IndOSS-Assam: investigating the feasibility of introducing a simple maternal morbidity surveillance and research system in Assam, India. Issue 1 (7th April 2016)

• Record Type: Journal Article
• Authors: Nair, Manisha; Choudhury, Manoj K; Choudhury, Saswati S; Kakoty, Swapna D; Sarma, Umesh C; Webster, Premila; Knight, Marian
• Is Part Of: BMJ global health. Volume 1:Issue 1(2016)
• Publication Date: 2016-04-07
• Subjects: World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2015-000024
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Objective: To assess the feasibility of establishing a simple maternal morbidity surveillance system in Assam (Indian Obstetric Surveillance System-Assam (IndOSS-Assam)) to investigate the incidence and trends in severe maternal complications. This study presents the surveillance platform of IndOSS-Assam. Design: Four tasks were undertaken: (1) setting up of a steering committee; (2) establishing priorities for the region; (3) mapping of surveillance sites; (4) piloting case-notification systems in selected centres. Setting: Two government tertiary hospitals in the state. Study population: Pregnant women delivering in the hospitals between March and August 2015. Main outcome measures: Incidence and case fatality rates with 95% CIs. Results: Local stakeholder ownership and a simple uncomplicated anonymous system for case notification were the key strengths of this project. Cases and deaths were reported for six conditions: eclampsia, postpartum haemorrhage, puerperal sepsis, septic abortion, uterine rupture and anaemic heart failure. Among 10 475 women delivering over 6 months, 402 had one of these conditions and 66 died (case fatality 16%). The incidence of eclampsia was 17 per 1000 deliveries (95% CI 14 to 19), postpartum haemorrhage was 11 per 1000 deliveries (95% CI 10 to 13) and anaemic heart failure was 3 per 1000 deliveries (95% CI 2 to 5). For each of the other three conditions—puerperal sepsis, septic abortion and uterine rupture—the incidence rate was 2 per 1000 deliveries. Conclusions: IndOSS-Assam was shown to be a feasible and simple system for ongoing surveillance of maternal morbidity that can be used to monitor the trends in the incidence of specific severe life-threatening conditions during pregnancy.