title: Insights into maternal mortality in Madang Province, Papua New Guinea.
abstract: OBJECTIVE
  To assess the frequency, causes, and reporting of maternal deaths at a provincial referral hospital in coastal Papua New Guinea (PNG), and to describe delays in care.
  
  
  METHODS
  In a structured retrospective review of maternal deaths at Modilon General Hospital, Madang, PNG, registers and case notes for the period January 2008 to July 2012 were analyzed to determine causes, characteristics, and management of maternal death cases. Public databases were assessed for underreporting.
  
  
  RESULTS
  During the review period, there were 64 maternal deaths (institutional maternal mortality ratio, 588 deaths per 100 000 live births). Fifty-two cases were analyzed in detail: 71.2% (n=37) were direct maternal deaths, and hemorrhage (n=24, 46.2%) and infection (n=16, 30.8%) were the leading causes of mortality overall. Women frequently did not attend prenatal clinics (n=34, 65.4%), resided in rural areas (n=45, 86.5%), and experienced delays in care (n=45, 86.5%). Maternal deaths were underreported in public databases.
  
  
  CONCLUSIONS
  The burden of maternal mortality was found to be high at a provincial hospital in PNG. Most women died of direct causes and experienced delays in care. Strategies to complement current hospital and national policy to reduce maternal mortality and to improve reporting of deaths are needed.
authors.affiliation: Department of Obstetrics and Gynecology, Modilon General Hospital, Madang, Papua New Guinea. Electronic address: johnbolnga@gmail.com.
authors.forename: John W
authors.initials: JW
authors.lastname: Bolnga
authors.affiliation: Department of Obstetrics and Gynecology, Modilon General Hospital, Madang, Papua New Guinea.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Hamura
authors.affiliation: Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Umbers
authors.affiliation: Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
authors.affiliation: Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.
authors.forename: Holger W
authors.initials: HW
authors.lastname: Unger
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D063130:Maternal Death / Q000209:etiology*; D008428:Maternal Mortality; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cause; Maternal death; Maternal mortality ratio; Papua New Guinea; Reporting; Three-delays model