The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58627

Lorraine Yeung, MD, MPH¹, Rongwei Ye, MD², Jacqueline Gindler, MD¹, Zhu Li, MD², RJ Berry, MD, MPHTM¹, Hong Wang, MD², and Junchi Zheng, MD². (1) National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-45, Atlanta, GA 30341, 770-488-7397, Lcy5@cdc.gov, (2) The National Center for Maternal and Infant Health and the Department of Health Care Epidemiology, Peking University Health Science Center, 38 College Road, Beijing, 100083, China

Background: China reports a high maternal mortality rate (26/100,000 live births in urban areas to 308/100,000 in rural areas), that timely identification of high-risk pregnancies might help to reduce. Since 1993, Haiyan County has maintained a reproductive health surveillance system (RHSS). Methods: Using the Centers for Disease Control and Prevention surveillance system evaluation guidelines, we evaluated the Haiyan RHSS, including its recently implemented real-time electronic data entry format, which allows immediate generation of reports; the older, paper format allowed generation of reports only after pregnancy ended. Among all women, we compared percentages of missing values in key variables between the electronic and paper versions. Among women with and without high-risk pregnancies, we calculated rates of delivery in tertiary care hospitals and of Cesarean delivery. Results: We found that the RHSS is estimated to provide 95% coverage among its target population. Two critical variables, delivery location and delivery method had very few missing values (<1.1% with paper format and <0.1% with electronic format). Women identified with high-risk factors in the third trimester delivered more frequently in tertiary care hospitals (risk ratio [RR] = 1.12, 95% CI = 1.08 – 1.17) and had more Cesarean deliveries (RR = 1.37, 95% CI = 1.33 – 1.41) than did women who did not have high-risk factors. Conclusion: This active, population-based surveillance system is useful in identifying and referring high-risk women to tertiary care hospitals for delivery. Its newly implemented electronic data entry format ensures better data quality and allows data to be transformed into information more quickly. A simplified version of this system should serve as a model to other developing countries.

Learning Objectives:

• Describe a high-risk pregnancy surveillance system in China
• Recognize that there are standard guidelines to evaluating surveillance systems
• Recognize the value of having few missing values in important variables in a pregnancy surveillance system.
• Describe the difference in delivery method between high-risk pregnancy and non high-risk pregnancy.

Keywords: Prenatal Interventions, Surveillance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.