RESUMO
BACKGROUND: Accurate estimates of the number of maternal deaths in both the community and facility are important, in order to allocate adequate resources to address such deaths. On the other hand, current studies show that routine methods of identifying maternal deaths in facilities underestimate the number by more than one-half. OBJECTIVE: To assess the utility of a new approach to identifying maternal deaths in hospitals. METHOD: Deaths of women of reproductive age were retrospectively identified from registers in two district hospitals in Indonesia over a 24-month period. Based on information retrieved, deaths were classified as 'maternal' or 'non-maternal' where possible. For deaths that remained unclassified, a detailed case note review was undertaken and the extracted data were used to facilitate classification. RESULTS: One hundred and fifty-five maternal deaths were identified, mainly from the register review. Only 67 maternal deaths were recorded in the hospitals' routine reports over the same period. This underestimation of maternal deaths was partly due to the incomplete coverage of the routine reporting system; however, even in the wards where routine reports were made, the study identified twice as many deaths. CONCLUSION: The RAPID method is a practical method that provides a more complete estimate of hospital maternal mortality than routine reporting systems.
RESUMO
OBJECTIVES: To examine the association between midwife density, other characteristics of midwifery provision and village contextual factors, and the percentage of births attended by a health professional and deliveries via caesarean section in two districts in West Java, Indonesia. METHODS: Analysis of: (i) a census of midwives; (ii) a population-based survey of women who had delivered over a 2-year period; (iii) a census of all caesareans in the four hospitals serving the two districts; and (iv) data from National Statistical Office. RESULTS: At an average density of 2.2 midwives per 10 000 population, 33% of births are with a health professional, and 1% by caesarean section. Having at least six midwives per 10 000 population was associated with a fourfold increase in caesareans [adjusted risk ratio (RR) 4.3: 95% confidence interval (CI): 3.3-5.5] and a threefold increase in the odds of having a health professional attend the delivery [adjusted odds ratio (OR) 2.88: 95% CI: 0.96-8.70]. The assigned midwife's professional status and the duration of her service in the village were also associated with higher rates of health professionals' attendance of delivery and caesareans. Regardless of the provision of services, women's education and wealth were strong predictors of delivery with a health professional. CONCLUSIONS: Promoting a stable workforce of midwives, better financial access for the poor and expanding female education are important for the achievement of the fifth Millennium Development Goal (MDG-5).
