title: Nationwide maternal mortality in Surinam.
abstract: OBJECTIVE
  To assess the magnitude, causes and associated factors of maternal mortality in Surinam.
  
  
  METHODS
  Nationwide confidential enquiry. Maternal deaths were identified using various methods and sources for the period 1991-1993. All cases were examined by a maternal mortality expert committee for substandard care analysis.
  
  
  RESULTS
  The national maternal mortality ratio was 226 per 100,000 live births, which is six times higher than the official maternal mortality ratio of 38 for the preceding three year period. The main causes of death were haemorrhage (30%) and pre-eclampsia (20%). In 95% of analysed cases, substandard care factors which had contributed to the deaths were present at one or more levels of maternity care.
  
  
  CONCLUSIONS
  Maternal mortality was found to be several times higher than had been officially reported for Surinam during the previous three decades. Improvement of maternity care services in Surinam is needed, and has to be addressed at all levels, from the community, health centre and hospital to the highest level of organisation.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Mungra
authors.forename: R W
authors.initials: RW
authors.lastname: van Kanten
authors.forename: H H
authors.initials: HH
authors.lastname: Kanhai
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D008318:Malpractice; D008427:Maternal Health Services / Q000592:standards; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D011251:Pregnancy Complications, Infectious / Q000401:mortality; D013532:Suriname / Q000453:epidemiology