A comprehensive assessment of maternal deaths in Argentina: translating multicentre collaborative research into action.
OBJECTIVE
To perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths.


METHODS
Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths.


RESULTS
A total of 121 maternal deaths occurred during 2002. The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%). Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26). The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age. Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas.


CONCLUSIONS
A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data. There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies.
Ramos
Silvina
S
Center for the Study of State and Society, Buenos Aires, Argentina.
Karolinski
Ariel
A
Romero
Mariana
M
Mercer
Raúl
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001118:Argentina / Q000453:epidemiology; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors