Development and validation of a questionnaire to identify severe maternal morbidity in epidemiological surveys

eligible women were traced and interviewed by telephone on the occurrence of obstetric complications and events related to their treatment. Their answers were compared with their medical records as gold standard. Sensitivity, specificity and likelihood ratios plus their correspondent 95% confidence intervals were used as main estimators of accuracy. Main outcomes: diagnosis of severe maternal morbidity associated with past pregnancies, including hemorrhage, eclampsia, infections, jaundice and related procedures (hysterectomy, admission to ICU, blood transfusion, laparotomy, inter-hospital transfer, mechanical ventilation and post partum stay above seven days).Women did not recall accurately the occurrence of obstetric complications, especially hemorrhage and infection. The likelihood ratios were < 5 for hemorrhage and infection, while for eclampsia it almost reached 10. The information recalled by women regarding hysterectomy, intensive care unit admission and blood transfusion were found to be highly correlated with finding evidence of the event in the medical records (likelihood ratios ranging from 12.7-240). The higher length of time between delivery and interview was associated with poor recall.Process indicators are better recalled by women than obstetric complication and should be considered when applying a questionnaire on severe maternal morbidity.Each year, more than 500,000 avoidable maternal deaths occur worldwide, the majority in the developing world [1]. Alongside family planning and preventing unsafe abortions, the most effective actions for the reduction of maternal mortality are those implemented immediately following the onset of an unexpected complication during pregnancy or childbirth. Delays in implementing required interventions have been associated with the inequality in maternal mortality between developed and developing countries [2].These delays in health care provision can be identified by auditing the cases of survivors of severe and acute