title: A practical approach to identifying maternal deaths missed from routine hospital reports: lessons from Indonesia.
abstract: BACKGROUND
  Accurate estimates of the number of maternal deaths in both the community and facility are important, in order to allocate adequate resources to address such deaths. On the other hand, current studies show that routine methods of identifying maternal deaths in facilities underestimate the number by more than one-half.
  
  
  OBJECTIVE
  To assess the utility of a new approach to identifying maternal deaths in hospitals.
  
  
  METHODS
  Deaths of women of reproductive age were retrospectively identified from registers in two district hospitals in Indonesia over a 24-month period. Based on information retrieved, deaths were classified as 'maternal' or 'non-maternal' where possible. For deaths that remained unclassified, a detailed case note review was undertaken and the extracted data were used to facilitate classification.
  
  
  RESULTS
  One hundred and fifty-five maternal deaths were identified, mainly from the register review. Only 67 maternal deaths were recorded in the hospitals' routine reports over the same period. This underestimation of maternal deaths was partly due to the incomplete coverage of the routine reporting system; however, even in the wards where routine reports were made, the study identified twice as many deaths.
  
  
  CONCLUSIONS
  The RAPID method is a practical method that provides a more complete estimate of hospital maternal mortality than routine reporting systems.
authors.affiliation: Center for Family Welfare, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia.
authors.forename: Siti Nurul
authors.initials: SN
authors.lastname: Qomariyah
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Bell
authors.forename: Eko S
authors.initials: ES
authors.lastname: Pambudi
authors.forename: Trisari
authors.initials: T
authors.lastname: Anggondowati
authors.forename: Kamaluddin
authors.initials: K
authors.lastname: Latief
authors.forename: Endang L
authors.initials: EL
authors.lastname: Achadi
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Graham