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IndOSS-Assam: investigating the feasibility of introducing a simple maternal morbidity surveillance and research system in Assam, India
  1. Manisha Nair1,
  2. Manoj K Choudhury2,
  3. Saswati S Choudhury3,
  4. Swapna D Kakoty3,
  5. Umesh C Sarma2,
  6. Premila Webster4,
  7. Marian Knight1
  8. On behalf of the IndOSS-Assam steering committee
  1. 1National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
  3. 3FAA Medical College, Barpeta, Assam, India
  4. 4Oxford School of Public Health, Oxford Deanery, Oxford, UK
  1. Correspondence to Dr Manisha Nair; manisha.nair{at}


Objective To assess the feasibility of establishing a simple maternal morbidity surveillance system in Assam (Indian Obstetric Surveillance System-Assam (IndOSS-Assam)) to investigate the incidence and trends in severe maternal complications. This study presents the surveillance platform of IndOSS-Assam.

Design Four tasks were undertaken: (1) setting up of a steering committee; (2) establishing priorities for the region; (3) mapping of surveillance sites; (4) piloting case-notification systems in selected centres.

Setting Two government tertiary hospitals in the state.

Study population Pregnant women delivering in the hospitals between March and August 2015.

Main outcome measures Incidence and case fatality rates with 95% CIs.

Results Local stakeholder ownership and a simple uncomplicated anonymous system for case notification were the key strengths of this project. Cases and deaths were reported for six conditions: eclampsia, postpartum haemorrhage, puerperal sepsis, septic abortion, uterine rupture and anaemic heart failure. Among 10 475 women delivering over 6 months, 402 had one of these conditions and 66 died (case fatality 16%). The incidence of eclampsia was 17 per 1000 deliveries (95% CI 14 to 19), postpartum haemorrhage was 11 per 1000 deliveries (95% CI 10 to 13) and anaemic heart failure was 3 per 1000 deliveries (95% CI 2 to 5). For each of the other three conditions—puerperal sepsis, septic abortion and uterine rupture—the incidence rate was 2 per 1000 deliveries.

Conclusions IndOSS-Assam was shown to be a feasible and simple system for ongoing surveillance of maternal morbidity that can be used to monitor the trends in the incidence of specific severe life-threatening conditions during pregnancy.

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