title: Predicting in-hospital maternal mortality in Senegal and Mali.
abstract: OBJECTIVE
  We sought to identify predictors of in-hospital maternal mortality among women attending referral hospitals in Mali and Senegal.
  
  
  METHODS
  We conducted a cross-sectional epidemiological survey using data from a cluster randomized controlled trial (QUARITE trial) in 46 referral hospitals in Mali and Senegal, during the pre-intervention period of the trial (from October 1st 2007 to October 1st 2008). We included 89,518 women who delivered in the 46 hospitals during this period. Data were collected on women's characteristics, obstetric complications, and vital status until the hospital discharge. We developed a tree-like classification rule (classification rule) to identify patient subgroups at high risk of maternal in-hospital mortality.
  
  
  RESULTS
  Our analyses confirm that patients with uterine rupture, hemorrhage or prolonged/obstructed labor, and those who have an emergency ante-partum cesarean delivery have an increased risk of in-hospital mortality, especially if they are referred from another health facility. Twenty relevant patterns, based on fourteen predictors variables, are used to predict in-hospital maternal mortality with 81.41% sensitivity (95% CI = [77.12%-87.70%]) and 81.6% specificity (95% CI = [81.16%-82.02%]).
  
  
  CONCLUSIONS
  The proposed class association rule method will help health care professionals in referral hospitals in Mali and Senegal to identify mothers at high risk of in-hospital death, and can provide scientific evidence on which to base their decisions to manage patients delivering in their health facilities.
authors.affiliation: Laboratoire d'Etudes et de Recherches en Statistiques et Développement, Université Gaston Berger, Saint-Louis, Sénégal.
authors.forename: Cheikh
authors.initials: C
authors.lastname: Ndour
authors.forename: Simplice
authors.initials: S
authors.lastname: Dossou Gbété
authors.forename: Noelle
authors.initials: N
authors.lastname: Bru
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
authors.forename: Mamadou
authors.initials: M
authors.lastname: Traoré
authors.forename: Aliou
authors.initials: A
authors.lastname: Diop
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumont
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008302:Mali / Q000453:epidemiology; D008428:Maternal Mortality; D011247:Pregnancy; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D012675:Senegal / Q000453:epidemiology