Objectives: To assess factors associated with under-reporting of maternal deaths from 1998, when maternal deaths became a Class I notifiable event in Jamaica and continuous maternal mortality surveillance was introduced, through 2003.
Methods: The number of deaths notified was compared with the number of independently identified deaths for each period and region studied, and key informants reported on their experience of the surveillance process.
Results: By 2000, approximately 80% of maternal deaths were reported, and was more consistent in 2 of the 4 regions. In these 2 regions someone was responsible for active surveillance and there was an established maternal mortality committee to review cases. Factors associated with nonreporting were no postmortem examination, death in the first trimester of pregnancy, and time interval between pregnancy termination and death. The surveillance staff requested guidelines on monitoring interregional transfers and technical assistance in developing action plans.
Conclusion: Active hospital surveillance must include all wards, including the emergency department. Community surveillance should include forensic pathologists. National leadership is needed to summarize trends, address policy, and provide technical assistance to the surveillance staff.