title: Improving the measurement of maternal mortality in Thailand using multiple data sources.
abstract: BACKGROUND
  Thailand uses cause of death records in civil registration to summarize maternal mortality statistics. A report by the Department of Health using the Reproductive Age Mortality Studies (RAMOS) reported that the maternal mortality ratio (MMR) in 1997 was approximately three to four times higher than MMR based on the civil registration cause of death records. Here, we used multiple data sources to systematically measure maternal mortality in Thailand and showed a disparity between age groups and regions.
  
  
  METHODS
  We calculated the number of maternal deaths using a two-stage method. In the first stage, we counted the number of deceased mothers who successfully gave live births. In the second stage, we counted the number of women who died during the pregnancy, delivery, or the postpartum period without a live birth.
  
  
  RESULTS
  The number of maternal deaths dropped from 268 in 2007 to 226 in 2014. Nearly 50 % of the deaths occurred in Stage 1. The maternal mortality ratio in 2007 was 33.6 per 100,000 live births; the rate fell to 31.8 in 2014. The age ranges of women observed were 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49, and the MMR averages were 21.5, 23.8, 27.0, 42.1, 67.7, 115.4, and 423.4 per 100,000 live births, respectively. The Southern region consistently exhibited the highest MMR compared to other regions for every year analyzed, except 2012. Women in Bangkok had a lower risk of dying during pregnancy, delivery, and the postpartum period than women from other regions.
  
  
  CONCLUSIONS
  We demonstrated that using multiple administrative data sources in the two-stage method was an efficient method that provided systematic measurement and timely reporting on the maternal mortality ratio. An additional benefit of the method was that information provided from the combined data sources, (e.g., the number of maternal deaths by age group and region) was relevant to the safe motherhood policy.
authors.affiliation: Faculty of Economics, Khon Kaen University, 123 Mitraphab Road, Muang, Khon Kaen 40002 Thailand ; Thailand Development Research Institute, 565 Ramkhamhaeng Rd. Soi 39, Bangkok, Wangthonglang 10310 Thailand.
authors.forename: Worawan
authors.initials: W
authors.lastname: Chandoevwit
authors.affiliation: Thailand Development Research Institute, 565 Ramkhamhaeng Rd. Soi 39, Bangkok, Wangthonglang 10310 Thailand.
authors.forename: Phasith
authors.initials: P
authors.lastname: Phatchana
authors.affiliation: National Health Security Office, The government complex commemorating His Majesty the King's 80th birthday Anniversary 5th December, B.E. 2550 Building B, 120 Moo 3, Chaengwattana Road, Bangkok, Lak Si District 10210 Thailand.
authors.forename: Kanjana
authors.initials: K
authors.lastname: Sirigomon
authors.affiliation: National Health Security Office, The government complex commemorating His Majesty the King's 80th birthday Anniversary 5th December, B.E. 2550 Building B, 120 Moo 3, Chaengwattana Road, Bangkok, Lak Si District 10210 Thailand.
authors.forename: Kunakorn
authors.initials: K
authors.lastname: Ieawsuwan
authors.affiliation: National Health Security Office, The government complex commemorating His Majesty the King's 80th birthday Anniversary 5th December, B.E. 2550 Building B, 120 Moo 3, Chaengwattana Road, Bangkok, Lak Si District 10210 Thailand.
authors.forename: Jutatip
authors.initials: J
authors.lastname: Thungthong
authors.affiliation: National Health Security Office, The government complex commemorating His Majesty the King's 80th birthday Anniversary 5th December, B.E. 2550 Building B, 120 Moo 3, Chaengwattana Road, Bangkok, Lak Si District 10210 Thailand.
authors.forename: Saray
authors.initials: S
authors.lastname: Ruangdej
keywords: Civil registration; Maternal death; Maternal mortality ratio; Pregnancy; Thailand