Surveillance and response system for maternal deaths in Sri Lanka: an audit

Abstract Background Many women in low-income countries die from pregnancy-related causes. Review of maternal deaths can help to prevent such deaths and improve delivery of maternal care services, but audits of maternal deaths are not easy to do in resource-poor settings. We audited probable maternal deaths reported during 2012 in Sri Lanka. Methods We analysed data for death collected by the Family Health Bureau, which coordinates audits of maternal death in Sri Lanka. Field and hospital health staff are required to notify deaths, do post mortems, investigate, and report to national level each maternal death. We analysed each death related to three delays: in seeking health care, in reaching a health facility, and in treatment. We asked health-care workers in 26 districts to suggest strategies to change and improve service delivery. Findings Of 218 probable maternal deaths, we classified 134 as maternal deaths (WHO definition) and calculated the national maternal mortality rate (37·7 per 100 000 live births). Haemorrhage (n=22) and heart disease (n=15) were leading causes of death. Women who died tended to be well educated (n=109, 81%) and from rural regions (n=106, 79%). 92 (69%) of these women died in the postnatal period. Delays in seeking health care contributed to 64 deaths (71%), whereas delays in receiving treatment contributed to 54 (60%) and delays in reaching a health facility contributed to two (2%). Not promoting family planning, substandard management, and inadequate field post-natal care were identified as deficiencies. Interpretation Sri Lanka implements a systematic surveillance of maternal deaths at low cost, with involvement of key partners to further reduce deaths and improve care. Such a system is replicable in any setting if launched methodically and in collaboration with committed partners. Funding None.