title: Maternal mortality ratio in Lebanon in 2008: a hospital-based reproductive age mortality study (RAMOS).
abstract: OBJECTIVE
  International agencies have recently assigned Lebanon to the group H of countries with "no national data on maternal mortality," and estimated a corresponding maternal mortality ratio (MMR) of 150 per 100,000 live births. The Ministry of Public Health addressed the discrepancy perceived between the reality of the maternal mortality ratio experience in Lebanon and the international report by facilitating a hospital-based reproductive age mortality study, sponsored by the World Health Organization Representative Office in Lebanon, aiming at providing an accurate estimate of a maternal mortality ratio for 2008. The survey allowed a detailed analysis of maternal causes of deaths.
  
  
  METHODS
  Reproductive age deaths (15-49 years) were initially identified through hospital records. A trained MD traveled to each hospital to ascertain whether recorded deaths were in fact maternal deaths or not. ICD10 codes were provided by the medical controller for each confirmed maternal deaths.
  
  
  RESULTS
  There were 384 RA death cases, of which 13 were confirmed maternal deaths (339%) (numerator). In 2008, there were 84823 live births in Lebanon (denominator). The MMR in Lebanon in 2008 was thus officially estimated at 23/100,000 live births, with an "uncertainty range" from 153 to 30.6. Hemorrhage was the leading cause of death, with double the frequency of all other causes (pregnancy-induced hypertension, eclampsia, infection, and embolism).
  
  
  CONCLUSIONS
  This specific enquiry responded to a punctual need to correct a clearly inadequate report, and it should be relayed by an on-going valid surveillance system. Results indicate that special attention has to be devoted to the management of peri-partum hemorrhage cases.
  
  
  BACKGROUND
  Arab, postpartum hemorrhage, development, pregnancy management, verbal autopsy
authors.forename: Elie
authors.initials: E
authors.lastname: Hobeika
authors.forename: Samer
authors.initials: S
authors.lastname: Abi Chaker
authors.forename: Hilda
authors.initials: H
authors.lastname: Harb
authors.forename: Rita
authors.initials: R
authors.lastname: Rahbany Saad
authors.forename: Walid
authors.initials: W
authors.lastname: Ammar
authors.forename: Salim
authors.initials: S
authors.lastname: Adib
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D007861:Lebanon; D008428:Maternal Mortality; D008875:Middle Aged; D016017:Odds Ratio; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D055815:Young Adult