Reducing maternal mortality in low- and middle-income countr
Incomplete vital registrations systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries.

To inform global efforts to reduce maternal mortality, researchers have studied the reasons why 143 women died during pregnancy and soon after birth in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized control trials of over 60,000 women in Pakistan (105 deaths), Mozambique (22 deaths) and India (16 deaths).

The team compared physician review and computerized analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on the maternal cause of death. It was concluded that careful review by doctors of individual women's stories before they died provided insights that agreed better with an older computerized approach to finding out why women died (InterVA-4) than with a newer version (InterVA-5).

"This gap between what InterVA-5 determined had happened and what had actually happened is very important, as we must learn from each and every one of these sad stories to provide better care in future."

The findings conclude that improvements need to be made to InterVA-5. While InterVA-4 and InterVA-5 were accurate in identifying high blood pressure in pregnancy as a cause of death, InterVA-5 chose bleeding after birth as the cause of death more frequently than it should have and was least likely to assign medical causes such as heart disease, HIV, and malaria as often as it should have. In the UK, these 'indirect' medical causes of maternal death are of increasing importance.

The Lancet Global Health