Presentation 2  mdr need for it-wb-2011
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  • 1. Maternal Death Review Need for taking it up
  • 2. For obstetricians & mid wives ….
    • Maternal mortality is not about statistics
    • Its about women with names, faces
    • - faces seen with agony, distress, despair
    • - faces that continue to live in the memories and haunt our dreams
    • Not because these women died in their prime lives, die at a time of expectation and joy, it’s a terrible way to die
    • But above all because……
  • 3. …… because almost every maternal death is an event that could be avoided and should never have been allowed to happen Dr. Mohamoud Fathalla Assuit University,Egypt
  • 4. Causes of Maternal Deaths
    • Medical Causes
    • 1. Direct obsteric causes
      • - Hemorrhage
      • - Infection
      • - Obstructed labour
      • - Hypertensive disorders
      • - Unsafe abortion
    • 2. Indirect obsteric causes
    • Contributory Causes
  • 5. Why are maternal deaths happening?
    • The Three Delays
      • Delay in deciding to seek care
      • Delay in reaching the medical facility
      • Delay in receiving adequate care at the facility
  • 6. Three delays leading to maternal death
    • Delay -1:
    • Delay in decision making
    • Delay in recognizing the need for health care
    • Lack of knowledge of danger signs
    • Delay in deciding to seek formal care
      • Women’s low social status
      • Lack of economic resources
      • Preference for traditional care
      • Other responsibilities, etc.
  • 7. Three delays leading to maternal death
    • Delay -2:
    • Delay in reaching the appropriate health facility
    • Arranging money for transportation and health care
    • Locating the transport
    • Knowing where to go
    • Distance to the appropriate facility
    • Infrastructure for transporting the patient – bad or no roads etc.
  • 8. Three delays leading to maternal death
    • Delay -3:
    • Delay in receiving quality care in the institution
    • Inadequate resources at the facility
    • Health personnel, supplies, equipment
    • Inappropriate treatment and referrals
  • 9. Averting Maternal Deaths…
    • Avoiding maternal deaths is possible even in resource poor countries, but it requires the right kind of information on which to base programmes
    • Each maternal death or case of life threatening complication has a story to tell and can provide indications on practical ways of addressing the problems
  • 10. Why MDR is introduced?
    • Maternal Death Review (MDR) as a strategy has been spelt out in the RCH –II National PIP.
    • It is an important strategy to improve the quality of obstetric care and reduce maternal mortality and morbidity.
    • MDR provides detailed information on various factors - that are needed to be addressed to reduce maternal deaths.
    • Analysis of these deaths can identify the delays that contribute to maternal deaths at various levels and the information used to adopt measures to fill the gaps in service.
  • 11. Maternal Death Review
    • Should have a mechanism to identify both the medical & contributory causes
    • Maternal death reviews should seek only to identify failures in the health care system.
    • A commitment to act on the findings of these reviews is key to reduce the MMR
    • Should never be used for litigation, punishment or blame. No name – no blame principle
  • 12. Different Approaches of MDR
    • Community based maternal death review
    • Facility based maternal deaths review
    • Confidential enquiries into maternal deaths
    • Surveys of severe morbidity(near miss)
    • Clinical audit
  • 13. Community Based Maternal Death Review
    • A method of investigation of maternal deaths using a tool- Verbal autopsy to find out the medical causes and ascertaining the personal, family or community factors that may have contributed to the deaths.
    • Verbal autopsy – interviewing people who are knowledgeable about the events leading to the death such as family members, neighbours, traditional birth attendants etc.
  • 14. Scope of CBMDR
    • Identify both medical and contributory causes leading maternal deaths
    • Community and family members perception about the quality and access to health care
    • Community level barriers (delays) can be identified
    • Health education to create awareness for seeking care
  • 15. Facility Based Maternal Death Review
    • A qualitative in depth investigation of the causes and of circumstances surrounding maternal deaths occurring in health facilities
  • 16. Scope of FB MDR
    • Identify circumstances under which the death took place
    • Identify causes of death: direct obstetric, indirect obstetric and non obstetric cause.
    • What steps are required to prevent such deaths in future:
          • Action related to infrastructural strengthening
          • Action required to augment human resource availability
          • Action required to develop protocols and strengthen competence of staff
          • Supplies and equipments
          • Demand side interventions to address first and second delays
          • Management interventions
          • Other interventions based on the findings of MDR
    •  
  • 17. Advantages of MDR
    • Identify the gaps in the existing health care delivery systems
    • Identify priorities and plan for intervention strategies
    • Reconfigure health services
  • 18.