Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study

Abstract

Background Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe—an SSA country. Methods In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007–2008 and 2018–2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. Discussion This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007–2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.

Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data

“…The detailed procedure for calculating the sample size is also described in the study protocol. 17 The two surveys required sample sizes of 45 000 and 71 500 births respectively.…”

“…The protocol for this study and analysis of the causes of death has been published elsewhere. 17 18 This paper describes changes in the MMR.…”

A Call to Rethink Nursing Education in Zimbabwe

“…Better health outcomes can be achieved through a highly educated nursing workforce. Zimbabwe currently is amongst the countries with a high maternal mortality rate of over 400 per 100 000 live births ( Musarandega et al, 2021 ). Improving the education of birth attendance can help reduce maternal mortality by providing quality and safe maternal care.…”

Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys

“…We conducted two reproductive age mortality surveys (RAMOS) to analyse the changes in Zimbabwe’s MMR and causes of death between 2007-08 and 2018-19. The study protocol has been published elsewhere [ 13 ]. This paper describes the important changes that occurred in the causes of reproductive age and maternal mortality in Zimbabwe during the review period.…”

“…The surveys were designed to produce representative samples of births (45000 and 46000 respectively), needed to calculate the MMR. The study protocol describes in detail the sampling procedures and sample size calculations [ 13 ].…”