title: Epidemiologic transition in maternal mortality and morbidity: new challenges for Jamaica.
abstract: OBJECTIVE
  Given interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998-2003.
  
  
  METHODS
  Records of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes.
  
  
  RESULTS
  Maternal mortality declined (p=0.023) since surveillance began in 1981-83. The fall in direct mortality (p=0.0003) included 24% fewer hypertension deaths (introduction of clinical guidelines, reorganization of antenatal services) and 36% fewer hemorrhage deaths (introduction of plasma expanders). These improvements were tempered by growing indirect mortality (p=0.057), moving to 31% of maternal deaths from 17% in 1993-95.
  
  
  CONCLUSIONS
  Declines in direct mortality may be associated with surveillance and related improvements in obstetric care. Increased indirect deaths from HIV/AIDS, cardiac disease, sickle cell disease and asthma suggests the need to improve collaboration with medical teams to implement guidelines to care for pregnant women with chronic diseases.
authors.affiliation: University of the West Indies, Kingston, Jamaica. affette.mccawbinns@uwimona.edu.jm
authors.forename: A
authors.initials: A
authors.lastname: McCaw-Binns
authors.forename: S F
authors.initials: SF
authors.lastname: Alexander
authors.forename: J L M
authors.initials: JL
authors.lastname: Lindo
authors.forename: C
authors.initials: C
authors.lastname: Escoffery
authors.forename: K
authors.initials: K
authors.lastname: Spence
authors.forename: K
authors.initials: K
authors.lastname: Lewis-Bell
authors.forename: G
authors.initials: G
authors.lastname: Lewis
mesh_terms: D002423:Cause of Death; D005260:Female; D006470:Hemorrhage / Q000401:mortality; D006779:Hospitals, Public; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality; D007563:Jamaica / Q000453:epidemiology; D008427:Maternal Health Services; D008428:Maternal Mortality / Q000639:trends*; D007744:Obstetric Labor Complications / Q000401:mortality; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D011256:Pregnancy Outcome