Surveillance Evaluation of Severe Maternal Morbidity - La Altagracia, Dominican Republic, 2017-2018

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  • Maternal and child health
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Background:
Severe maternal morbidity (SMM) is a public health problem and its surveillance is a strategy proposed to reduce the maternal mortality rate. It is estimated that 40% of women will develop complications during pregnancy, delivery and puerperium and sometimes almost die. Since 2013 it ́s an immediate mandatory notification event. We evaluated attributes of Severe maternal morbidity surveillance system (SMMSS) in La Altagracia province 2017-2018.

Methods:
We conducted a descriptive study of the SMMSS, defined as any woman who during pregnancy, childbirth or the first 42 days of the puerperium present at least one of the criteria defined in the surveillance protocol of the National Epidemiological Surveillance System (SINAVE). We apply anonymous qualitative survey to Maternal health services (MHS) surveillance officers and analyze the notification flow to assess simplicity and acceptability, we analyzed data quality, notification opportunity and review the completeness of demographic, clinical and diagnostic data, of the SINAVE database and hospital records and perinatal clinical history of MHS.

Results:
53% (8/15) persons responsible for notification were surveyed. 88% (7/8) answered questions related to simplicity, 100% of them reported that the electronic system is relatively easy to operate, although they claim that it requires irrelevant data, and had difficulty to loading and extracting data. 50% (4/8) of respondents expressed doubts about the criteria to classify an event as SMM. Only 27% (4/15) of the MHS had notified cases to the SINAVE. 19 SMM were reported for the 2017-2018 period, 79% (15/19) was notified by one of the MHS. 37% (7/19) met the case definition and 95% (18/19) were reported with incomplete data. The average number of notification days was 2 (range 0-7 days). When reviewing medical records at Maternal Health Service (MHS), we identified 117 cases of SMM in 2017 that met at least one inclusion criteria and had not been notified.

Conclusion:
Although surveillance of Severe Maternal Morbidity (SMM) is relatively simple, acceptability is low. Lack of knowledge in detection and notification procedures affects the quality of the data. We recommend strengthening SMM surveillance especially in detection and notification procedures.

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