Vital registration and under-reporting of maternal mortality in Jamaica.
OBJECTIVE
To identify why vital registration under-reports maternal deaths in Jamaica.


METHODS
A cross-sectional study was undertaken to identify all maternal deaths (during pregnancy or ≤42 days after pregnancy ended) occurring in 2008. Data sources included vital registration, hospital records, forensic pathology records, and an independent maternal mortality surveillance system. Potential cases were cross-referenced to registered live births and stillbirths, and hospital records to confirm pregnancy status, when the pregnancy ended, and registration. Medical certificates were inspected for certification, transcription, and coding errors. Maternal mortality ratios (MMRs) for registered and/or unregistered deaths were calculated.


RESULTS
Of 50 maternal deaths identified, 10 (20%) were unregistered. Eight unregistered deaths were coroners' cases. Among 40 registered deaths, pregnancy was undocumented in 4 (10%). Among the other 36, 24 (67%) had been misclassified (59% direct and 89% indirect deaths). Therefore, only 12 (30%) registered maternal deaths had been coded as maternal deaths, yielding an MMR of 28.3 per 100 000 live births (95% confidence interval [CI] 12.3-48.3), which was 76% lower than the actual MMR of 117.8 (95% CI 85.2-150.4).


CONCLUSION
Under-reporting of maternal deaths in Jamaica in 2008 was attributable to delayed registration of coroners' cases and misclassification. Timely registration of coroners' cases and training of nosologists to recognize and code maternal deaths is needed.
['McCaw-Binns|Affette M|AM|', 'Mullings|Jasneth A|JA|', 'Holder|Yvette|Y|']
D003430:Cross-Sectional Studies D005260:Female D006801:Humans D007563:Jamaica D050498:Live Birth D063130:Maternal Death D008428:Maternal Mortality D008499:Medical Records D011247:Pregnancy D011248:Pregnancy Complications D012042:Registries D050497:Stillbirth
Vital registration Under-reporting Maternal mortality Jamaica Surveillance Misclassification International Classification of Diseases-Maternal Mortality (ICD-MM)