This document outlines the process for maternal and child death reviews in India. It describes both community-based and facility-based review methods. The goal is to identify gaps in healthcare services, determine causes of deaths, and implement corrective actions to prevent future deaths. The process involves notifying local officials of deaths, investigating circumstances, analyzing data at district and state levels, and taking appropriate actions to improve quality of care. Reviews are not fault-finding missions but aim to enhance healthcare delivery and reduce mortality.

2. MATERNAL AND CHILD DEATH
REVIEW
PG STUDENT:
Dr.Joshua Anish

3. BOOSTER PILLS
• SISTERHOOD METHOD
• 3DELAYS
• RHIME

4. CONTENT
• INTRODUCTION
• OBJECTIVES
• CDR
• MDR
• SUMMARY

5. INTRODUCTION
• It was introduced along with RCH-2
• Its an important strategy to improve the quality of obstetric care and to reduce
maternal and child mortality and morbidity
• It was first started by some states like Tamilnadu, Kerala and west Bengal
• Maharashtra on may 28th 2010
• Reviews can lead to action to prevent other deaths

6. OBJECTIVES
• Understand the geographical variations
• Identify gaps in delivery of health services
• To take appropriate corrective measures
• Find a specific interventions
• Improve quality of care
• Know the success of the program
• Improves the communication between district and state

7. MOST IMPORTANT
• Death review is not a fault finding mission
• No disciplinary action will be initiated
against any service providers
• Its not a court of law

8. CDR
• All deaths of 0-5yrs are recorded
• All deaths in this age group will be reported
• The review processes will remain the same for all children; however the
details to be investigated will vary in neonates (0-28 days) and Post
neonate (29 days-5 years).

9. CHILD DEATH REVIEW
CDR
CBCDR FBCDR
CBCDR-community based child death review
FBCDR- facility based child death review

10. COMMUNITY BASED CHILD DEATH
REVIEW
• Accounts for all death occurred in a community it doesn’t
consider where it has taken place.

11. STEPS
1. Notification of child death
2. Investigation of child death
3. Data transmission
4. Analysis of data and making action plan

12. NOTIFICATION OF CHILD DEATH
• Primary informant-
– Rural - ASHA/AWW/ANM/panchayat member
– Urban - link worker / ASHA/AWW/other persons employed in
municipal wards

13. NOTIFICATION
ASHA
ANM BMO
(Within 24hrs by phone or SMS)
ASHA-Accredited social health activist
ANM-Auxiliary nurse midwife
BMO-block medical officer

14. CONTENT IN THE MESSAGE
• Name-baby/mothers name
• Fathers name
• Age
• Resident
• Date and time of death

15. NOTIFICATION CARD
ASHA
ANM FAMILY
(Fills the notification
card Within 48hrs of
death)
The primary informant is given Rs.50/ per child death report.
ASHA-Accredited social health activist
ANM-Auxiliary nurse midwife
BMO-block medical officer
BMO

18. INVESTIGATION
BRIEF DETAILED

19. FIRST BRIEF INVESTIGATION
ANM
BMO
FBR must be conducted within 2 weeks after notification of death
(within 1 month)

20. INVESTIGATION OF CHILD DEATH
• First brief investigation will be conducted for all child deaths
• ANM
• Interviewing the parents/close caregiver of the deceased,
who were present at the time of death.
• First brief investigation report (FBIR) (form 2)
• ANM is given Rs-100/-per child death investigation

24. DETAILED INVESTIGATION
• Verbal Autopsy is an investigation of chain of events, circumstances,
symptoms and signs of illness leading to death
• Collected by interviewing of the family/relatives of the deceased.
• Detailed investigation will be carried out only in selected cases of child
deaths and not for all cases.
• A minimum of 6 cases per block per month will be investigated; two
each from neonatal (up to 28 days of life), post-neonatal (29 days -1 year)
and children (1-5 years) age groups.
• Done by a investigation team of 2 persons(1 medico/1 non med)

25. INVESTIGATION TEAM
• Should have at least 2 persons(1 medical and 1 para medical)
• Medical
– MO of PHC
– Public health nurse
– Lady health visitor
• Para medical
– Block supervisor
– ASHA facilitator

32. CASE SUMMARY
• After verbal autopsy is recorded
• CDR summary is filled by BMO
• It is sent to DNO

33. FACILITY BASED CHILD DEATH
REVIEW

34. FACILITY BASED CHILD DEATH REVIEW
• It is done at
– Teaching hospitals
– Referral hospitals
– District ,sub-district, CHC) where more than 500 deliveries are
conducted in a year.

35. STEPS
1. Notification of child death
2. Investigation of child death
3. Data transsmission
4. Analysis of data and making action plan

36. NOTIFICATION
DMO
FNO
Duty medical officer act as an
primary informant and fills the
notification card
(Within 24 hrs.)
DNO
(Within 48 hrs.)
DMO-duty medical officer
FNO- Facility nodal officer
DNO-district nodal officer

37. INVESTIGATION
DMO(2 copies)
FNO
DNO HOSPITAL
(WITHIN 1 MONTH)
DMO- duty medical officer
FNO-facility nodal officer
DNO- district nodal officer
(within 48 hrs.)

38. INVESTIGATION
• All cases of child deaths taking place in a hospital
• Facility based death review form is filled by DMO Within 48
hrs.
• FNO reviews the form and then submits it to DNO within 1
month of death

45. COMMITTEE
COMMUNITY BASED
1. DCDRC
2. DMCDRC
3. STATE LEVEL TASK FORCE
FACILITY BASED
1. FBCDRC
2. DCDRC
3. DMCDRC
4. STATE LEVEL TASK FORCE
DCDRC-district child death review committee
DMCDRC- district magistrate child death review committee
FBCDRC-facility based child death review committee

46. FBCDR COMMITTE
• Once in a month
• Selected cases are discussed
• Corrective measure which can be improved are discussed

47. DISTRICT CHILD DEATH REVIEW
COMITTEE (DCDRC)
• DNO selects 6 cases for review
• Consist of-
a. CMO/ Civil surgeon
b. DNO
c. Pediatrician
d. obstetrician
e. Anesthesiologist
f. Senior nurse

48. DISTRICT MAGISTRATE CHILD DEATH
REVIEW
• At the end of DCDRC meeting 3 cases are selected by CMO for
review by district magistrate
• Committee consist of
1. District magistrate
2. CMO
3. DNO
4. FNO(obstetrician/pediatrician)
5. Parents/relatives of diseased(max-2)

49. WHAT TAKES PLACE?
• The parents/relatives of the deceased child will first narrate the
events leading to the death of the child, in front of the DM and the
service providers who attended the deceased child
• After narrating the events the parents/ relatives will be sent back
• Then discuss the various delays - the decision making at the family,
getting the transport and institutional delays would be discussed in
detail.
• The outcome of the meeting will be recorded as minutes and
corrective actions will be listed with a time line to prevent similar
delays in future.

50. WHAT TAKES PLACE?
The corrective measures will be grouped into 3 categories with time lines:
A. Corrective measures at the community level
B. Corrective measures needed at the facility level
C. Corrective measures for which state support is needed

51. STATE LEVEL TASK FORCE
• Its conducted every 6 months
• Data from the districts compiled at the state level should be reviewed and
analyzed
• Members:
– Principal Secretary Health & Family Welfare
– State Mission Director NHM
– State Nodal Officer
– Pediatricians Govt. and Private Medical Colleges (max. 3)
– Obstetric Specialists from Govt. and Private Medical Colleges (max.1)
– State ICDS Officer
– Deputy Director/Director Nursing
– Deputy Director/Director MSD (materials/supplies and disposables)
– IAP representative

52. MATERNAL DEATH REVIEW

54. INTRODUCTION
• 28M experience pregnancy
• 26M live birth
• 67K maternal death
• 1M newborn death

55. MATERNAL MORTALITY RATIO
• MMR- No. of women die from any cause related/aggravated
by pregnancy
Or
during child birth
Or
within 42 days of termination of pregnancy irrespective of
duration and site of pregnancy but not from accidental or
incidental cause
Per 1 lakh live birth

56. STATISTIC
• MMR-
• INDIA – 130 (SRS-16)
• MAHARASTRA -61
• TAMILNADU -66

57. MMR
• MMR varies from region due to
– Access to emergency obstetric care
– Antenatal care
– Anemia
– Education
– Economic status

58. MATERNAL DEATH REVIEW
MDR
CBMDR FBMDR
CBMDR-community based maternal death review
FBMDR- facility based maternal death review

59. WHY IT WAS INTRODUCED?
• To identify the delay and gaps in health care system
• To analyze and formulate strategies to reduce the maternal death
• Understand determinants of maternal death
• To improve the quality of obstetric care
• Reduce mortality and morbidity

60. COMMUNITY BASED MATERNAL
DEATH REVIEW
• All the deaths occurred in a particular geographical area (age 15-49)must
be reviewed irrespective of place of death(home/facility/transit)
• It’s the method to find out the personal, family or community factors that
may contributed to the death

61. NOTIFICATION
ASHA/AWW/ANM
BMO
Notify all women death between 15-49
Within 24 hrs.
ASHA/AWW/ANM
BMO
Fills Notification card within 48hrs of death

62. NOTIFICATION
• Primary informant form helps the BMO to know whether the
death is due to maternal or non maternal cause
• If its due to maternal cause verbal autopsy is done by a
investigation team

64. VERBAL AUTOPSY
• Verbal autopsy format(annexure 2)is used
• It is done by investigation team
• It consist of
– Block medical officer/any MO
– Lady health visitor
– Block public nurse
– Health supervisor
– ANM
• Team consist of 3 members
• It has to be done with 3 weeks of notification

65. ANNEXURE-2

71. CASE SUMMARY
• After verbal autopsy is recorded
• MDR summary is filled by BMO in annexure:3
• It is sent to DNO

73. FBMDR
• It is done at
– Teaching hospitals
– Referral hospitals
– District ,sub-district, CHC) where more than 500 deliveries are
conducted in a year.
• Notification is done by facility based nodal
officer

74. NOTIFICATION
DMO
FNO
DNO SNO
(WITHIN 24 hrs.)
DMO- duty medical officer
FNO- facility nodal officer
DNO- district nodal officer
F-MDR – facility maternal death
review committee

75. INVESTIGATION
DMO
FNO
DNO F-MDR
committee
DMO- duty medical officer
FNO- facility nodal officer
DNO- district nodal officer
F-MDR – facility maternal death
review committee

76. MATERNAL DEATH REVIEW AT
DISTRICT LEVEL
• At district level there will be two review meetings,
– Under the chairmanship of the CMO
– District magistrate

77. COMMITTEE
COMMUNITY BASED
1. DMDRC
2. DMMDRC
3. STATE LEVEL TASK FORCE
FACILITY BASED
1. FBMDRC
2. DMDRC
3. DMMDRC
4. STATE LEVEL TASK FORCE
DMDRC-district maternal death review committee
DMCDRC- district magistrate maternal death review committee
FBMDRC-facility based maternal death review committee

78. FBMDR COMMITTE
• Once in a month
• Selected cases are discussed
• Corrective measure which can be improved are discussed

79. FACILITY BASED MATERNAL DEATH
REVIEW
• Superintendent of the Hospital/ Other Administrative Head of the
Institution
• Head Of Department (OBG dept.)
• FNO (Obstetrician from the department)
• At least three members should be OBG specialists from the Dept.
• One anesthetist
• One blood bank MO
• Nursing representative
• One physician

80. DISTRICT MATERNAL DEATH REVIEW
COMITTEE (DMDRC)
• DNO selects 6 cases for review
• Consist of-
a. CMO/ Civil surgeon
b. DNO
c. HOD of obstetrics and gynecology ( teaching hospitals)
d. Anesthesiologist
e. Senior nurse
f. MO officer who attended the case

81. DISTRICT MAGISTRATE MATERNAL
DEATH REVIEW
• At the end of DMMDRC meeting 3 cases are selected by CMO
for review by district magistrate
• Committee consist of
1. District magistrate
2. CMO
3. DNO
4. FNO(obstetrician)
5. Parents/relatives of diseased(max-2)

82. STATE LEVEL TASK FORCE
• Its conducted every 6 months
• Data from the districts compiled at the state level should be reviewed and
analyzed
• Members:
– Principal Secretary Health & Family Welfare
– State Mission Director NHM
– State Nodal Officer
– Pediatricians Govt. and Private Medical Colleges (max. 1)
– Obstetric Specialists from Govt. and Private Medical Colleges (max.3)
– State ICDS Officer
– Deputy Director/Director Nursing
– Deputy Director/Director MSD (materials/supplies and disposables)

84. SUMMARY

85. NOTIFICATION
CBDRC FBDRC
PRIMARY
INFORMANT
PRIMARY
INFORMANT
FNODUAL
REPORTING
TO ANM &
BMO
TIMING?

86. INVESTIGATION
FBIR
ANM DMO
BMO FNO

87. INVESTIGATION
VERBAL AUTOPSY
INVESTIGSTION TEAM DMO WITH FNO
DNO
DNO

88. DATA TRANSMISSION
REPORTING CHAIN
BMO
DNO
SNO
DMO
FMO
DNO
SNO
MoHFW
PROGRAME OFFICER

89. REFERENCE
• http://pbhealth.gov.in/Operational%20Guide%20of%20Child
%20Death%20Review.pdf
• http://www.nrhmhp.gov.in/content/reporting-formats-child-
health
• IAPSM’s textbook of community medicine-pg. no-733
• http://nhsrcindia.org/sites/default/files/MDR%20Handbook%
20Dec%209.pdf
• http://tripuranrhm.gov.in/Guidlines/MDRGuidelines/MDRFor
mats_Annex_Pg85_113.pdf