The National Maternal Mortality Study in Jordan, 2007-2008

This report describes the surveillance that was conducted to identify pregnancy-related deaths for the biennium 2007-2008. The aim and objectives were to review the factors that contributed to those deaths, to analyze and interpret the information gathered, with the ultimate goal of acting on the results to reduce such deaths in the future.

 

Worldwide, in 2005 there were over 500,000 maternal deaths. By the broad Millennium Development Goals, developing countries accounted for 99% of these deaths, at 450 maternal deaths per 100,000 live births, in contrast to developed countries at 9 per 100,000 live births. It is estimated that the adult lifetime risk of maternal death, i.e. the probability that a 15-year-old female will die from a maternal cause, is 1 in 26 in Africa, 1 in 120 in Asia, in contrast to 1 in 7300 in the developed world.

 

 

The objectives of maternal mortality study in Jordan, 2007-2008, were as follows:

 

1. Estimate maternal mortality ratio among Jordanian women in the reproductive age.

2. Identify the direct and indirect causes of maternal mortality.

3. Determine the extent to which maternal deaths are preventable.

4. Determine the factors which if addressed, would prevent maternal deaths.

5. Assess hospital medical records and vital records in terms of appropriateness and completeness.

 

 

This study aimed to identify all maternal deaths for the years 2007-2008 in jordan. The reproductive-age mortality survey (RAMOS) approach was applied to study maternal deaths. Multiple approaches for data collection and validation were followed during the study. Civil registration systems, household surveys, sister hoods methods, reproductive-age mortality studies (RAMOS), community-based maternal death reviews (verbal autopsy) and facility-based maternal deaths review. RAMOS is the gold standard for identifying pregnancy-related approach.

 

 

A total of 76 maternal deaths were identified in the biennium 2007-2008 out of 397588 live births, a maternal mortality ratio of 19.1 deaths per 100,000 live births. Analysis of trends showed that young age, large family size, being from the Southern Region of the country, attending peripheral hospitals, lower education and lower monthly family income were associated with a higher risk of maternal death.

Of the total of 76 maternal deaths, 56.6% were attributable to haemorrhage, thrombosis and thromboembolism and sepsis. Avoidable factors were judged to be present in 53.9% of the total maternal deaths, and 52.6% had substandard care, Antenatal care was poor as 19.7% women did not attend any health facility for antenantel care 33.3% had less than 3 or less antenatal visits in total.

Of all 76 women maternal deaths, the details of family planning were not available for 32.9% of women. Of those with available information, only 29.4% had ever used any form of contraception, and 70.6% had never used any form of contraception. Of the total, 39 (51.3%) women were planning to conceive the index pregnancy.

 

 

1. Develop a national maternal health policy which prioritize the interventions needed to reach the population groups most in need and bring all elements of maternal health together in one policy document.

 

2. Adopt and scale up the implementation of the strategies and plans of action related to Making Pregnancy Safer, these having proved effective in supporting national efforts towards achieving the MDGs. In this respect, appropriate monitoring mechanisms to ensure effective implementation of national plans in accordance with their targets and objectives should be set up.

 

3. Upgrade recording and reporting systems to ensure data consistency and efficient input to the national health information systems, and further develop national surveillance systems to identify epidemiological patterns and maternal morbidity and mortality trends.

 

4. Extend efforts in implementing community-based interventions related to maternal health as an investment towards developing and empowering the community to play an active and effective role in caring for mothers and children. Particular focus should be placed both on early recognition of the danger signs of sickness and also on preventive measures to promote maternal health.

 

5. Introduce the adapted maternal health-related guidelines into the formal teaching curricula of medical and paramedical schools, both to improve the quality of teaching and to ensure sustainability of the effective interventions.