Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)

Florence Mgawadere; R. Unkels; N. van den Broek

doi:10.1111/1471-0528.13969

Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)

Florence Mgawadere, R. Unkels, N. van den Broek

International Public Health

Liverpool School of Tropical Medicine

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

Objective

To compare methodology used to assign cause of and factors contributing to maternal death.

Design

Reproductive Age Mortality Study.

Setting

Malawi.

Population

Maternal deaths among women of reproductive age.

Methods

We compared cause of death as assigned by a facility-based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (ICD-10) cause classification for deaths during pregnancy, childbirth and the puerperium (ICD-MM) and a computer-based probabilistic program (InterVA-4).

Main outcome measures

Number and cause of maternal deaths.

Results

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% CI 307–425). There was poor agreement between cause of death assigned by a facility-based maternal death review team and an expert panel (κ = 0.37, 86 maternal deaths). The review team considered 36% of maternal deaths to be indirect and caused by non-obstetric complications (ICD-MM Group 7) whereas the expert panel considered only 17.4% to be indirect maternal deaths with 33.7% due to obstetric haemorrhage (ICD-MM 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 InterVA-4 regarding cause of death was good (κ = 0.66, 151 maternal deaths). However, contributing conditions are not identified by InterVA-4.

Conclusions

Training in the use of ICD-MM 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.

Tweetable abstract

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.

Original language	English
Pages (from-to)	1647-1653
Number of pages	7
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	123
Issue number	10
DOIs	https://doi.org/10.1111/1471-0528.13969
Publication status	Published - 9 Mar 2016

Keywords

Cause of death classification
expert panel
ICD-MM
InterVA-4
maternal death review

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/1471-0528.13969Licence: CC BY-NC

Cite this

@article{0218d9f2305d4dc1bbccd69add2f4db5,

title = "Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)",

abstract = "ObjectiveTo compare methodology used to assign cause of and factors contributing to maternal death.DesignReproductive Age Mortality Study.SettingMalawi.PopulationMaternal deaths among women of reproductive age.MethodsWe compared cause of death as assigned by a facility-based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (ICD-10) cause classification for deaths during pregnancy, childbirth and the puerperium (ICD-MM) and a computer-based probabilistic program (InterVA-4).Main outcome measuresNumber and cause of maternal deaths.ResultsThe 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\% CI 307–425). There was poor agreement between cause of death assigned by a facility-based maternal death review team and an expert panel (κ = 0.37, 86 maternal deaths). The review team considered 36\% of maternal deaths to be indirect and caused by non-obstetric complications (ICD-MM Group 7) whereas the expert panel considered only 17.4\% to be indirect maternal deaths with 33.7\% due to obstetric haemorrhage (ICD-MM 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 InterVA-4 regarding cause of death was good (κ = 0.66, 151 maternal deaths). However, contributing conditions are not identified by InterVA-4.ConclusionsTraining in the use of ICD-MM 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.Tweetable abstractFor 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.",

keywords = "Cause of death classification, expert panel, ICD-MM, InterVA-4, maternal death review",

author = "Florence Mgawadere and R. Unkels and \{van den Broek\}, N.",

year = "2016",

month = mar,

day = "9",

doi = "10.1111/1471-0528.13969",

language = "English",

volume = "123",

pages = "1647--1653",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

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}

Mgawadere, F, Unkels, R & van den Broek, N 2016, 'Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 123, no. 10, pp. 1647-1653. https://doi.org/10.1111/1471-0528.13969

Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4). / Mgawadere, Florence; Unkels, R.; van den Broek, N.
In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 123, No. 10, 09.03.2016, p. 1647-1653.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)

AU - Mgawadere, Florence

AU - Unkels, R.

AU - van den Broek, N.

PY - 2016/3/9

Y1 - 2016/3/9

N2 - ObjectiveTo compare methodology used to assign cause of and factors contributing to maternal death.DesignReproductive Age Mortality Study.SettingMalawi.PopulationMaternal deaths among women of reproductive age.MethodsWe compared cause of death as assigned by a facility-based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (ICD-10) cause classification for deaths during pregnancy, childbirth and the puerperium (ICD-MM) and a computer-based probabilistic program (InterVA-4).Main outcome measuresNumber and cause of maternal deaths.ResultsThe 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% CI 307–425). There was poor agreement between cause of death assigned by a facility-based maternal death review team and an expert panel (κ = 0.37, 86 maternal deaths). The review team considered 36% of maternal deaths to be indirect and caused by non-obstetric complications (ICD-MM Group 7) whereas the expert panel considered only 17.4% to be indirect maternal deaths with 33.7% due to obstetric haemorrhage (ICD-MM 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 InterVA-4 regarding cause of death was good (κ = 0.66, 151 maternal deaths). However, contributing conditions are not identified by InterVA-4.ConclusionsTraining in the use of ICD-MM 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.Tweetable abstractFor 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.

AB - ObjectiveTo compare methodology used to assign cause of and factors contributing to maternal death.DesignReproductive Age Mortality Study.SettingMalawi.PopulationMaternal deaths among women of reproductive age.MethodsWe compared cause of death as assigned by a facility-based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (ICD-10) cause classification for deaths during pregnancy, childbirth and the puerperium (ICD-MM) and a computer-based probabilistic program (InterVA-4).Main outcome measuresNumber and cause of maternal deaths.ResultsThe 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% CI 307–425). There was poor agreement between cause of death assigned by a facility-based maternal death review team and an expert panel (κ = 0.37, 86 maternal deaths). The review team considered 36% of maternal deaths to be indirect and caused by non-obstetric complications (ICD-MM Group 7) whereas the expert panel considered only 17.4% to be indirect maternal deaths with 33.7% due to obstetric haemorrhage (ICD-MM 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 InterVA-4 regarding cause of death was good (κ = 0.66, 151 maternal deaths). However, contributing conditions are not identified by InterVA-4.ConclusionsTraining in the use of ICD-MM 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.Tweetable abstractFor 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.

KW - Cause of death classification

KW - expert panel

KW - ICD-MM

KW - InterVA-4

KW - maternal death review

U2 - 10.1111/1471-0528.13969

DO - 10.1111/1471-0528.13969

M3 - Article

SN - 1470-0328

VL - 123

SP - 1647

EP - 1653

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - 10

ER -

Assigning cause of maternal death: a comparison of findings by a facility-based review team, an expert panel using the new ICD-MM cause classification and a computer-based program (InterVA-4)

Abstract

Keywords

UN SDGs

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