{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:42:31Z","timestamp":1793104951122,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,3,9]],"date-time":"2016-03-09T00:00:00Z","timestamp":1457481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005922","name":"Icelandic International Development Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005922","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000862","name":"Sir Halley Stewart Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000862","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare methodology used to assign cause of and factors contributing to maternal death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Reproductive Age Mortality Study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Maternal deaths among women of reproductive age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We compared cause of death as assigned by a facility\u2010based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (<jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\u201010) cause classification for deaths during pregnancy, childbirth and the puerperium (<jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content>) and a computer\u2010based probabilistic program (I<jats:sc>nter<\/jats:sc><jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>\u20104).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Number and cause of maternal deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of maternal deaths occurred at a health facility (94\/151; 62.3%). The estimated maternal mortality ratio was 363 per 100 000 live births (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 307\u2013425). There was poor agreement between cause of death assigned by a facility\u2010based maternal death review team and an expert panel (<jats:italic>\u03ba<\/jats:italic> = 0.37, 86 maternal deaths). The review team considered 36% of maternal deaths to be indirect and caused by non\u2010obstetric complications (<jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> Group 7) whereas the expert panel considered only 17.4% to be indirect maternal deaths with 33.7% due to obstetric haemorrhage (<jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> Group 3). The review team incorrectly assigned a contributing condition rather than cause of death in up to 15.1% of cases. Agreement between the expert panel and I<jats:sc>nter<\/jats:sc><jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>\u20104 regarding cause of death was good (<jats:italic>\u03ba<\/jats:italic> = 0.66, 151 maternal deaths). However, contributing conditions are not identified by I<jats:sc>nter<\/jats:sc><jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>\u20104.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Training in the use of <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> is needed for healthcare providers conducting maternal death reviews to be able to correctly assign underlying cause of death and contributing factors. Such information can help to identify what improvements in quality of care are needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>For maternal deaths assigning cause of death is best done by an expert panel and helps to identify where quality of care needs to be improved.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13969","type":"journal-article","created":{"date-parts":[[2016,3,9]],"date-time":"2016-03-09T08:50:44Z","timestamp":1457513444000},"page":"1647-1653","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Assigning cause of maternal death: a comparison of findings by a facility\u2010based review team, an expert panel using the new <scp>ICD<\/scp>\u2010<scp>MM<\/scp> cause classification and a computer\u2010based program (I<scp>nter<\/scp><scp>VA<\/scp>\u20104)"],"prefix":"10.1111","volume":"123","author":[{"given":"F","family":"Mgawadere","sequence":"first","affiliation":[{"name":"Centre for Maternal and Newborn Health Liverpool School of Tropical Medicine Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Unkels","sequence":"additional","affiliation":[{"name":"Centre for Maternal and Newborn Health Liverpool School of Tropical Medicine Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"van den Broek","sequence":"additional","affiliation":[{"name":"Centre for Maternal and Newborn Health Liverpool School of Tropical Medicine Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,9]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"United Nations Millenium Declaration. 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