Improving maternal mortality reporting in Georgia

Improving maternal mortality data in Georgia is crucial for measuring the progress towards the reduction of maternal deaths and planning prompt interventions. Official data showed significant MMR fluctuations over the last years (52.1 in 2009 vs 19.2 in 2010). Objective: To identify deficiencies in maternal deaths reporting and classification of causes of deaths and identify areas for improvements. Methods: The study, initiated by JSI SUSTAIN project (funded by USAID) and the Ministry of Health, collected data on the deaths of women of reproductive age (WRA) that occurred in 2010 using: vital statistics, linkage of death records with birth and fetal death records, health statistics and medical record review. Results: The study identified five unregistered deaths of WRA. Discrepancies between different sources in ascertainment and coding of underlying causes of death were overwhelming (62%). Vital records review showed that undetermined causes of death were most commonly reported (51%). Misclassification of underlying causes of deaths, particularly cancer, as a death due to circulatory system diseases (52%) remains to be a challenge. The study revealed two additional maternal deaths that were originally misclassified in official statistics. Thus, the revised MMR for 2010 increased from 19.2 to 20.8 per 100000 live births. Conclusion: Despite the recent reforms in the civil registration system, intersectoral collaboration between all stakeholders is required for further improvements in the functionality of the system. Death certification and ICD coding trainings for health professionals and implementation of maternal death surveillance will be essential to improve maternal mortality reporting and cause-of-death registration.