Maternal Death Surveillance and Response

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MDSR is a component of the health information system, which permits identification, notification, quantification, and determination of causes and avoidability of maternal deaths, for a defined time period and geographic location, with the goal of orienting the measures necessary for its prevention.

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Maternal Death Surveillance and Response

  1. 1. Maternal Death Surveillance and Response Prepared by Najibullah Hamid October 2012
  2. 2. Why is MDSR important?• Maternal mortality continues to be unacceptably high in many countries• Maternal death surveillance provides information for taking appropriate actions to prevent deaths• “A maternal death surveillance and response system that includes maternal death identification, reporting, review and response can provide the essential information to stimulate and guide actions to prevent future maternal deaths and improve the measurement of maternal mortality.” (Danel, Graham & Boerma. Bull World Health Organ Nov 2011; 89:779–779A)
  3. 3. The Need for MDSR• Due to the lack of complete and reliable data in low income countries, levels and trends in maternal mortality have long been generated through modeling exercises based on survey results• The resulting maternal mortality ratios are generated periodically, have very wide confidence intervals and reflect situations five to 10 years prior to the surveys• What is needed, is a surveillance approach that reflects maternal deaths in real time
  4. 4. The Need for MDSR….• Real-time monitoring provides information that can be used in the development of programs and interventions to improve maternal health, reduce maternal morbidity, and improve the quality of care of women during pregnancy, delivery, and postpartum• MDSR involves systematic notification of pregnancy- related deaths, continuous analysis of the causes and geographic distribution of these deaths, and the use of that information to inform and evaluate public health practices
  5. 5. Introduction• MDSR is a component of the health information system, which permits identification, notification, quantification, and determination of causes and avoidability of maternal deaths, for a defined time period and geographic location, with the goal of orienting the measures necessary for its prevention• It provides information that can be used in the development of programs and interventions to improve maternal health, reduce maternal morbidity, and improve the quality of care of women during pregnancy, delivery, and postpartum
  6. 6. Introduction….Maternal death surveillance and response system: a continuous action cycle at community, facility, regional & national level
  7. 7. Rationales• MDSR provides information about avoidable factors that contributed to a maternal death and guides actions that need to be taken at the community level, within the formal health care system, and at the intersectoral level to prevent similar deaths in the future• MDSR establishes the framework for an accurate assessment of the magnitude of womens deaths related to pregnancy• Accurate assessment of maternal mortality, let policy and decision makers, to give the problem the attention it deserves. It let evaluators accurately assess the effectiveness of interventions
  8. 8. Aim• An MDSR system aim to identify every maternal death in order to accurately monitor maternal mortality and the impact of interventions to reduce it
  9. 9. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  10. 10. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  11. 11. Set Up• For successful implementation of maternal death review the following settings are needed: – Establish National, regional and local committee • National MDSR task force • Regional safe motherhood technical working group/ RH task force • Facility based MDSR committee – Determine roles and responsibilities of key actors • Provincial MNCH focal person • Director of hospital / health center • CBHC officers • Community Health Supervisors • HMIS focal persons at provincial, regional and national level
  12. 12. Set Up….– Availing tools and guidelines for MDSR • Notification and verbal autopsy tool • Community based maternal death review tool • Facility based maternal death summary form • Reporting template from Health facility to Next level • Reporting format from province to region • Reporting format from Region to National • M&E of MDSR guide– Legal and ethical considerations • Autonomy • Privacy • Beneficence
  13. 13. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  14. 14. Awareness Creation• In MDSR system, health care workers will be involved in a variety of ways such as data collection, revision or care provision• Orientation is needed for health care staff on objectives, processes and principles of MDSR• Awareness creation to community is important as deaths occur there and for establishment of ownership of the review process• For community-based reviews, the support of local village leaders and religious & cultural leaders is essential
  15. 15. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  16. 16. Process of MDSR System• Sources of information – Community • For identification: community health workers, CHS, religious leaders/community leaders, administrative leaders, community members) • For verbal autopsy: persons primarily attended the women during illness, labour/delivery at home, person present at the side of woman at the time of death, husband – Health Facility • For notifying: head of maternity/labour ward • For facility deaths reviews: referral sheets, medical records, log books, attending health workers, others
  17. 17. Process of MDSR System….• Identification and reporting of maternal deaths – In the community (identification by CHWs, reporting by CHS) – In facility (head nurse/midwife) • Data contents and data collection – Demographic data – Prenatal history – Delivery information – Information on death – Potentially avoidable factors – Info on MDR • Reviewing of the Event • The chairperson of the review committee at each level of the review process will assign two reviewers for every death to be reviewed and produce summary reports
  18. 18. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  19. 19. Analysis• Data analysis is critical to provide useful information to guide action• The best approach is a combination of both qualitative and quantitative analysis• Qualitative analysis of each case, identifies the medical and non- medical problems that contributed to that death• Grouping the findings, especially the problems, and looking at them quantitatively provides information on which problems are most common• The use of qualitative and quantitative analysis together allows one to both understand what the problems are and prioritize the actions to remediate them• Analysis needs to be done at provincial level, regional level, and national level
  20. 20. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  21. 21. Dissemination of results• Whom to inform of the results: – Ministry of health; local, regional, and national health care planners, policy-makers and politicians; professional organizations and their members; social, security and the private sector; academic institutions; community members; national or local advocacy groups; the media; opinion leaders who can promote and facilitate beneficial changes in local customs; all those who participated in the survey• Methods for dissemination of results: – Team meetings; thematic seminars at facilities; community meetings; radio programmes; printed reports; training programmes; posters; video clips • Publish the results: – single facility death review report; facilities-based review report; community-based review report
  22. 22. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  23. 23. Response• Taking action to prevent maternal deaths is the primary objective of MDSR• In most reviews, multiple problems will be identified, and a number of potential actions will be recommended• Possible actions include interventions in the community, within health services, and in the public sector
  24. 24. MDSR System• Set Up• Awareness creation among health care workers and the community• Process of the MDSR system (Identification, reporting and reviewing of maternal deaths)• Analysis (aggregation of multiple case reviews) - perspective on national, regional and provincial level• Dissemination of results• Response• M&E for MDSR
  25. 25. M&E for MDSR• Indicators for monitoring of MDSR – Overall system indicators: • Maternal death is a notifiable event • National maternal death review task force exists that meets regularly • National maternal mortality report published annually • % of facilities with maternal death review committees • % of provinces with someone responsible for MDSR – Identification and reporting: • % of maternal deaths reported within 48 hours in facilities • % of community maternal deaths reported within 1 week
  26. 26. M&E for MDSR…– Review • % of facilities with a review committee • % of facility maternal deaths are reviewed • % of verbal autopsies conducted for pregnancy related deaths in community • Regional maternal mortality review committee exists and meets regularly to review facility and community deaths • percentage of deaths reviewed by the region among reported ones– Response • % of committee recommendations that are implemented at facility level • % of committee recommendations that are implemented at community level
  27. 27. M&E for MDSR…– Reports • National Committee produces annual report • Regional committee produces annual report– Impact • Case fatality rate (facility) • National maternal mortality ratio • Regional maternal mortality ratio • In addition to the monitoring indicators, periodically a more detailed evaluation is useful • The evaluation of MDSR system should take efficiency and effectiveness into consideration
  28. 28. Key messages• Avoiding maternal death and improving quality of care is possible, even in resource constrained settings. Obtaining the right kind of information to guide action is critical• Every maternal death is a tragedy and should be a notifiable event that is reviewed, discussed and that leads to corrective actions to address the problems encountered• Understanding the underlying factors leading to the deaths is critical to prevent future mortality
  29. 29. Key messages…..• Data collection must be linked to action. A commitment to act upon findings is a key prerequisite for success• As a starting point, all maternal deaths in health facilities and communities should be identified, reported, reviewed and responded to with measures to prevent future deaths
  30. 30. Thank You

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