–2012 | 8/91 | 8.8% | 1.3 | Yes | MD notification form | Audit of complete file | Panel, expertise unclear |
| China, Henan reg. | u‐MIC | 45,5‡ | 1996–2009 | 90/1129 | 8.0% | 3.6 | Yes | MD notification form | Audit of complete file | Panel with O&G specialist |
| China, Shanghai reg. | u‐MIC | 20,5‡ | 2000–2009 | 24/262 | 9.2% | 1.9 | Yes | MD notification form | Audit of complete file | Panel with O&G specialist |
| China, Zhejiang reg. | u‐MIC | 58† | 1995–2008 | 95/901 | 10.5% | 6.1 | Yes | MD notification form | Audit of complete file | Panel, expertise unclear |
| China combined§ | u‐MIC | 35§ | 1995–2012 | 217/2383 | 9.1% | 3.2 | ||||
| Fiji | u‐MIC | 34† | 2008–2012 | 5/37 | 13.5% | 4.6 | If reported | MD notification form | None | Staff at facility |
| Irak | u‐MIC | 27‡ | 2010–2012 | 79/1039 | 7.6% | 2.1 | Yes | MD notification form | Audit of complete file | Panel with O&G specialist |
| Iran, Yazd reg. | u‐MIC | 34† | 2002–2011 | 8/40 | 20.0% | 6.8 | Unknown | MD notification form | Unclear | Unclear |
| Malaysia* | u‐MIC | 28,7‡ | 2009–2011 | 65/430 | 15.1% | 4.3 | Yes | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Malaysia | u‐MIC | 27‡ | 2006–2008 | 49/396 | 12.4% | 3.4 | Yes | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa* | u‐MIC | 138† | 2014 | 49/1238 | 4.0% | 5.5 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa | u‐MIC | 154† | 2011–2013 | 169/4333 | 3.9% | 6.0 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa | u‐MIC | 154† | 2008–2010 | 157/4867 | 3.2% | 5.0 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa | u‐MIC | 112† | 2005–2007 | 97/3959 | 2.5% | 2.7 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa | u‐MIC | 112† | 2002–2004 | 85/3296 | 2.6% | 2.9 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa | u‐MIC | 85† | 1999 | 23/584 | 3.9% | 3.3 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| South Africa | u‐MIC | 85† | 1998 | 28/565 | 5.0% | 4.2 | No | Facility audit | CEMD, audit of complete file | Panel with O&G and non‐O&G specialists |
| Surinam | u‐MIC | 130‡ | 2010–2014 | 2/65 | 3.1% | 4.0 | Yes | MD notification form | Audit of complete file | Panel with O&G and non‐O&G specialists |
CEMD, Confidential enquiry into maternal deaths; LIC, low‐income country; l‐MIC, lower middle‐income country; u‐MIC, upper middle‐income countries; MD, maternal death; MMR, maternal mortality ratio/100 000 live births; cMMR, cardiac‐related maternal mortality ratio/100 000 live births; N/A, not available; OFD, out‐of‐facility deaths; O&G, obstetrics and gynaecology.
*
Data report used for figure 3, as most representative data for country.
†
MMR estimation of WHO, population‐based study but no MMR available in report or not population‐based study.
‡
MMR from report, population‐based study.
§
MMR based on average of 4 reports from China.
¶
MMR from report used even though facility‐based report. The region is known for a consistently lower MMR than the national MMR due to better health indicators, more details available in supplement 2.
**
Missing data.