MMM-R RAMOS

RAMOS

RAMOS: BACKGROUND

Reproductive Age Mortality Studies (RAMOS) use varied sources, depending on the context, to identify all deaths of women of reproductive age and ascertain which of these are maternal or pregnancy-related. The defining features of RAMOS are not well described in the literature. We characterize its key feature as starting with all reproductive aged female deaths (or a representative sample). Others have characterized RAMOS as relying on multiple sources of deaths, or as taking an in-depth look at multiple determinants. RAMOS provides an estimate of the proportion of maternal deaths among female deaths (PMDF) but can be combined with other data to obtain the maternal mortality ratio (MMR), the maternal mortality rate (MMRate) and the lifetime risk (LTR).

Identification of death

Varied, and sometimes multiple, sources used to identify all deaths of reproductive aged women including:

Existing records (civil registration, health facility records, morgue records, burial/cemetery records, newspapers)
Survey/census of households with direct questions (not sisterhood)
Survey of Key Informants

Ascertainment of maternal/pregnancy related status

All deaths are investigated (using family verbal autopsy reports, death certificates with medical cause, health facility reports or medical record reviews) to ascertain if they are pregnancy related/maternal.

Advantages:

if rigorous, can provide one of the most complete estimations of maternal mortality
may provide additional information on cases and circumstances of maternal deaths for investigating avoidable causes of death

Limitations:

it requires complete death reporting, which may require multiple sources to ensure coverage
use of multiple sources to ensure complete death reporting can be complex
time consuming to conduct on a large scale
if multiple sources are used, duplicate deaths need to be avoided

Measurement requirements:

an adaptation for ensuring more complete identification of maternal deaths in facilities is termed RAPID
if verbal autopsy questions are used they must be coded and classified as maternal deaths (ICD coding)
data on births are needed to calculate MMR and LTR
data on the population of women aged 15-49 are needed to calculate the MMRate

RAMOS Questions

Please see Verbal Autopsy for verbal autopsy questions

Please see ICD Coding for classification of causes of maternal death

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RAMOS: GUIDELINES

General description from Measure Evaluation Compendium

World Health Organization. Studying maternal mortality in developing countries: a guidebook. HO/FHE/87.7.Geneva, World Health Organization, 1987

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RAMOS: REFERENCES

Betran A, Wojdyla D, Posner SF, Metin Gülmezoglu A (2005) National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity. BMC Public Health, 5:131.

Saleh, S; Gadalla, S; Fortney, J (1987) Maternal mortality in Menoufia: A study of reproductive age mortality. Cairo: Social Research Center, the American University of Cairo.

Smith JM, Burnham G (2005) Conceiving and dying in Afghanistan. Lancet, 365(9462): 827-28.

Walker GJA et al. Identifying deaths in developing countries. Experiences from Jamaica. International Journal of Epidemiology, 1990;19:599-605.

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RAMOS: ADDITIONAL RESOURCES

Example of a recent RAMOS-based national maternal mortality study:

	Hacettepe University Institute of Population Studies, ICON-INSTITUT Public Sector GmbH and BNB Consulting (2006) National maternal mortality study, 2005. Ministry of Health, General Directorate of Mother and Child Health and Family Planning and Delegation of European Commission to Turkey: Ankara

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Back to Materials Index Background Guidelines References Additional Resources

RAMOS

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Background
Guidelines
References
Additional Resources