OBSERVACIONES NORMA INEN 2-266:2010 TRANSPORTE, ALMACENAMIENTO Y MANEJO DE

3.2.1 Search strategy

The search strategy was divided into three strings: 1) literature on approaches that have been used to estimate MM 2) literature on a place of death, causes and contributing factors to MDs and 3) studies comparing cause classification of maternal deaths using Verbal Autopsy (VA) data [Table 3.1].

Peer reviewed literature

A systematic search strategy with a narrative synthesis of published peer-reviewed literature was conducted using MEDLINE, CINAHLL Plus, Global health and LILACS. A further search was conducted using relevant websites such as the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), World Bank, World Health Organisation (WHO) and Initiative for Maternal Mortality Programme Assessment (IMMPACT). Electronically unavailable articles were obtained from the holdings of the libraries of the University of Liverpool and Liverpool School of Tropical Medicine.

Grey literature

Internet searches, using Google search and a hand search of grey literature from ELDIS data base under ‘Health and Malawi’, ‘maternal and new-born health’ ‘sexual reproductive health’ and using the Malawi government website under ‘Health’ was also conducted. A hand search in the library and MoH offices were also done. The references of retrieved articles were also screened to identify relevant data.

Titles were scanned and abstracts which were considered relevant to the research questions above were reviewed and retrieved to obtain full text.

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3.2.2 Search terms used

Search terms and strings in Table 3.1 were used either in combination or isolation using Boolean terms “AND” / “OR”, based on the search questions. Synonyms were used to retrieve as much information as possible.

Table 3.1: Search terms used during literature search

String No.

Literature review section

Questions guiding the literature review

Search words

String 1

Identification of studies that have measured MMA

What are the current approaches for estimating MM in LIC?

Maternal deaths* OR maternal mortality OR *pregnancy death* AND *civil registration* AND *health facility data*AND census AND Reproductive Age Mortality Studies, AND sisterhood method AND surveys AND verbal autopsy AND developing countries. String

2

Place of death Where are women dying?

Maternal deaths*OR *maternal mortality* OR *Maternal death* OR *pregnancy death* OR ‘*motherhood death* OR *women deaths* AND place

String 3

Characteristics of maternal deaths

What are the characteristics of MDs?

Maternal deaths*OR *Maternal mortality* OR *Maternal death* OR *pregnancy death* OR ‘*motherhood death* OR *women deaths* AND age OR parity OR educational level AND developing countries

String 4 Causes, contributing and associated factors of maternal deaths

What are the causes of maternal death in developing countries?

Maternal deaths*OR *Maternal mortality* OR *Maternal death* OR *pregnancy death* OR ‘*motherhood death* OR *women deaths* AND Causes AND associated factors developing countries String 5 Comparing cause classification Physician-coded verbalautopsy (PCVA) and other methods of assigning VA cause of death How do PCVA ,hospital diagnosis and InterVA-4 compare as methods of cause classification for VA data

Maternal deaths*OR *Maternal mortality* OR *Maternal death* OR *pregnancy death* OR ‘*motherhood death* OR *women deaths* AND cause of death AND physician coded verbal autopsy OR computer coded verbal autopsy OR interVA-4 Or InterVA

3.2.3 Inclusion and exclusion criteria

Papers written between 2000 and June 2014 were selected from low and middle income countries as defined by the World Bank income categorization in 2012 (World Bank 2012).

The period of 2000 to 2014 was selected to cover the period when many developing countries became proactive in addressing the burden of maternal mortality through implementation of interventions to achieve MDG5 (United Nations 2000a).

Inclusion criteria

 Studies that had precisely estimated MM regardless of method used.

 Studies identifying cause, contributing factors and factors associated to with MDs.

 Studies comparing methods of verbal autopsy cause classification.

 Written in English language.

 Conducted in low and middle income countries according to World Bank income

categorisation for 2012 (World Bank 2012).

 Studies comparing different methods of assigning cause of death using verbal autopsy

data.

Exclusion criteria

 Studies assessing impact of interventions on MM.

 Studies from high income countries as defined by World Bank income categorisation

2012 (World Bank 2012).

 Demographic and health surveys and global estimates by WHO, UNICEF, UNFPA,

The World Bank.

 Reviews, posters, editorials, and discussion papers.

3.2.4 Data extraction

Two reviewers independently screened all titles and abstracts. Full texts of included records were subsequently screened independently by the same reviewers for inclusion in the review. Any discrepancies in the selection were resolved through discussion between the reviewers and consultation with a third researcher (4 records). Duplicates were excluded. A summary table was developed and agreed by both reviewers before full-text review and all included studies were then summarized using the table in Appendix 3. Studies in the summary table were grouped into two outcome categories based on the search strings. Results for search strings 1 to 4 are grouped together while studies for search string 5 are separate [Appendix 3].

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Quality of the included studies was assessed by using the grade system on study design, data source, and clarity of content and outcome included in the assessment (Grade Working Group 2004).