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RAMOS

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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:

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:

Limitations:

Measurement requirements:

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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Measure Evaluation General description from Measure Evaluation Compendium

World Health Organisation

BMC Public Health 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.

American University of Cairo 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.

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

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

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

Hacettepe University 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
ICON Institut Public Sector GmbH
BNB Consulting

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