Beyond Maternal Mortality Investigations: Improving Maternal Morbidity Surveillance in Anuradhapura Sri Lanka

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The following is part of a series of project updates from the Department of Community Medicine at Rajarata University of Sri Lanka. MHTF is supporting their project, Measuring Economic Impact of Maternal Morbidity. More information on MHTF supported projects can be found here.

Written by: Department of Community Medicine

Maternal mortality has been given a high priority in public health system in Sri Lanka during last few decades. As a result, Sri Lanka has achieved exceptional progress in reducing maternal mortality, which has been an exemplary role model to other developing countries. It has a strong maternal death investigation procedure with one of the best maternal death surveillance systems in the developing world. The next step in reducing maternal mortality in Sri Lanka would be reducing maternal morbidities. Surveillance being the corner stone of any type of disease prevention programme, a well established surveillance system on maternal morbidities is an urgent need. However, maternal morbidity surveillance in Sri Lanka is still in its initial stage.

As a part of “Disease Burden and the Economic Impact of Maternal Morbidity” project we carried out an analysis of routinely reported data on maternal morbidities for a three year period in Anuradhapura district, Sri Lanka. Further, a sample of pregnancy reports of recently delivered mothers were also analyzed in order to understand the current status of maternal morbidity surveillance. Specific sample survey was conducted on assessing screening procedures for Gestational Diabetes Mellitus.

The first part of the analysis was on 45,544 deliveries during 2007-9 period. Reported prevalence of PIH, GDM and Anemia was 1.71% (779), .37% (169) and 2.66% (1033) respectively. Analysis of pregnancy records also revealed similar rates (This analysis was presented in First Global Maternal Health Conference). Data on maternal morbidity obtained in this study do not correspond with the global figures and figures from studies done elsewhere in Sri Lanka. As an example, prevalence of GDM, PIH and Anemia were reported as 10%, 8% and 30% respectively in previous studies. The results of this initial analysis show gross underreporting of maternal morbidity in the study area. A major effort is needed to improve the quality and completeness of these data in order to achieve further reduction of maternal mortality by reducing maternal morbidity.

In the GDM screaming method assessment, a total of 223 pregnant mothers with a period of amenorrhea more than 24 weeks were selected from 20 public health midwife areas. Altogether 95 (42.6%) mothers had risk factors for GDM. Of which only 6 mothers had PPBS during the first trimester. Of the 223 mothers studied, not a single mother was diagnosed as having GDM. Thus GDM was grossly under diagnosed. This could have severe consequences on pregnancy outcome with deprivation of both maternal and child health conditions. (This analysis was presented in Annual Scientific sessions of Ceylon College of Physicians by Dr.N.J.Dahanayake and awarded as the best paper in endocrinology and diabetes).

The project team is currently working on determining the true burden of these morbidities in the study through a prevalence study. Primary objective of this study is to provide service providers and policy makers with high quality data on maternal morbidities and improve maternal morbidity surveillance. District level public health administrators are working hand in hand with the project team in this regard.

More information is available on the project’s website.