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Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019 | Journal of Epidemiology and Global Health
<!DOCTYPE html> <html lang="en" class="no-js"> <head> <meta charset="UTF-8"> <meta http-equiv="X-UA-Compatible" content="IE=edge"> <meta name="applicable-device" content="pc,mobile"> <meta name="viewport" content="width=device-width, initial-scale=1"> <meta name="robots" content="max-image-preview:large"> <meta name="access" content="Yes"> <meta name="360-site-verification" content="1268d79b5e96aecf3ff2a7dac04ad990" /> <title>Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019 | Journal of Epidemiology and Global Health</title> <meta name="twitter:site" content="@SpringerLink"/> <meta name="twitter:card" content="summary_large_image"/> <meta name="twitter:image:alt" content="Content cover image"/> <meta name="twitter:title" content="Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019"/> <meta name="twitter:description" content="Journal of Epidemiology and Global Health - We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of..."/> <meta name="twitter:image" content="https://media.springernature.com/full/springer-static/cover-hires/journal/44197"/> <meta name="journal_id" content="44197"/> <meta name="dc.title" content="Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019"/> <meta name="dc.source" content="Journal of Epidemiology and Global Health 2024"/> <meta name="dc.format" content="text/html"/> <meta name="dc.publisher" content="Springer"/> <meta name="dc.date" content="2024-11-12"/> <meta name="dc.type" content="OriginalPaper"/> <meta name="dc.language" content="En"/> <meta name="dc.copyright" content="2024 The Author(s)"/> <meta name="dc.rights" content="2024 The Author(s)"/> <meta name="dc.rightsAgent" content="journalpermissions@springernature.com"/> <meta name="dc.description" content="We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1–1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)]. Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue."/> <meta name="prism.issn" content="2210-6014"/> <meta name="prism.publicationName" content="Journal of Epidemiology and Global Health"/> <meta name="prism.publicationDate" content="2024-11-12"/> <meta name="prism.section" content="OriginalPaper"/> <meta name="prism.startingPage" content="1"/> <meta name="prism.endingPage" content="8"/> <meta name="prism.copyright" content="2024 The Author(s)"/> <meta name="prism.rightsAgent" content="journalpermissions@springernature.com"/> <meta name="prism.url" content="https://link.springer.com/article/10.1007/s44197-024-00318-1"/> <meta name="prism.doi" content="doi:10.1007/s44197-024-00318-1"/> <meta name="citation_pdf_url" content="https://link.springer.com/content/pdf/10.1007/s44197-024-00318-1.pdf"/> <meta name="citation_fulltext_html_url" content="https://link.springer.com/article/10.1007/s44197-024-00318-1"/> <meta name="citation_journal_title" content="Journal of Epidemiology and Global Health"/> <meta name="citation_journal_abbrev" content="J Epidemiol Glob Health"/> <meta name="citation_publisher" content="Springer Netherlands"/> <meta name="citation_issn" content="2210-6014"/> <meta name="citation_title" content="Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019"/> <meta name="citation_online_date" content="2024/11/12"/> <meta name="citation_firstpage" content="1"/> <meta name="citation_lastpage" content="8"/> <meta name="citation_article_type" content="Research Article"/> <meta name="citation_fulltext_world_readable" content=""/> <meta name="citation_language" content="en"/> <meta name="dc.identifier" content="doi:10.1007/s44197-024-00318-1"/> <meta name="DOI" content="10.1007/s44197-024-00318-1"/> <meta name="size" content="138472"/> <meta name="citation_doi" content="10.1007/s44197-024-00318-1"/> <meta name="citation_springer_api_url" content="http://api.springer.com/xmldata/jats?q=doi:10.1007/s44197-024-00318-1&api_key="/> <meta name="description" content="We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of dea"/> <meta name="dc.creator" content="Musarandega, Reuben"/> <meta name="dc.creator" content="Nystrom, Lennarth"/> <meta name="dc.creator" content="Murewanhema, Grant"/> <meta name="dc.creator" content="Gwanzura, Chipo"/> <meta name="dc.creator" content="Ngwenya, Solwayo"/> <meta name="dc.creator" content="Pattinson, Robert"/> <meta name="dc.creator" content="Machekano, Rhoderick"/> <meta name="dc.creator" content="Munjanja, Stephen Peter"/> <meta name="dc.subject" content="Medicine/Public Health, general"/> <meta name="citation_reference" content="WHO. 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We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. Methods We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. Results All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1–1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)]. Conclusion Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue."/> <meta property="og:image" content="https://media.springernature.com/full/springer-static/cover-hires/journal/44197"/> <meta name="format-detection" content="telephone=no"> <link rel="apple-touch-icon" sizes="180x180" href=/oscar-static/img/favicons/darwin/apple-touch-icon-92e819bf8a.png> <link rel="icon" type="image/png" sizes="192x192" href=/oscar-static/img/favicons/darwin/android-chrome-192x192-6f081ca7e5.png> <link rel="icon" type="image/png" sizes="32x32" href=/oscar-static/img/favicons/darwin/favicon-32x32-1435da3e82.png> <link rel="icon" type="image/png" sizes="16x16" href=/oscar-static/img/favicons/darwin/favicon-16x16-ed57f42bd2.png> <link rel="shortcut icon" data-test="shortcut-icon" href=/oscar-static/img/favicons/darwin/favicon-c6d59aafac.ico> <meta name="theme-color" content="#e6e6e6"> <!-- Please see discussion: 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We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1–1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)]. Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.","datePublished":"2024-11-12T00:00:00Z","dateModified":"2024-11-12T00:00:00Z","pageStart":"1","pageEnd":"8","license":"http://creativecommons.org/licenses/by-nc-nd/4.0/","sameAs":"https://doi.org/10.1007/s44197-024-00318-1","keywords":["Pregnancy-related deaths","Maternal deaths","Maternal mortality","Missingness","Incompleteness","Misclassification","Medicine/Public Health","general"],"image":[],"isPartOf":{"name":"Journal of Epidemiology and Global Health","issn":["2210-6014"],"@type":["Periodical"]},"publisher":{"name":"Springer Netherlands","logo":{"url":"https://www.springernature.com/app-sn/public/images/logo-springernature.png","@type":"ImageObject"},"@type":"Organization"},"author":[{"name":"Reuben Musarandega","url":"http://orcid.org/0000-0002-0622-2195","affiliation":[{"name":"University of Pretoria","address":{"name":"School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa","@type":"PostalAddress"},"@type":"Organization"}],"email":"rmusara@gmail.com","@type":"Person"},{"name":"Lennarth Nystrom","affiliation":[{"name":"Umea University","address":{"name":"Department of Epidemiology and Global Health, Umea University, Umea, Sweden","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"Grant Murewanhema","affiliation":[{"name":"University of Zimbabwe","address":{"name":"Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"Chipo Gwanzura","affiliation":[{"name":"University of Zimbabwe","address":{"name":"Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"Solwayo Ngwenya","affiliation":[{"name":"Mpilo Central Hospital, National University of Science and Technology","address":{"name":"Department of Obstetrics and Gynaecology, Mpilo Central Hospital, National University of Science and Technology, Bulawayo, Zimbabwe","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"Robert Pattinson","affiliation":[{"name":"University of Pretoria","address":{"name":"Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"Rhoderick Machekano","affiliation":[{"name":"Stellenbosch University","address":{"name":"Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"Stephen Peter Munjanja","affiliation":[{"name":"University of Zimbabwe","address":{"name":"Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"}],"isAccessibleForFree":true,"@type":"ScholarlyArticle"},"@context":"https://schema.org","@type":"WebPage"}</script> </head> <body class="" > <!-- Google Tag Manager (noscript) --> <noscript> <iframe src="https://www.googletagmanager.com/ns.html?id=GTM-MRVXSHQ" height="0" width="0" style="display:none;visibility:hidden"></iframe> </noscript> <!-- End Google Tag Manager (noscript) --> <!-- Google Tag Manager (noscript) --> <noscript data-test="gtm-body"> <iframe src="https://www.googletagmanager.com/ns.html?id=GTM-MRVXSHQ" height="0" width="0" style="display:none;visibility:hidden"></iframe> </noscript> <!-- End Google Tag Manager 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class="c-context-bar__title"> Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019 </div> <div data-test="inCoD" data-track-context="sticky banner"> <div class="c-pdf-container"> <div class="c-pdf-download u-clear-both u-mb-16"> <a href="/content/pdf/10.1007/s44197-024-00318-1.pdf" class="u-button u-button--full-width u-button--primary u-justify-content-space-between c-pdf-download__link" data-article-pdf="true" data-readcube-pdf-url="true" data-test="pdf-link" data-draft-ignore="true" data-track="content_download" data-track-type="article pdf download" data-track-action="download pdf" data-track-label="button" data-track-external download> <span class="c-pdf-download__text">Download PDF</span> <svg aria-hidden="true" focusable="false" width="16" height="16" class="u-icon"><use xlink:href="#icon-eds-i-download-medium"/></svg> </a> </div> </div> </div> </div> </div> <div class="c-article-header"> <header> <ul class="c-article-author-list c-article-author-list--short" data-test="authors-list" data-component-authors-activator="authors-list"><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Reuben-Musarandega-Aff1" data-author-popup="auth-Reuben-Musarandega-Aff1" data-author-search="Musarandega, Reuben" data-corresp-id="c1">Reuben Musarandega<svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-mail-medium"></use></svg></a><span class="u-js-hide"> <a class="js-orcid" href="http://orcid.org/0000-0002-0622-2195"><span class="u-visually-hidden">ORCID: </span>orcid.org/0000-0002-0622-2195</a></span><sup class="u-js-hide"><a href="#Aff1">1</a></sup>, </li><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Lennarth-Nystrom-Aff2" data-author-popup="auth-Lennarth-Nystrom-Aff2" data-author-search="Nystrom, Lennarth">Lennarth Nystrom</a><sup class="u-js-hide"><a href="#Aff2">2</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Grant-Murewanhema-Aff3" data-author-popup="auth-Grant-Murewanhema-Aff3" data-author-search="Murewanhema, Grant">Grant Murewanhema</a><sup class="u-js-hide"><a href="#Aff3">3</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Chipo-Gwanzura-Aff3" data-author-popup="auth-Chipo-Gwanzura-Aff3" data-author-search="Gwanzura, Chipo">Chipo Gwanzura</a><sup class="u-js-hide"><a href="#Aff3">3</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Solwayo-Ngwenya-Aff4" data-author-popup="auth-Solwayo-Ngwenya-Aff4" data-author-search="Ngwenya, Solwayo">Solwayo Ngwenya</a><sup class="u-js-hide"><a href="#Aff4">4</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Robert-Pattinson-Aff5" data-author-popup="auth-Robert-Pattinson-Aff5" data-author-search="Pattinson, Robert">Robert Pattinson</a><sup class="u-js-hide"><a href="#Aff5">5</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Rhoderick-Machekano-Aff6" data-author-popup="auth-Rhoderick-Machekano-Aff6" data-author-search="Machekano, Rhoderick">Rhoderick Machekano</a><sup class="u-js-hide"><a href="#Aff6">6</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Stephen_Peter-Munjanja-Aff3" data-author-popup="auth-Stephen_Peter-Munjanja-Aff3" data-author-search="Munjanja, Stephen Peter">Stephen Peter Munjanja</a><sup class="u-js-hide"><a href="#Aff3">3</a></sup> & </li><li class="c-article-author-list__item"><a data-test="author-name" data-author-popup="group-1" href="#group-1">and the Zimbabwe Maternal and Perinatal Mortality Study Group</a></li></ul><button aria-expanded="false" class="c-article-author-list__button"><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-down-medium"></use></svg><span>Show authors</span></button> <div data-test="article-metrics"> <ul class="app-article-metrics-bar u-list-reset"> <li class="app-article-metrics-bar__item"> <p class="app-article-metrics-bar__count"><svg class="u-icon app-article-metrics-bar__icon" width="24" height="24" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-accesses-medium"></use> </svg>192 <span class="app-article-metrics-bar__label">Accesses</span></p> </li> <li class="app-article-metrics-bar__item"> <p class="app-article-metrics-bar__count"><svg class="u-icon app-article-metrics-bar__icon" width="24" height="24" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-altmetric-medium"></use> </svg>7 <span class="app-article-metrics-bar__label">Altmetric</span></p> </li> <li class="app-article-metrics-bar__item app-article-metrics-bar__item--metrics"> <p class="app-article-metrics-bar__details"><a href="/article/10.1007/s44197-024-00318-1/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Explore all metrics <svg class="u-icon app-article-metrics-bar__arrow-icon" width="24" height="24" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-arrow-right-medium"></use> </svg></a></p> </li> </ul> </div> <div class="u-mt-32"> </div> </header> </div> <div data-article-body="true" data-track-component="article body" class="c-article-body"> <section aria-labelledby="Abs1" data-title="Abstract" lang="en"><div class="c-article-section" id="Abs1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Abs1">Abstract</h2><div class="c-article-section__content" id="Abs1-content"><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Introduction</h3><p>We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Methods</h3><p>We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Results</h3><p>All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1–1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)].</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Conclusion</h3><p>Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.</p></div></div></section> <div data-test="cobranding-download"> </div> <section aria-labelledby="inline-recommendations" data-title="Inline Recommendations" class="c-article-recommendations" data-track-component="inline-recommendations"> <h3 class="c-article-recommendations-title" id="inline-recommendations">Similar content being viewed by others</h3> <div class="c-article-recommendations-list"> <div class="c-article-recommendations-list__item"> <article class="c-article-recommendations-card" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="c-article-recommendations-card__img"><img src="https://media.springernature.com/w215h120/springer-static/image/art%3A10.1186%2Fs12884-023-06077-4/MediaObjects/12884_2023_6077_Fig1_HTML.png" loading="lazy" alt=""></div> <div class="c-article-recommendations-card__main"> <h3 class="c-article-recommendations-card__heading" itemprop="name headline"> <a class="c-article-recommendations-card__link" itemprop="url" href="https://link.springer.com/10.1186/s12884-023-06077-4?fromPaywallRec=false" data-track="select_recommendations_1" data-track-context="inline recommendations" data-track-action="click recommendations inline - 1" data-track-label="10.1186/s12884-023-06077-4">Incompleteness and misclassification of maternal death recording: a systematic review and meta-analysis </a> </h3> <div class="c-article-meta-recommendations" data-test="recommendation-info"> <span class="c-article-meta-recommendations__item-type">Article</span> <span class="c-article-meta-recommendations__access-type">Open access</span> <span class="c-article-meta-recommendations__date">15 November 2023</span> </div> </div> </article> </div> <div class="c-article-recommendations-list__item"> <article class="c-article-recommendations-card" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="c-article-recommendations-card__img"><img src="https://media.springernature.com/w92h120/springer-static/cover-hires/book/978-3-319-71538-4?as=webp" loading="lazy" alt=""></div> <div class="c-article-recommendations-card__main"> <h3 class="c-article-recommendations-card__heading" itemprop="name headline"> <a class="c-article-recommendations-card__link" itemprop="url" href="https://link.springer.com/10.1007/978-3-319-71538-4_15?fromPaywallRec=false" data-track="select_recommendations_2" data-track-context="inline recommendations" data-track-action="click recommendations inline - 2" data-track-label="10.1007/978-3-319-71538-4_15">Problems with Epidemiological Surveillance and Under-Reporting of Maternal Deaths in Yucatan, Mexico: An Analysis of Six Studies </a> </h3> <div class="c-article-meta-recommendations" data-test="recommendation-info"> <span class="c-article-meta-recommendations__item-type">Chapter</span> <span class="c-article-meta-recommendations__date">© 2018</span> </div> </div> </article> </div> <div class="c-article-recommendations-list__item"> <article class="c-article-recommendations-card" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="c-article-recommendations-card__img"><img src="https://media.springernature.com/w215h120/springer-static/image/art%3A10.1186%2Fs12884-016-0959-z/MediaObjects/12884_2016_959_Fig1_HTML.gif" loading="lazy" alt=""></div> <div class="c-article-recommendations-card__main"> <h3 class="c-article-recommendations-card__heading" itemprop="name headline"> <a class="c-article-recommendations-card__link" itemprop="url" href="https://link.springer.com/10.1186/s12884-016-0959-z?fromPaywallRec=false" data-track="select_recommendations_3" data-track-context="inline recommendations" data-track-action="click recommendations inline - 3" data-track-label="10.1186/s12884-016-0959-z">Examining the impact of introducing ICD-MM on observed trends in maternal mortality rates in the UK 2003–13 </a> </h3> <div class="c-article-meta-recommendations" data-test="recommendation-info"> <span class="c-article-meta-recommendations__item-type">Article</span> <span class="c-article-meta-recommendations__access-type">Open access</span> <span class="c-article-meta-recommendations__date">20 July 2016</span> </div> </div> </article> </div> </div> </section> <script> window.dataLayer = window.dataLayer || []; window.dataLayer.push({ recommendations: { recommender: 'semantic', model: 'specter', policy_id: 'NA', timestamp: 1732702257, embedded_user: 'null' } }); </script> <div class="app-card-service" data-test="article-checklist-banner"> <div> <a class="app-card-service__link" data-track="click_presubmission_checklist" data-track-context="article page top of reading companion" data-track-category="pre-submission-checklist" data-track-action="clicked article page checklist banner test 2 old version" data-track-label="link" href="https://beta.springernature.com/pre-submission?journalId=44197" data-test="article-checklist-banner-link"> <span class="app-card-service__link-text">Use our pre-submission checklist</span> <svg class="app-card-service__link-icon" aria-hidden="true" focusable="false"><use xlink:href="#icon-eds-i-arrow-right-small"></use></svg> </a> <p class="app-card-service__description">Avoid common mistakes on your manuscript.</p> </div> <div class="app-card-service__icon-container"> <svg class="app-card-service__icon" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-clipboard-check-medium"></use> </svg> </div> </div> <div class="main-content"> <section data-title="Introduction"><div class="c-article-section" id="Sec1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec1"><span class="c-article-section__title-number">1 </span>Introduction</h2><div class="c-article-section__content" id="Sec1-content"><p>Reducing maternal mortality is a high-priority goal [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 1" title="WHO. Sustainable development goals. 
 https://www.who.int/topics/sustainable-development-goals/targets/en/
 
 . Published 2020. Accessed 14 Nov 2020 2020." href="/article/10.1007/s44197-024-00318-1#ref-CR1" id="ref-link-section-d10943790e642">1</a>], particularly in sub-Saharan Africa (SSA), where maternal mortality ratios (MMR) are still high. SSA’s average MMR was estimated at 536 maternal deaths per 100,000 live births in 2020, against the global average of 223/100,000, while Zimbabwe’s MMR estimate was 357/100,000 [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 2" title="WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva. 2023." href="/article/10.1007/s44197-024-00318-1#ref-CR2" id="ref-link-section-d10943790e645">2</a>].</p><p>Incompleteness or under-registration of maternal deaths occurs in all data sources–surveys, surveillance, and civil registration and vital statistics (CRVS) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. Measuring maternal mortality: an overview of opportunities and options for developing countries. BMC Med. 2008;6:12." href="#ref-CR3" id="ref-link-section-d10943790e651">3</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Peterson E, Chou D, Moller AB, Gemmill A, Say L, Alkema L. Estimating misclassification errors in the reporting of maternal mortality in national civil registration vital statistics systems: a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple countries and years with missing data. Stat Med. 2022. 
 https://doi.org/10.1002/sim.9335
 
 ." href="#ref-CR4" id="ref-link-section-d10943790e651_1">4</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="#ref-CR5" id="ref-link-section-d10943790e651_2">5</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Adair T, Lopez AD. How reliable are self-reported estimates of birth registration completeness? Comparison with vital statistics systems. PLoS One. 2021;16(6): e0252140." href="#ref-CR6" id="ref-link-section-d10943790e651_3">6</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 7" title="Silva R, Amouzou A, Munos M, Marsh A, Hazel E, Victora C, et al. Can community health workers report accurately on births and deaths? Results of field assessments in Ethiopia, Malawi and Mali. PLoS One. 2016;11(1): e0144662." href="/article/10.1007/s44197-024-00318-1#ref-CR7" id="ref-link-section-d10943790e654">7</a>]. Surveys miss community deaths that respondents underreport and deaths occurring before pregnancies are known [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 4" title="Peterson E, Chou D, Moller AB, Gemmill A, Say L, Alkema L. Estimating misclassification errors in the reporting of maternal mortality in national civil registration vital statistics systems: a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple countries and years with missing data. Stat Med. 2022. 
 https://doi.org/10.1002/sim.9335
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR4" id="ref-link-section-d10943790e657">4</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Kante AM, Mulungo A, Ibraimo M, Akum A, Titus N, Adriano A, et al. Completeness and factors affecting community workers’ reporting of births and deaths in the countrywide mortality surveillance for action in mozambique. Am J Trop Med Hyg. 2023;108(5_Suppl):29–39." href="#ref-CR8" id="ref-link-section-d10943790e660">8</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="UN. Improving adult mortality data collection through household surveys and population censuses: a set of recommendations. In: United Nations Expert Group Meeting on Innovative methods to measure the impact of COVID-19 on mortality through surveys and censuses. Dubai. 2022." href="#ref-CR9" id="ref-link-section-d10943790e660_1">9</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Bayley O, Chapota H, Kainja E, Phiri T, Gondwe C, King C, et al. Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi. BMJ Open. 2015;5(4): e007753." href="#ref-CR10" id="ref-link-section-d10943790e660_2">10</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 11" title="Basera TJ, Schmitz K, Price J, Willcox M, Bosire EN, Ajuwon A, et al. Community surveillance and response to maternal and child deaths in low- and middle-income countries: a scoping review. PLoS One. 2021;16(3): e0248143." href="/article/10.1007/s44197-024-00318-1#ref-CR11" id="ref-link-section-d10943790e663">11</a>]. Surveillance misses community deaths where the systems are weaker [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 12" title="Maphosa M, Juru TP, Masuka N, Mungati M, Gombe N, Nsubuga P, et al. Evaluation of the maternal death surveillance and response system in Hwange District, Zimbabwe, 2017. BMC Pregn Childb. 2019;19(1):103." href="/article/10.1007/s44197-024-00318-1#ref-CR12" id="ref-link-section-d10943790e667">12</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Faith Mutsigiri-Murewanhema PTM, Tsitsi Juru, Notion Tafara Gombe, Donewell Bangure, More Mungati, Mufuta Tshimanga: Evaluation of the maternal mortality surveillance system in Mutare district, Zimbabwe, 2014–2015: a cross sectional study. Pan Afr Med J 2017;27(204)." href="/article/10.1007/s44197-024-00318-1#ref-CR13" id="ref-link-section-d10943790e670">13</a>]. It misses institutional deaths which staff avoid reporting such as deaths due to management complications [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 14" title="Melberg A, Mirkuzie AH, Sisay TA, Sisay MM, Moland KM. “Maternal deaths should simply be 0”: politicization of maternal death reporting and review processes in Ethiopia. Health Policy Plan. 2019;34(7):492–8." href="/article/10.1007/s44197-024-00318-1#ref-CR14" id="ref-link-section-d10943790e673">14</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 15" title="MCHIP. Assessment of maternal and perinatal death surveillance and response Implementation in Zimbabwe. A Technical report. Harare. 2017." href="/article/10.1007/s44197-024-00318-1#ref-CR15" id="ref-link-section-d10943790e676">15</a>]. Resource shortages make surveillance not digitalize records and under-report the deaths [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 15" title="MCHIP. Assessment of maternal and perinatal death surveillance and response Implementation in Zimbabwe. A Technical report. Harare. 2017." href="/article/10.1007/s44197-024-00318-1#ref-CR15" id="ref-link-section-d10943790e679">15</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 16" title="Qomariyah SN, Bell JS, Pambudi ES, Anggondowati T, Latief K, Achadi EL, et al. A practical approach to identifying maternal deaths missed from routine hospital reports: lessons from Indonesia. Glob Health Act. 2009;2(1):1905." href="/article/10.1007/s44197-024-00318-1#ref-CR16" id="ref-link-section-d10943790e682">16</a>]. CRVS misses unregistered deaths and those occurring before pregnancies are known [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 4" title="Peterson E, Chou D, Moller AB, Gemmill A, Say L, Alkema L. Estimating misclassification errors in the reporting of maternal mortality in national civil registration vital statistics systems: a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple countries and years with missing data. Stat Med. 2022. 
 https://doi.org/10.1002/sim.9335
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR4" id="ref-link-section-d10943790e686">4</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 6" title="Adair T, Lopez AD. How reliable are self-reported estimates of birth registration completeness? Comparison with vital statistics systems. PLoS One. 2021;16(6): e0252140." href="/article/10.1007/s44197-024-00318-1#ref-CR6" id="ref-link-section-d10943790e689">6</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 8" title="Kante AM, Mulungo A, Ibraimo M, Akum A, Titus N, Adriano A, et al. Completeness and factors affecting community workers’ reporting of births and deaths in the countrywide mortality surveillance for action in mozambique. Am J Trop Med Hyg. 2023;108(5_Suppl):29–39." href="/article/10.1007/s44197-024-00318-1#ref-CR8" id="ref-link-section-d10943790e692">8</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 10" title="Bayley O, Chapota H, Kainja E, Phiri T, Gondwe C, King C, et al. Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi. BMJ Open. 2015;5(4): e007753." href="/article/10.1007/s44197-024-00318-1#ref-CR10" id="ref-link-section-d10943790e695">10</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 11" title="Basera TJ, Schmitz K, Price J, Willcox M, Bosire EN, Ajuwon A, et al. Community surveillance and response to maternal and child deaths in low- and middle-income countries: a scoping review. PLoS One. 2021;16(3): e0248143." href="/article/10.1007/s44197-024-00318-1#ref-CR11" id="ref-link-section-d10943790e698">11</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 17" title="Rutgers S. Two years maternal mortality in Matebeleland North Province, Zimbabwe. CAJM. 2001. 
 https://doi.org/10.4314/cajm.v47i2.8591
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR17" id="ref-link-section-d10943790e701">17</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 18" title="WHO. Guidance for measuring maternal mortality from a census. World Health Organization, Geneva. 2013." href="/article/10.1007/s44197-024-00318-1#ref-CR18" id="ref-link-section-d10943790e705">18</a>], and institutional deaths whose records fail to reach CRVS offices [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 19" title="Musarandega R, Cresswell J, Magwali T, Makosa D, Machekano R, Ngwenya S, et al. Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data. BMJ Glob Health. 2022;7(8): e009465." href="/article/10.1007/s44197-024-00318-1#ref-CR19" id="ref-link-section-d10943790e708">19</a>].</p><p>Misclassification has many causes. It occurs when maternal deaths are classified as non-maternal and vice versa [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="/article/10.1007/s44197-024-00318-1#ref-CR5" id="ref-link-section-d10943790e714">5</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 20" title="WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva. 2019." href="/article/10.1007/s44197-024-00318-1#ref-CR20" id="ref-link-section-d10943790e717">20</a>]. It occurs when the timing of a death is incorrectly measured against the termination of pregnancy [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Say L, Chou D. Better understanding of maternal deaths—the new WHO cause classification system. BJOG. 2011;118(s2):15–7." href="/article/10.1007/s44197-024-00318-1#ref-CR21" id="ref-link-section-d10943790e720">21</a>]. It also occurs when the cause of death is incorrectly identified [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 22" title="Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. The Lancet. 2006;367(9516):1066–74." href="/article/10.1007/s44197-024-00318-1#ref-CR22" id="ref-link-section-d10943790e723">22</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 23" title="Owolabi H, Ameh CA, Bar-Zeev S, Adaji S, Kachale F, van den Broek N. Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification. BJOG. 2014;121(s4):95–101." href="/article/10.1007/s44197-024-00318-1#ref-CR23" id="ref-link-section-d10943790e726">23</a>]. When the actual causes of death are misclassified as “fortuitous” or “unknown”, a death becomes non-maternal [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="/article/10.1007/s44197-024-00318-1#ref-CR5" id="ref-link-section-d10943790e730">5</a>]. When coders are incompetent to use ICD-MM codes [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="/article/10.1007/s44197-024-00318-1#ref-CR5" id="ref-link-section-d10943790e733">5</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Say L, Chou D. Better understanding of maternal deaths—the new WHO cause classification system. BJOG. 2011;118(s2):15–7." href="/article/10.1007/s44197-024-00318-1#ref-CR21" id="ref-link-section-d10943790e736">21</a>], and the clinicians diagnosing a death have insufficient obstetric information of the woman, deaths are misclassified [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 24" title="WHO. Maternal mortality: guidance to improve national reporting. World Health Organization. Geneva. 2022." href="/article/10.1007/s44197-024-00318-1#ref-CR24" id="ref-link-section-d10943790e739">24</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Musarandega R, Ngwenya S, Murewanhema G, Machekano R, Magwali T, Nyström L, et al. Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007–08 to 2018–19: findings from two reproductive age mortality surveys. BMC Public Health 2021." href="/article/10.1007/s44197-024-00318-1#ref-CR25" id="ref-link-section-d10943790e742">25</a>]. Supplementary file 1 summarises the causes of missingness and misclassification in each data source.</p><p>We conducted two reproductive age mortality surveys (RAMOS) in 2007–08 and 2018–19 to assess changes in Zimbabwe’s MMR and causes of maternal deaths. This paper analyses the completeness and misclassification of deaths in the two surveys. Figure 1 in supplementary file 1 illustrates the data sources and flow in the information systems.</p></div></div></section><section data-title="Materials and Methods"><div class="c-article-section" id="Sec2-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec2"><span class="c-article-section__title-number">2 </span>Materials and Methods</h2><div class="c-article-section__content" id="Sec2-content"><h3 class="c-article__sub-heading" id="Sec3"><span class="c-article-section__title-number">2.1 </span>Study Design</h3><p>The RAMOS were implemented in 11 districts selected using multi-stage clustering of the population into provinces and simple random sampling of one district per province. The 11th district was purposively selected from Harare province to include the largest tertiary hospitals in the country. Details of the methodology were published elsewhere [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 19" title="Musarandega R, Cresswell J, Magwali T, Makosa D, Machekano R, Ngwenya S, et al. Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data. BMJ Glob Health. 2022;7(8): e009465." href="/article/10.1007/s44197-024-00318-1#ref-CR19" id="ref-link-section-d10943790e760">19</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Musarandega R, Ngwenya S, Murewanhema G, Machekano R, Magwali T, Nyström L, et al. Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007–08 to 2018–19: findings from two reproductive age mortality surveys. BMC Public Health 2021." href="/article/10.1007/s44197-024-00318-1#ref-CR25" id="ref-link-section-d10943790e763">25</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 26" title="Musarandega R, Machekano R, Pattinson R, Munjanja SP, Zimbabwe M. Perinatal Mortality Study g: protocol for analysing the epidemiology of maternal mortality in Zimbabwe: a civil registration and vital statistics trend study. PLoS One. 2021;16(6): e0252106." href="/article/10.1007/s44197-024-00318-1#ref-CR26" id="ref-link-section-d10943790e766">26</a>].</p><h3 class="c-article__sub-heading" id="Sec4"><span class="c-article-section__title-number">2.2 </span>Data Sources and Data Collection Process</h3><p>The data were collected from health institutions, CRVS, community survey, and surveillance. Trained research midwives collected the data using study protocols, tools and standard operating procedures. Health institution data were collected from patient registers and charts at maternity units, operating theatres, high dependency and intensive care units, gynaecological, medical, and surgical wards, mortuaries, police posts, and casualty departments.</p><p>Vital registration data were collected from the Registrar General (RG)’s offices. The office registered deaths through health facility, police, and the public’s reports. Police reported community deaths which they attended to, after a doctor’s post-mortem. The doctors documented the underlying and antecedent causes of death using the International Classification of Disease Version 10 (ICD-10) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 27" title="WHO. The WHO application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM. World Health Organization. Geneva. 2011." href="/article/10.1007/s44197-024-00318-1#ref-CR27" id="ref-link-section-d10943790e780">27</a>]. The RG’s office also registered deaths not attended by the police, for which village heads wrote death confirmation letters presented by relatives with a verbal report. It also registered deaths through community birth and death registration outreaches [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 28" title="Allafrica. Countrywide mobile registration blitz begins. 
 https://allafrica.com/stories/202109140535.html
 
 . Published 2021. Accessed 16 May 2022." href="/article/10.1007/s44197-024-00318-1#ref-CR28" id="ref-link-section-d10943790e783">28</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 29" title="Kubatana. BVR, IDs mobile registration: citizens speak. 
 https://kubatana.net/2017/09/19/bvr-ids-mobile-registration-citizens-speak/
 
 . Accessed 16 May 2022." href="/article/10.1007/s44197-024-00318-1#ref-CR29" id="ref-link-section-d10943790e786">29</a>].</p><p>In 2007–2008, community deaths were collected through a survey that used village death registers, and verbal autopsy (VA) forms adapted from WHO [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 30" title="WHO. Verbal autopsy standards: ascertaining and attributing causes of death tool. 
 https://www.who.int/standards/classifications/other-classifications/verbal-autopsy-standards-ascertaining-and-attributing-causes-of-death-tool
 
 . Published 2007. Accessed 9 December 2021 2021." href="/article/10.1007/s44197-024-00318-1#ref-CR30" id="ref-link-section-d10943790e792">30</a>]. Village health workers (VHW) recorded deaths of women of reproductive age in the registers, including their pregnancy status. The research midwives visited the women's families and administered VAs with relatives (husband, mother, sister or other) who cared for the woman before death. In the 2018–2019 survey, community deaths and other institutional deaths came from the maternal and perinatal death surveillance and response (MPDSR) system [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 31" title="MOHCC. Maternal and perinatal death surveillance and response report. Ministry of Health and Child Care Zimbabwe, Family and Child Health Department. Harare. 2018." href="/article/10.1007/s44197-024-00318-1#ref-CR31" id="ref-link-section-d10943790e795">31</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 32" title="MOHCC. Guidelines for maternal and perinatal death audits in zimbabwe. Zimbabwe ministry of health and child care, reproductive health unit. Harare. 2013." href="/article/10.1007/s44197-024-00318-1#ref-CR32" id="ref-link-section-d10943790e798">32</a>]. Nurses and doctors completed maternal death notification forms in health institutions. In the community, VHWs reported suspected pregnancy-related deaths to health workers, who visited the homes and documented confirmed pregnancy-related deaths on notification forms.</p><h3 class="c-article__sub-heading" id="Sec5"><span class="c-article-section__title-number">2.3 </span>Data Recollection, Verification, Cleaning and Review</h3><p>Data for each survey were collected in two rounds. The 2007–2008 survey data were collected from May 1, 2007, to June 15, 2008, and recollected from May 1 to July 31, 2020. The 2018–2019 survey data were collected from July 1 to July 31, 2020, and recollected from May 3 to July 20, 2021. Qualitative data were collected on availability, accessibility and storage of death records through observation and interviews with records staff, nurses, and RG’s officers using structured observation and interview guides adapted from WHO [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 33" title="WHO. Medical records manual: a guide for developing countries. World Health Organization. Geneva. 2006." href="/article/10.1007/s44197-024-00318-1#ref-CR33" id="ref-link-section-d10943790e809">33</a>], and South African medical record review guidelines [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 34" title="HPCSA. Guideline for the good practice in the health care profession: guidelines on the keeping of patient records. Booklet 9. Pretoria: Health Professions Council of South Africa. Pretoria. 2016." href="/article/10.1007/s44197-024-00318-1#ref-CR34" id="ref-link-section-d10943790e812">34</a>]. Trained obstetricians reviewed and recorded the deaths using the ICD-MM manual [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Say L, Chou D. Better understanding of maternal deaths—the new WHO cause classification system. BJOG. 2011;118(s2):15–7." href="/article/10.1007/s44197-024-00318-1#ref-CR21" id="ref-link-section-d10943790e815">21</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 27" title="WHO. The WHO application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM. World Health Organization. Geneva. 2011." href="/article/10.1007/s44197-024-00318-1#ref-CR27" id="ref-link-section-d10943790e818">27</a>], which allowed misclassification analysis.</p><h3 class="c-article__sub-heading" id="Sec6"><span class="c-article-section__title-number">2.4 </span>Data Analysis</h3><p>We calculated and compared proportions of missed deaths (total initially collected/total re-collected deaths) between the two surveys using Chi-square or Fisher’s exact tests (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab1">1</a>, <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab2">2</a>). Using log-linear regression models unadjusted and adjusted for deaths identified in multiple sources, we calculated risk ratios (RRs) for deaths missed by each data source (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab3">3</a>). We calculated and compared proportions of misclassified deaths (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab4">4</a>) and MMR changes due to misclassification of deaths using RRs calculated through Binomial exact tests (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab5">5</a>). We also analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and RRs calculated through Binomial exact tests.</p><div class="c-article-table" data-test="inline-table" data-container-section="table" id="table-1"><figure><figcaption class="c-article-table__figcaption"><b id="Tab1" data-test="table-caption">Table 1 Missingness in data collection in surveys: number of pregnancy-related and maternal deaths collected and proportion missed by one round of data collection in the Zimbabwe Maternal and Perinatal Mortality Surveys, 2007–08 and 2018–19; Chi-square P-value of difference in proportions of missed deaths between the two surveys</b></figcaption><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="table-link" data-track="click" data-track-action="view table" data-track-label="button" rel="nofollow" href="/article/10.1007/s44197-024-00318-1/tables/1" aria-label="Full size table 1"><span>Full size table</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><div class="c-article-table" data-test="inline-table" data-container-section="table" id="table-2"><figure><figcaption class="c-article-table__figcaption"><b id="Tab2" data-test="table-caption">Table 2 Missingness in data collection in surveys versus misclassification of deaths: number and proportion of missed or misclassified pregnancy-related deaths by the cause of missingness/misclassification in the Zimbabwe Maternal and Perinatal Mortality Surveys, 2007–08 and 2018–19; Chi-square P-value of difference in proportions of missed/misclassified deaths in the two surveys</b></figcaption><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="table-link" data-track="click" data-track-action="view table" data-track-label="button" rel="nofollow" href="/article/10.1007/s44197-024-00318-1/tables/2" aria-label="Full size table 2"><span>Full size table</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><div class="c-article-table" data-test="inline-table" data-container-section="table" id="table-3"><figure><figcaption class="c-article-table__figcaption"><b id="Tab3" data-test="table-caption">Table 3 Number and percentage of deaths identified; log-linear regression risk ratio (RR), with 95% confidence intervals comparing pregnancy-related deaths identified in different data sources; RR (95% CI) comparing deaths identified by each or in two data sources in the surveys; Zimbabwe Maternal and Perinatal Mortality Surveys, 2007–08 and 2018–19</b></figcaption><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="table-link" data-track="click" data-track-action="view table" data-track-label="button" rel="nofollow" href="/article/10.1007/s44197-024-00318-1/tables/3" aria-label="Full size table 3"><span>Full size table</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><div class="c-article-table" data-test="inline-table" data-container-section="table" id="table-4"><figure><figcaption class="c-article-table__figcaption"><b id="Tab4" data-test="table-caption">Table 4 Number and percentage of misclassified deaths from each data source; RR (95% CI) comparing misclassification in data sources; RR (95% CI) comparing misclassification in survey years; Zimbabwe Maternal and Perinatal Mortality Surveys, 2007–08 and 2018–19</b></figcaption><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="table-link" data-track="click" data-track-action="view table" data-track-label="button" rel="nofollow" href="/article/10.1007/s44197-024-00318-1/tables/4" aria-label="Full size table 4"><span>Full size table</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><div class="c-article-table" data-test="inline-table" data-container-section="table" id="table-5"><figure><figcaption class="c-article-table__figcaption"><b id="Tab5" data-test="table-caption">Table 5 Number of deaths identified by each data source with and without each type of misclassification; MMR (with 95% confidence intervals); RRs (95% confidence intervals) comparing MMRs with and without misclassification in the data sources; 2018–19 Zimbabwe Maternal and Perinatal Mortality Surveys</b></figcaption><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="table-link" data-track="click" data-track-action="view table" data-track-label="button" rel="nofollow" href="/article/10.1007/s44197-024-00318-1/tables/5" aria-label="Full size table 5"><span>Full size table</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div></div></div></section><section data-title="Results"><div class="c-article-section" id="Sec7-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec7"><span class="c-article-section__title-number">3 </span>Results</h2><div class="c-article-section__content" id="Sec7-content"><p>We identified 237 pregnancy-related and 208 maternal deaths in the first round of the 2007–2008 survey, and 325 and 296 after the second round of data collection. In the 2018–2019 survey, we identified 112 pregnancy-related and 104 maternal deaths in the first round and 137 pregnancy-related and 130 maternal deaths after the second round of data collection. The proportion of missed deaths declined from 2007–2008 to 2018–2019–pregnancy-related deaths (27% vs 18%; p = 0.044) and maternal deaths (30% vs 20%; p = 0.037) (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab1">1</a>). Missing deaths in the 1st round of data collection was the main cause of incompleteness of data in both surveys (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab2">2</a>).</p><p>Health facility records identified the highest proportion of pregnancy-related deaths in 2018–19 (60%), up from 11% in 2007–2008 (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab3">3</a>). The community survey (VAs) was seven times and CRVS three times more likely to identify a maternal death than health facility records in 2007–2008, while CRVS and the MPDSR were less likely to identify a death than health facility records in 2018–2019. After adjusting for deaths identified in multiple sources CRVS were two times and community survey nine times more likely to identify unique deaths than health facility records in 2007–2008. CRVS and surveillance were equally likely to identify unique deaths as health facility records in 2018–2019.</p><p>Misclassification of maternal and non-maternal deaths was higher in health facility records (17%) than in CRVS (1.7%) and VA records (5.6%) in 2007–2008 (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab4">4</a>). In 2018–19, misclassification was not different between health facility records and CRVS and the MPDSR. Misclassification of causes of death was not significantly different between health facility records and CRVS or VA/MPDSR in 2007–2008.</p><p>Misclassification of maternal and non-maternal deaths did not reduce the MMRs. Misclassification of the causes of death reduced the MMR estimates (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00318-1#Tab5">5</a>).</p><p>Sensitivity of the study–the probability of correctly identifying true maternal deaths slightly declined from 2007–2008 to 2018–2019. The specificity–probability of misclassifying non-maternal deaths as maternal increased but not significantly (Table 6 in supplementary file 2).</p><p>The documentation and record keeping in the data systems had numerous gaps, which included lost records and absence of record storerooms in health facilities, assigning of non-medical causes of death in CRVS records and collecting few community deaths in the MPDSR (Table 7 in supplementary file 2).</p></div></div></section><section data-title="Discussion"><div class="c-article-section" id="Sec8-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec8"><span class="c-article-section__title-number">4 </span>Discussion</h2><div class="c-article-section__content" id="Sec8-content"><p>Our study showed that missing maternal deaths remains a major challenge in the measurement of maternal mortality in Zimbabwe, as in other developing countries [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 3" title="Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. Measuring maternal mortality: an overview of opportunities and options for developing countries. BMC Med. 2008;6:12." href="/article/10.1007/s44197-024-00318-1#ref-CR3" id="ref-link-section-d10943790e2445">3</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 6" title="Adair T, Lopez AD. How reliable are self-reported estimates of birth registration completeness? Comparison with vital statistics systems. PLoS One. 2021;16(6): e0252140." href="/article/10.1007/s44197-024-00318-1#ref-CR6" id="ref-link-section-d10943790e2448">6</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 35" title="Wilmoth JR, Mizoguchi N, Oestergaard MZ, Say L, Mathers CD, Zureick-Brown S, et al. A new method for deriving global estimates of maternal mortality. Stat Politics Policy. 2012. 
 https://doi.org/10.1515/2151-7509.1038
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR35" id="ref-link-section-d10943790e2451">35</a>]. No data source provided more than 60% of the maternal deaths in 2018–2019. CRVS identified less than 50% of the deaths in both surveys, despite the community registration campaigns done during these years [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 29" title="Kubatana. BVR, IDs mobile registration: citizens speak. 
 https://kubatana.net/2017/09/19/bvr-ids-mobile-registration-citizens-speak/
 
 . Accessed 16 May 2022." href="/article/10.1007/s44197-024-00318-1#ref-CR29" id="ref-link-section-d10943790e2454">29</a>].</p><p>WHO corroborates this and has adjusted the data in their estimates by up to 150% to correct for under-reporting [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 4" title="Peterson E, Chou D, Moller AB, Gemmill A, Say L, Alkema L. Estimating misclassification errors in the reporting of maternal mortality in national civil registration vital statistics systems: a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple countries and years with missing data. Stat Med. 2022. 
 https://doi.org/10.1002/sim.9335
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR4" id="ref-link-section-d10943790e2460">4</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 35" title="Wilmoth JR, Mizoguchi N, Oestergaard MZ, Say L, Mathers CD, Zureick-Brown S, et al. A new method for deriving global estimates of maternal mortality. Stat Politics Policy. 2012. 
 https://doi.org/10.1515/2151-7509.1038
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR35" id="ref-link-section-d10943790e2463">35</a>]. The causes of missing deaths are summarised in supplementary file 1 and well described in literature [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 3" title="Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. Measuring maternal mortality: an overview of opportunities and options for developing countries. BMC Med. 2008;6:12." href="/article/10.1007/s44197-024-00318-1#ref-CR3" id="ref-link-section-d10943790e2466">3</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 8" title="Kante AM, Mulungo A, Ibraimo M, Akum A, Titus N, Adriano A, et al. Completeness and factors affecting community workers’ reporting of births and deaths in the countrywide mortality surveillance for action in mozambique. Am J Trop Med Hyg. 2023;108(5_Suppl):29–39." href="/article/10.1007/s44197-024-00318-1#ref-CR8" id="ref-link-section-d10943790e2469">8</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Bayley O, Chapota H, Kainja E, Phiri T, Gondwe C, King C, et al. Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi. BMJ Open. 2015;5(4): e007753." href="#ref-CR10" id="ref-link-section-d10943790e2472">10</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Basera TJ, Schmitz K, Price J, Willcox M, Bosire EN, Ajuwon A, et al. Community surveillance and response to maternal and child deaths in low- and middle-income countries: a scoping review. PLoS One. 2021;16(3): e0248143." href="#ref-CR11" id="ref-link-section-d10943790e2472_1">11</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 12" title="Maphosa M, Juru TP, Masuka N, Mungati M, Gombe N, Nsubuga P, et al. Evaluation of the maternal death surveillance and response system in Hwange District, Zimbabwe, 2017. BMC Pregn Childb. 2019;19(1):103." href="/article/10.1007/s44197-024-00318-1#ref-CR12" id="ref-link-section-d10943790e2476">12</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 14" title="Melberg A, Mirkuzie AH, Sisay TA, Sisay MM, Moland KM. “Maternal deaths should simply be 0”: politicization of maternal death reporting and review processes in Ethiopia. Health Policy Plan. 2019;34(7):492–8." href="/article/10.1007/s44197-024-00318-1#ref-CR14" id="ref-link-section-d10943790e2479">14</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 16" title="Qomariyah SN, Bell JS, Pambudi ES, Anggondowati T, Latief K, Achadi EL, et al. A practical approach to identifying maternal deaths missed from routine hospital reports: lessons from Indonesia. Glob Health Act. 2009;2(1):1905." href="/article/10.1007/s44197-024-00318-1#ref-CR16" id="ref-link-section-d10943790e2482">16</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Rutgers S. Two years maternal mortality in Matebeleland north Province. Zimbabwe Cent Afr J Med. 2001;47(2):39–43." href="#ref-CR36" id="ref-link-section-d10943790e2485">36</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Garenne M, Kahn K, Collinson MA, Gómez-Olivé FX, Tollman S. Maternal mortality in rural South Africa: the impact of case definition on levels and trends. Int J Womens Health. 2013;5:457–63." href="#ref-CR37" id="ref-link-section-d10943790e2485_1">37</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 38" title="Mnyani CN, Buchmann EJ, Chersich MF, Frank KA, McIntyre JA. Trends in maternal deaths in HIV-infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015. J Int AIDS Soc. 2017. 
 https://doi.org/10.1002/jia2.25022
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR38" id="ref-link-section-d10943790e2488">38</a>].</p><p>Deaths identified in two data sources reflect the extent of record transmission across data systems. All deaths recorded in health records should be registered in CRVS because policy requires health institutions to transfer death records to CRVS offices. Similarly, health records and the MPDSR should identify the same deaths because data flows between them. However, we found low proportions of the same deaths identified in two data sources, signifying breaks in information flow across data sources.</p><p>This study showed that cause-of-death misclassification underestimates MMRs. Higher misclassification of maternal and non-maternal deaths was observed in 2007–2008 before establishment of the MPDSR [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 31" title="MOHCC. Maternal and perinatal death surveillance and response report. Ministry of Health and Child Care Zimbabwe, Family and Child Health Department. Harare. 2018." href="/article/10.1007/s44197-024-00318-1#ref-CR31" id="ref-link-section-d10943790e2497">31</a>]. A 2015 MPDSR evaluation observed that 50% of nurses using the system incorrectly defined a maternal death [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Faith Mutsigiri-Murewanhema PTM, Tsitsi Juru, Notion Tafara Gombe, Donewell Bangure, More Mungati, Mufuta Tshimanga: Evaluation of the maternal mortality surveillance system in Mutare district, Zimbabwe, 2014–2015: a cross sectional study. Pan Afr Med J 2017;27(204)." href="/article/10.1007/s44197-024-00318-1#ref-CR13" id="ref-link-section-d10943790e2500">13</a>].</p><p>Misclassification of pregnancy-related deaths commonly occurs to “fortuitous” deaths and those of “unknown” causes which become non-maternal deaths [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="/article/10.1007/s44197-024-00318-1#ref-CR5" id="ref-link-section-d10943790e2507">5</a>]. The nexus of HIV/AIDS and maternal mortality is a common cause of misclassification. Some studies classify pregnancy-related HIV/AIDS deaths as maternal and others do not [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Musarandega R, Ngwenya S, Murewanhema G, Machekano R, Magwali T, Nyström L, et al. Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007–08 to 2018–19: findings from two reproductive age mortality surveys. BMC Public Health 2021." href="/article/10.1007/s44197-024-00318-1#ref-CR25" id="ref-link-section-d10943790e2510">25</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 38" title="Mnyani CN, Buchmann EJ, Chersich MF, Frank KA, McIntyre JA. Trends in maternal deaths in HIV-infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015. J Int AIDS Soc. 2017. 
 https://doi.org/10.1002/jia2.25022
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR38" id="ref-link-section-d10943790e2513">38</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 39" title="Garenne M, Kahn K, Collinson MA, Gomez-Olive FX, Tollman S. Maternal mortality in rural South Africa: the impact of case definition on levels and trends. Int J Womens Health. 2013;5:457–63." href="/article/10.1007/s44197-024-00318-1#ref-CR39" id="ref-link-section-d10943790e2516">39</a>]. Misclassification also occurs when coders are incompetent to use the ICD-MM codes [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="/article/10.1007/s44197-024-00318-1#ref-CR5" id="ref-link-section-d10943790e2519">5</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Say L, Chou D. Better understanding of maternal deaths—the new WHO cause classification system. BJOG. 2011;118(s2):15–7." href="/article/10.1007/s44197-024-00318-1#ref-CR21" id="ref-link-section-d10943790e2523">21</a>], and when clinicians who diagnose the deaths have insufficient obstetric histories of the women [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 24" title="WHO. Maternal mortality: guidance to improve national reporting. World Health Organization. Geneva. 2022." href="/article/10.1007/s44197-024-00318-1#ref-CR24" id="ref-link-section-d10943790e2526">24</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Musarandega R, Ngwenya S, Murewanhema G, Machekano R, Magwali T, Nyström L, et al. Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007–08 to 2018–19: findings from two reproductive age mortality surveys. BMC Public Health 2021." href="/article/10.1007/s44197-024-00318-1#ref-CR25" id="ref-link-section-d10943790e2529">25</a>].</p><p>Sensitivity of data sources to correctly identify maternal deaths was high in both surveys, while specificity was low in 2007–2008. Data collectors misclassified late maternal deaths as maternal. In 2018–2019, clinicians possibly applied the definition of maternal death more accurately. Sensitivity declined in 2018–2019 due to higher misclassification of causes of death. Obstetricians had patient notes to review and reclassify the deaths. This signifies the importance of ongoing health worker capacity building to assign accurate causes of maternal deaths [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 4" title="Peterson E, Chou D, Moller AB, Gemmill A, Say L, Alkema L. Estimating misclassification errors in the reporting of maternal mortality in national civil registration vital statistics systems: a Bayesian hierarchical bivariate random walk model to estimate sensitivity and specificity for multiple countries and years with missing data. Stat Med. 2022. 
 https://doi.org/10.1002/sim.9335
 
 ." href="/article/10.1007/s44197-024-00318-1#ref-CR4" id="ref-link-section-d10943790e2535">4</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Kao S, Chen LM, Shi L, Weinrich MC. Underreporting and misclassification of maternal mortality in Taiwan. Acta Obstet Gynecol Scand. 1997;76(7):629–36." href="/article/10.1007/s44197-024-00318-1#ref-CR5" id="ref-link-section-d10943790e2538">5</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Say L, Chou D. Better understanding of maternal deaths—the new WHO cause classification system. BJOG. 2011;118(s2):15–7." href="/article/10.1007/s44197-024-00318-1#ref-CR21" id="ref-link-section-d10943790e2541">21</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 40" title="Ameh C, Adegoke A, Pattinson R, van den Broek N. Using the new ICD-MM classification system for attribution of cause of maternal death—a pilot study. BJOG. 2014;121(s4):32–40." href="/article/10.1007/s44197-024-00318-1#ref-CR40" id="ref-link-section-d10943790e2544">40</a>].</p><p>Storage of health records was a challenge. CRVS offices stored their records better than health facilities and the MPDSR. Some health facilities lacked storage rooms. Others did not enforce record-keeping standards, lacked the personnel and record filing resources. Data completeness in the records was a challenge. The 2015 Zimbabwe MPDRS system evaluation observed similar challenges. Average completeness of notification forms was 76% and only 53% of forms had supporting documents [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Faith Mutsigiri-Murewanhema PTM, Tsitsi Juru, Notion Tafara Gombe, Donewell Bangure, More Mungati, Mufuta Tshimanga: Evaluation of the maternal mortality surveillance system in Mutare district, Zimbabwe, 2014–2015: a cross sectional study. Pan Afr Med J 2017;27(204)." href="/article/10.1007/s44197-024-00318-1#ref-CR13" id="ref-link-section-d10943790e2550">13</a>]. Digitalizing patient-level maternal death reporting will strengthen the data management and death surveillance.</p><h3 class="c-article__sub-heading" id="Sec9"><span class="c-article-section__title-number">4.1 </span>Strengths and Limitations of the Study</h3><p>Recollecting and triangulating the data across sources enabled the missingness analysis. Review and reclassifying of the deaths by trained obstetricians using the ICD-MM manual enabled both the incompleteness and misclassification analysis. The 2007–2008 deaths had fewer patient notes for obstetricians’ review. However, the study findings support recommendations to use multiple data sources to monitor maternal mortality in low-income countries which strengthens the data systems.</p></div></div></section><section data-title="Conclusions"><div class="c-article-section" id="Sec10-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec10"><span class="c-article-section__title-number">5 </span>Conclusions</h2><div class="c-article-section__content" id="Sec10-content"><p>Incompleteness and misclassification of maternal deaths are still major challenges in maternal mortality measurement in Zimbabwe. All data systems fail to identify as many deaths as possible and assign accurate causes of death. Policy prescribed transfer of records is weak across data systems. Strengthened policy frameworks and more resources are needed to improve record-keeping. Continuous training is required to improve the use of ICD-MM to assign causes to maternal deaths.</p></div></div></section> </div> <section data-title="Data Availability"><div class="c-article-section" id="data-availability-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="data-availability">Data Availability</h2><div class="c-article-section__content" id="data-availability-content"> <p>Data will be made available on a reasonable request.</p> </div></div></section><section data-title="Abbreviations"><div class="c-article-section" id="abbreviations-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="abbreviations">Abbreviations</h2><div class="c-article-section__content" id="abbreviations-content"><dl class="c-abbreviation_list"><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>CRVS:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Civil registration and vital statistics</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>ICD-MM:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>International classification of diseases for maternal mortality</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>MMR:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Maternal mortality ratio</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>MPDSR:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Maternal and perinatal death surveillance and response</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>MoHCC:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Ministry of health and child care</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>RG:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Registrar general</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>RR:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Risk ratio</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>VA:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Verbal autopsy</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>VHW:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Village health worker</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>RAMOS:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Reproductive age mortality study</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>SDG:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Sustainable development goal</p> </dd><dt class="c-abbreviation_list__term u-text-bold u-float-left u-pr-16" style="min-width:50px;"><dfn>UI:</dfn></dt><dd class="c-abbreviation_list__description u-mb-24"> <p>Uncertainty interval</p> </dd></dl></div></div></section><div id="MagazineFulltextArticleBodySuffix"><section aria-labelledby="Bib1" data-title="References"><div class="c-article-section" id="Bib1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Bib1">References</h2><div class="c-article-section__content" id="Bib1-content"><div data-container-section="references"><ol class="c-article-references" data-track-component="outbound reference" data-track-context="references section"><li class="c-article-references__item js-c-reading-companion-references-item" data-counter="1."><p class="c-article-references__text" id="ref-CR1">WHO. 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The support received from various MoHCC and RG’s department staff is acknowledged and appreciated.</p></div></div></section><section data-title="Funding"><div class="c-article-section" id="Fun-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Fun">Funding</h2><div class="c-article-section__content" id="Fun-content"><p>The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and WHO-Geneva funded in part the recollection of 2007–08 and collection 2018–19 data, through a sub-grant from the Improving Maternal Health Measurement (IMHM) Project at the Women & Health Initiative of the Harvard T.H. Chan School of Public Health funded by the Bill & Melinda Gates Foundation [Grant Number OPP1169546]. Production of the manuscript was not funded.</p></div></div></section><section aria-labelledby="author-information" data-title="Author information"><div class="c-article-section" id="author-information-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="author-information">Author information</h2><div class="c-article-section__content" id="author-information-content"><h3 class="c-article__sub-heading" id="affiliations">Authors and Affiliations</h3><ol class="c-article-author-affiliation__list"><li id="Aff1"><p class="c-article-author-affiliation__address">School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa</p><p class="c-article-author-affiliation__authors-list">Reuben Musarandega</p></li><li id="Aff2"><p class="c-article-author-affiliation__address">Department of Epidemiology and Global Health, Umea University, Umea, Sweden</p><p class="c-article-author-affiliation__authors-list">Lennarth Nystrom</p></li><li id="Aff3"><p class="c-article-author-affiliation__address">Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe</p><p class="c-article-author-affiliation__authors-list">Grant Murewanhema, Chipo Gwanzura & Stephen Peter Munjanja</p></li><li id="Aff4"><p class="c-article-author-affiliation__address">Department of Obstetrics and Gynaecology, Mpilo Central Hospital, National University of Science and Technology, Bulawayo, Zimbabwe</p><p class="c-article-author-affiliation__authors-list">Solwayo Ngwenya</p></li><li id="Aff5"><p class="c-article-author-affiliation__address">Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa</p><p class="c-article-author-affiliation__authors-list">Robert Pattinson</p></li><li id="Aff6"><p class="c-article-author-affiliation__address">Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa</p><p class="c-article-author-affiliation__authors-list">Rhoderick Machekano</p></li></ol><div class="u-js-hide u-hide-print" data-test="author-info"><span class="c-article__sub-heading">Authors</span><ol class="c-article-authors-search u-list-reset"><li id="auth-Reuben-Musarandega-Aff1"><span class="c-article-authors-search__title u-h3 js-search-name">Reuben Musarandega</span><div class="c-article-authors-search__list"><div class="c-article-authors-search__item c-article-authors-search__list-item--left"><a href="/search?dc.creator=Reuben%20Musarandega" class="c-article-button" data-track="click" data-track-action="author link - 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publication" data-track-label="link" rel="nofollow">View author publications</a></div><div class="c-article-authors-search__item c-article-authors-search__list-item--right"><p class="search-in-title-js c-article-authors-search__text">You can also search for this author in <span class="c-article-identifiers"><a class="c-article-identifiers__item" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Stephen%20Peter%20Munjanja" data-track="click" data-track-action="author link - pubmed" data-track-label="link" rel="nofollow">PubMed</a><span class="u-hide"> </span><a class="c-article-identifiers__item" href="http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Stephen%20Peter%20Munjanja%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en" data-track="click" data-track-action="author link - scholar" data-track-label="link" rel="nofollow">Google Scholar</a></span></p></div></div></li></ol></div><h3 class="c-article__sub-heading" id="groups">Consortia</h3><div class="c-article-author-institutional-author" id="group-1"><h3 class="c-article-author-institutional-author__name u-h3">and the Zimbabwe Maternal and Perinatal Mortality Study Group</h3></div><h3 class="c-article__sub-heading" id="contributions">Contributions</h3><p>RM1 conceptualized, conducted the analysis, and drafted the paper. RM2 guided the analysis. LN, GM, CG, SN, RM2 and SPM reviewed several versions of the paper. All authors approved the final manuscript.</p><h3 class="c-article__sub-heading" id="corresponding-author">Corresponding author</h3><p id="corresponding-author-list">Correspondence to <a id="corresp-c1" href="mailto:rmusara@gmail.com">Reuben Musarandega</a>.</p></div></div></section><section data-title="Ethics declarations"><div class="c-article-section" id="ethics-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="ethics">Ethics declarations</h2><div class="c-article-section__content" id="ethics-content"> <h3 class="c-article__sub-heading" id="FPar1">Conflict of Interest</h3> <p>The authors declare no competing interests.</p> <h3 class="c-article__sub-heading" id="FPar2">Ethics Approval and Consent to Participate</h3> <p>The University of Pretoria and the Medical Research Council of Zimbabwe institutional review boards (IRBs) approved the study including collection of clinical notes for obstetricians to use to recode the causes of death. The MoHCC and RG’s office approved the study including collecting person identifying data used to link and de-duplicate data across sources. Verbal autopsy informants gave written informed consent to be interviewed in the 2007–08 survey. Informed consent was waived in the 2018–19 survey when all data were collected from existing records.</p> <h3 class="c-article__sub-heading" id="FPar3">Consent for Publication</h3> <p>Not applicable.</p> </div></div></section><section data-title="Additional information"><div class="c-article-section" id="additional-information-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="additional-information">Additional information</h2><div class="c-article-section__content" id="additional-information-content"><p>Synopsis: Completeness and correct classification of deaths ensure accurate maternal mortality estimates.</p></div></div></section><section data-title="Supplementary Information"><div class="c-article-section" id="Sec11-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec11">Supplementary Information</h2><div class="c-article-section__content" id="Sec11-content"><div data-test="supplementary-info"><div id="figshareContainer" class="c-article-figshare-container" data-test="figshare-container"></div><p>Below is the link to the electronic supplementary material.</p><div class="c-article-supplementary__item" data-test="supp-item" id="MOESM1"><h3 class="c-article-supplementary__title u-h3"><a class="print-link" data-track="click" data-track-action="view supplementary info" data-test="supp-info-link" data-track-label="supplementary file1 (docx 32 kb)" href="https://static-content.springer.com/esm/art%3A10.1007%2Fs44197-024-00318-1/MediaObjects/44197_2024_318_MOESM1_ESM.docx" data-supp-info-image="">Supplementary file1 (DOCX 32 KB)</a></h3></div><div class="c-article-supplementary__item" data-test="supp-item" id="MOESM2"><h3 class="c-article-supplementary__title u-h3"><a class="print-link" data-track="click" data-track-action="view supplementary info" data-test="supp-info-link" data-track-label="supplementary file2 (docx 27 kb)" href="https://static-content.springer.com/esm/art%3A10.1007%2Fs44197-024-00318-1/MediaObjects/44197_2024_318_MOESM2_ESM.docx" data-supp-info-image="">Supplementary file2 (DOCX 27 KB)</a></h3></div></div></div></div></section><section data-title="Rights and permissions"><div class="c-article-section" id="rightslink-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="rightslink">Rights and permissions</h2><div class="c-article-section__content" id="rightslink-content"> <p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. 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id="citeas">Cite this article</h3><p class="c-bibliographic-information__citation">Musarandega, R., Nystrom, L., Murewanhema, G. <i>et al.</i> Incompleteness and Misclassification of Maternal Deaths in Zimbabwe: Data from Two Reproductive Age Mortality Surveys, 2007–2008 and 2018–2019. <i>J Epidemiol Glob Health</i> (2024). https://doi.org/10.1007/s44197-024-00318-1</p><p class="c-bibliographic-information__download-citation u-hide-print"><a data-test="citation-link" data-track="click" data-track-action="download article citation" data-track-label="link" data-track-external="" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1007/s44197-024-00318-1?format=refman&flavour=citation">Download citation<svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-download-medium"></use></svg></a></p><ul class="c-bibliographic-information__list" data-test="publication-history"><li class="c-bibliographic-information__list-item"><p>Received<span class="u-hide">: </span><span class="c-bibliographic-information__value"><time datetime="2024-01-23">23 January 2024</time></span></p></li><li class="c-bibliographic-information__list-item"><p>Accepted<span class="u-hide">: </span><span class="c-bibliographic-information__value"><time datetime="2024-10-15">15 October 2024</time></span></p></li><li class="c-bibliographic-information__list-item"><p>Published<span class="u-hide">: </span><span class="c-bibliographic-information__value"><time datetime="2024-11-12">12 November 2024</time></span></p></li><li class="c-bibliographic-information__list-item c-bibliographic-information__list-item--full-width"><p><abbr title="Digital Object Identifier">DOI</abbr><span class="u-hide">: </span><span class="c-bibliographic-information__value">https://doi.org/10.1007/s44197-024-00318-1</span></p></li></ul><div data-component="share-box"><div 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href="/search?query=Maternal%20mortality&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">Maternal mortality</a></span></li><li class="c-article-subject-list__subject"><span><a href="/search?query=Missingness&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">Missingness</a></span></li><li class="c-article-subject-list__subject"><span><a href="/search?query=Incompleteness&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">Incompleteness</a></span></li><li class="c-article-subject-list__subject"><span><a href="/search?query=Misclassification&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">Misclassification</a></span></li></ul><div 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