In March 2015 we shared the news that the Evidence for Action programme in Ghana was piloting the use of Maternal Death Audit Monitoring Forms. This case study presents some of the key findings from this pilot, key challenges and lessons learned.
Ghana is faced with high maternal mortality. In 2015, the maternal mortality ratio was an estimated 319 deaths per 100,000 live births . Facility-based maternal death audits have been used in Ghana as an important strategy to improve maternal health care since 2000. These audits are a qualitative improvement process that seeks to improve pregnancy care and outcomes through the systematic review of the care received. The ultimate purpose of maternal death audits is to identify factors contributing to the deaths and to take remedial action . Continue reading
This case study is an excerpt from a collection of 22 case studies by the Evidence for Action-MamaYe! programme based on their experiences. These case studies bring to light new learning about the specific ways in which evidence, advocacy and accountability must work together to bring about change.
Evidence for Action-MamaYe! was established in 2011 through funding from the UK Department of International Development. The programme’s goal is to save maternal and newborn lives in Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone and Tanzania, through better resource allocation and improved quality of care.
When the Evidence for Action-MamaYe (E4A) programme first started operations in Malawi, we observed that while some facilities and districts were carrying out maternal death reviews, committees met only rarely and did not communicate systematically with other levels. Rudimentary action plans were sometimes developed, but there were no follow-up meetings to track change. Furthermore, the maternal death review process did not include the community level. Consequently, community factors that might have contributed to facility deaths and maternal deaths occurring within communities were not recorded, no explanation was fed back to families or communities on the reasons for facility-based deaths, and no actions were taken in response. This led to distrust between community members and facility staff, who themselves often blamed the families for bringing the woman to the facility too late. Continue reading
The Ministry of Health in Malawi released Maternal Death Surveillance and Response (MDSR) guidelines for health professionals in 2014. These guidelines aim to inform capacity building and implementation of a functional MDSR system in Malawi, incorporating it within the current Integrated Disease Surveillance and Response (IDSR) system.
Download Malawi’s MDSR guidelines here.
This article by Felix Sayinzoga and colleagues, published by BMJ Open in January 2016, presents the findings of a review of all health facility-based maternal death audits in Rwanda between January 2009 and December 2013. Based on this review, the authors found that the facility-based maternal death audit approach has helped facility teams to identity causes of death and contributing factors, as well as make recommendations for action to prevent future deaths. They recommend that Rwanda better inform corrective actions by complementing these audits with other strategies, such as confidential enquiries and near-miss audits
This article by Moke Magoma and colleagues, published by BMC Pregnancy and Childbirth in December 2015, presents the findings of a statistical analysis of data from maternal death reviews (MDR) in Bugando Medical Centre, north-western Tanzania between 2008 and 2012. The study presents the findings from the analysis, as well as describing the challenges of the analysis and how it provided a greater understanding of maternal deaths. The authors found that routine MDRs in this setting were not complete, with key documentation missing, such as actions to address weaknesses in the system. The authors conclude that the roll-out of new national guidelines in Tanzania may help to build capacity for tertiary institutions to carry-out training of health professionals in maternal and perinatal death reviews.
This article by Heather Scott and colleagues, published by the Journal of Obstetrics and Gynecology Canada in October 2015, provides an overview of the status of MDSR implementation in East and Southern Africa by presenting key findings from 1) a knowledge-sharing regional meeting in Johannesburg, South Africa in November 2014, and 2) an evaluation of the Confidential Enquiry into Maternal Deaths in South Africa by UNFPA. The authors found that MDSR is still not at an optimal level in many countries in sub-Saharan Africa. More work by national authorities, communities, and development organisations is needed, particularly in addressing key challenges.
This report, published by the African Union Commission and UN Women in May 2015, examines how maternal death audits or MDSR systems are being used to track gender inequalities. The researchers carried out in-depth interviews with key informants from five African countries, Chad, Ethiopia, Nigeria, South Africa and Tunisia, as well as a documentary analysis of key documents. On the basis of the findings from this research, the document provides recommendations on ways these systems can be used to monitor more effectively gender-related contributors and how to mainstream gender in MDSR systems in Africa.
This article by Joseph Adomako and colleagues, published by the Bulletin of the World Health Organization in February 2016, presents the findings of a study examining the feasibility and effectiveness of community-based surveillance of maternal deaths in rural Ghana. Using a modified reproductive age mortality survey (RAMOS 4+2) and verbal autopsies in Bosomtwe district, the study found that community-based surveillance of deaths of women of reproductive age is feasible and can help to identify maternal deaths in rural communities where they can go unreported.
This article by Animesh Biswas and colleagues, published by Health in September 2014, presents findings from a mixed-method study examining the process, feasibility, and acceptance of community death notification in Thakurgaon district, Bangladesh. The study found that community death notification was achievable and acceptable at the district level.
This article by Olivia Bayley and colleagues, published by BMJ Open in April 2015, describes a pilot study in rural Malawi which assesses the value of involving communities in investigating and responding to local maternal deaths. The pilot developed and implemented a community-led maternal death review (CLMDR) system over a 1-year period in the Mchinji District of Malawi. The study found that engaging and empowering communities through the CLMDR system can help ensure effective review of maternal deaths, and can facilitate targeted response planning and accountability.