A practical approach to identifying maternal deaths missed from routine hospital reports: lessons from Indonesia.
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.
Qomariyah
Siti Nurul
SN
Center for Family Welfare, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia.
Bell
Jacqueline S
JS
Pambudi
Eko S
ES
Anggondowati
Trisari
T
Latief
Kamaluddin
K
Achadi
Endang L
EL
Graham
Wendy J
WJ