The National Institute for Health and Clinical Excellence (NICE), the U.K., will collaborate with the State Health Department in evolving risk-reduction strategies and standard clinical guidelines for reducing maternal mortality in Kerala.

NICE will also help the State design, for the very first time, a methodology for infant death audits, which will help the Health Department improve the monitoring, surveillance and reporting of infant deaths in the State and eventually work towards strategies for bringing down the Infant Mortality Rate (IMR).

A team of senior officials from NICE International, the wing of NICE UK, which works with other health systems to guide them in effective and equitable use of resources and helps them in capacity building for evidence-based decision-making to achieve better health care, had been in Kerala on a three-day visit to discuss how best they could work with the State Health Department in drawing up protocols and standard practice guidelines to better maternal and childcare services here.

Senior advisers of NICE International Francis Ruiz and Francoise Cluzeau, and founding director of NICE’s international programme Kalipso Chalkidou held detailed discussions with high-level Health officials and participated in a workshop on Kerala’s maternal mortality scenario here on Wednesday.

Mortality rate

As per the latest Sample Registration Survey (SRS) data of 2007-09, the maternal mortality rate (MMR) of Kerala is 81.

The data collected by the Directorate of Health Services from the field (2011-12) indicates that the MMR of Kerala is just 27. However, Kerala Federation of Obstetricians and Gynaecologists (KFOG), which will be an active partner in the exercise that the Health Department and NICE would be undertaking, puts the MMR of Kerala around 50 because “a lot of maternal deaths do not get reported at all.”

The data available with the Health Department indicates that in Kerala, the primary cause of maternal deaths is post partum haemorrhage (19.38 per cent). “Diabetes and hypertensive disorders are a major worry for us, so is rheumatic heart disease. There are also issues like the inadequacies in health care institutions, lack of emergency transport and the public perception that Caesarean section is a very safe option for delivering a baby,” pointed out V.P. Paily, senior obstetrician and president of KFOG.

“Measuring MMR accurately is difficult because of under-reporting, system of issuing medical certificate of cause of death, the challenges of determining the cause of death and so on. NICE has been engaging with the Government of Kerala since 2009 and we fully intend to draw up a plan with clear deliverables and timelines on developing clinical standards, policies and guidelines for reducing the maternal mortality here,” Ms. Cluzeau said.

NICE International will be working with the huge repository of data collected by KFOG since 2004 as part of an exercise they had launched, Confidential Maternal Death Review, as well as the baseline statistics provided by the Health Department on why mothers are dying in Kerala.

“We are very excited about this project because the basic building blocks and the measurable indicators are all here. NICE team will work with KFOG’s recommendations and try to identify the key matrices involved and develop standard clinical practices and protocols,” Dr. Chalkidou said.