Provincial Maternal Mortality Surveillance Systems in China

The 2014 systematic review Provincial Maternal Mortality Surveillance Systems in China, by X-L Gan, C-L Hao, X-J Dong, S. Alexander, M.W. Dramaix, L-N Hu and W-H Zhang in BioMed Research International, describes the current situation of the Provincial Maternal Mortality Surveillance Systems (PMMSS) and provincial maternal mortality ratio (PMMR) data in China. This is the first English language review of PMMSS and is hoped to help health professionals, government officials and international organisations better understand the current state of this surveillance system in China.  There are 31 provinces in China and each provincial government is responsible for establishing a PMMSS that aims to monitor maternal mortality at the provincial level. Two types of surveillance modes are generally used: 1) maternal death registration, whereby maternal deaths in all counties/districts are reported and audited; and 2) stratified random sampling surveillance, whereby only maternal deaths in sampled counties/districts are reported and reviewed.

ChinaThe review highlights that the PMMSS is financed by the provincial governments, meaning that these systems are limited by the local socioeconomic development of the province. The financial conditions of the province thus influences the type of surveillance mode used in each province. In the more affluent provinces (coast region), nearly all conducted complete registration of maternal deaths, whereas those provinces from the less affluent inland and remote regions used stratified random sampling surveillance.

In addition, the review found that that the PMMSS’s large population coverage and in-depth quality control make up for the weaknesses of national level maternal and child mortality surveillance systems in China, such as the National Maternal and Child Mortality Surveillance System (NMCMSS) and the National Maternal and Child Health Routine Reporting System (NMCHRS). PMMSS have greater population coverage compared to the NMCMSS with 40% of provinces using complete maternal death registrations and those provinces using a sampling surveillance mode having a sampling percentage ranging between 14.6 to 34.8%. The sampling percentage for the NMCMSS is about 5%. Also, PMMSS is more thorough in reporting and finding out the causes of maternal deaths. Every maternal death recorded is confirmed and reviewed in detail, meaning that lessons learnt and actions to reduce maternal mortality can be determined.

As such, the researchers conclude that PMMSS may be the most reliable source for estimation of provincial maternal mortality in each province when compared to national level maternal and child mortality surveillance systems. They advise that more emphasis should be placed on improving PMMSS to ensure that they provide robust, adequate, complete and comparable data. Moreover, they encourage the publication and wide-spread dissemination of PMMSS data.