Case definition of maternal mortality and estimates of MMR in Africa

Michel Garenne, Institut Pasteur

Much confusion arose in the estimates of maternal mortality ratios (MMR) in developing countries because of a lack of rigor in the case definition. Most demographic surveys do not apply the WHO definition of maternal deaths, itself confusing because of the ambiguity of the concept of indirect causes of maternal death. Based on empirical evidence from sub-Saharan Africa, the paper shows the discrepancies between estimates based solely on ‘obstetric causes’, those including ‘indirect causes’ (WHO definition) and total ‘pregnancy related deaths’ the most common definition used in demographic surveys. The paper also proposes a method to convert ‘pregnancy related mortality ratio’ into ‘obstetric mortality ratio’ taking into account the prevalence of HIV in the female adult population. Applying a consistent case definition is necessary to monitor mortality trends and to assess progresses towards Millenium Development Goal # 5.