Abstractobjective To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. results Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women's autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care.conclusion Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women.keywords adolescent, pregnancy in adolescence, health-seeking behaviour or use of maternal health services, Bangladesh

Abstractobjective To describe the development of the maternal death surveillance system (MDSS) in Morocco and discuss the initial results.method The nationwide MDSS was implemented in 2009 with the involvement of health professionals and local authorities. It comprises (i) notification of all deaths of women of reproductive age (from 15 to 49 years); (ii) a preliminary survey to identify pregnancy-related deaths; (iii) a confidential enquiry into all pregnancy-related deaths. The information thus obtained describes socio-demographic characteristics of the women, their obstetric and medical history, the mode of delivery, its follow-up and the medical cause of death.results From 1st of January 2009 to 31st of December 2009, 3814 deaths of women of reproductive age were recorded, and a total of 436 pregnancy-related deaths were identified, with 73.4% of those occurring in health facilities. Among the 313 reviewed records, 80.8% were direct obstetric deaths, and 13.5% were classified as indirect. Haemorrhage was the first direct obstetric cause of death (33%). Heart disease was the main indirect obstetric cause of death (39% of indirect causes).conclusion The Moroccan MDSS is a powerful tool for understanding the causes and circumstances of maternal deaths. However, challenges remain regarding the full coverage of the system, the decentralisation of the data entry and analysis and the completeness of medical records.

Abstractobjective In 2009, the Ministry of Health of Morocco launched a national confidential enquiry around maternal deaths based on the newly implemented routine maternal death surveillance system (MDSS). The objective of this paper is to show the importance of substandard care among the factors associated with maternal deaths.methods The Moroccan National Expert Committee (NEC) organised an audit of maternal deaths identified by the MDSS to determine the medical cause, the preventability of the deaths and the type of substandard care involved.results Three hundred and three cases of maternal deaths were analysed for the year 2009. Direct causes accounted for 80.8%. 75.9% were considered avoidable by the NEC. The three main factors were insufficient follow-up of care in 45.6% of cases, inadequate treatment in 43.9% and delay in seeking care in 41.3%. The auditors found that 54.3% of all maternal deaths could have been avoided if appropriate action had been taken at the health facilities.conclusion The audit of maternal deaths in Morocco enabled a better understanding of the circumstances contributing to maternal deaths and pinpointed that more than half of maternal deaths were associated with substandard care in hospitals.

ObjectiveTo assess the reliability of maternal deaths surveillance system (MDSS) and to determine the factors that influence its completeness in one region of Morocco.MethodsWe conducted a retrospective survey in “Gharb Chrarda Bni Hssen” region (GCBH) between January the 1st, 2013 and September the 30th, 2014 using multiple sources approach. All deaths of women of reproductive age (WRA) were investigated using certificates with medical cause, medical records and interviews with household members and relatives to ascertain a pregnancy-related or maternal death. An External Expert Committee reviewed the information collected to assign a cause for each death. Our results were compared to those reported in the same period by the MDSS.FindingsOur study identified 690 deaths of WRA and 69 maternal deaths of which 34.8% occurred outside health facilities. The MDSS recorded during the study period 538 deaths of WRA and 29 maternal deaths (including only one outside health facility) representing respectively an underreporting of 22.0% and 58.0%. Late maternal deaths represented 11.4% of all deaths of women with a registered pregnancy within 12 months prior to the death, while the MDSS identified none. The maternal mortality ratio (MMR) was estimated at 103, approximately 2.5 times higher than that reported in the MDSS.ConclusionOur study has shown weaknesses in the current notification system for maternal deaths in the region of GCBH. Therefore, more attention must be given to the regional committees in charge of auditing the cases and defining actions to be implemented to prevent further maternal deaths.