Measuring maternal mortality in middle-income Arab countries: The challenge

Oona Campbell, London School of Hygiene and Tropical Medicine

The presentation will begin by providing a contextual look at the measurement of maternal mortality n the Arab Region. It will then examined in depth the approaches adopted in Egypt, Lebanon, Syria, and Tunisia, where I have been involved in work. Work in Turkey, which is being presented in another session, will also be alluded to because the Ottoman Civil registration system influenced what is done in countries such as Lebanon and Syria. A wide range of approaches, covering nearly the entire gamut of approaches have been used to estimate the maternal mortality ratio in the countries concerned. Most have tried the Sisterhood Method linked to large scale surveys. Egypt and Syria have worked with Civil Registration to conduct RAMOS studies. Both have innovated in this respect, with Egypt going on to develop a continuous surveillance system and Syria conducting a case-control study. Tunisia and Lebanon have done facility based studies, This is successful in Tunisia, where the system is ongoing and includes all public sector facilities where about 85% of births occur. In Lebanon, the large proportion of private sector facilities, and the low priority given by the Ministry of Public Health make if difficult to conduct such studies in a representative sample of facilities. All these countries need to make existing data more accessible and consider putting data inteh public domain. I will conclude by putting forward the challenge which is to begin to use and improve civil registration systems in the region.