Maternal Mortality ratio (MMR) and Pregnancy Related Mortality ratio (PRMR)

By Kaboni Whitney Gondwe | 06 Nov, 2018

I just wanted to share. Recently while reviewing MDHS for Malawi I noticed that the report said MMR in the 7 years before the 2015-2016 MDHS was 439 (page 245) and then also said the PRMR in the 7 years before the 2015-2016 MDHS was 497 (page 248). I missed the update and I had no idea why they reported the two differently. As I read on their blog I found that DHS has been updating their instrument to capture deaths per WHO definition excluding accidental deaths and deaths between 42 days and 2 months, which they were not doing before. It made me curious though, what could have been the actual rates? It really makes the interpretations tricky, but I am glad they noted that in the blog as well

This the blog:

On their blog they state this implication:
"Implications: While the newly added questions allow for a more precise and up-to-date measure of maternal mortality, the change does present challenges for interpretation. DHS has reported on maternal mortality for 30 years, but estimates obtained using the new definition of maternal mortality cannot be directly compared to the old definition of maternal mortality which included deaths up to 2 months after delivery and did not exclude deaths due to accidents and violence. And yet, one of the main objectives for conducting DHS surveys is to provide trend data. Fortunately, the old definition of maternal mortality can still be applied to calculate the mortality ratio estimate comparable to estimates from previously collected mortality data. This less precise measure of mortality is referred to as the pregnancy-related mortality ratio (PRMR).......Keep in mind that the new measure of maternal mortality, by definition, will result in a lower maternal mortality ratio than the old measure because the accidental and violence-related deaths to women during the maternal period and deaths occurring between 42 days and 2 months after childbirth are being excluded from maternal deaths while using the new definition but included while using the old definition."




Elizabeth Glaser Moderator Emeritus Replied at 9:50 AM, 6 Dec 2018

Hi Kaboni,
You make good points. This is important and something which most of us may miss, that pre 2015 the DHS defined and calculated the MMR using a less inclusive definition closer to pregnancy _related mortality .
The DHS states "When comparing estimates over time, the pregnancy-related mortality estimates from surveys since 2015 should be compared with those labeled maternal mortality in survey reports prior to 2015. Do not compare maternal mortality for surveys after 2015 with those from before 2015 as the definitions are different."

If you wanted to consider trends over a long period of time with the DHS then best you use use the pregnancy-related mortality estimates.

The WHO definitions are :

Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy,_irrespective of the cause of death_.

ยท Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management _but not from accidental or incidental causes_.

To consider issues with definitions and measurement of the MMR, then consider the paper that I have linked below.


Attached resource:

Kaboni Whitney Gondwe Replied at 3:36 PM, 6 Dec 2018

Thank you so much Elizabeth for the comment and the article you sent. In my research on preterm birth in Malawi and US, I have also been curious with preterm birth rates considering that some countries viability is lower than others. For example Malawi where viability is 28 weeks and is regarded to have the highest preterm birth rate at 18.1 per 100 (WHO report), I was wondering if the rates are comparable like for example with the US which sets 20 weeks although talking to obstetricians and reviewing literature I would say their responses ranged from 23-24 weeks. At that moment I thought what is Malawi counted the infants from 24 to 28 as preterm not as miscarriages? Do you have any thoughts on that?

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