Monthly Archives: September 2017

Using data to prevent maternal deaths in crisis settings

Triggers and chain of events leading to maternal deaths vary greatly according to contexts in humanitarian settings. We really need to dig up the issues. A systematic review of individual events is essential to take appropriate, life-saving corrective measures. You just need a few reports to understand what is happening, and you can do a lot to change the situation” – Nadine Cornier.
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Every maternal death has a story to tell and should be counted, so that appropriate responses can be developed to prevent similar deaths. But how do we do so effectively and in a timely manner in settings where health systems are disrupted and populations are displaced? Continue reading

New MDSR reports galvanise action to improve quality of care in Malawi Northern Zone

As part of its efforts to improve accountability for women and children’s health, Malawi classified maternal death as a notifiable event in 2003, and the National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) was established in 2009. Like many other countries, from 2013, Malawi moved from maternal death reviews (MDRs) to the more robust system of maternal death surveillance and response (MDSR), which entails not only that maternal deaths are notifiable, but also places greater emphasis on response, and on the monitoring and evaluation of MDSR itself. Continue reading

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Is scaling-up community maternal verbal autopsies a viable approach to inform action to reduce maternal mortality?

Key messages

  • Community verbal autopsies are recommended in Maternal Death Surveillance and Response systems. Potentially they can inform action to prevent further deaths by improving our understanding of: The circumstances surrounding deaths occurring in the community; individual and community-level factors contributing to delays for those deaths occurring at facilities; and family perspectives of treatment received at facilities. However, undertaking verbal autopsies at scale may not always be feasible.
  • Maternal deaths are rare events and, particularly in settings that are experiencing rapid increases in institutional delivery rates, are increasingly occurring in facilities.
  • Community verbal autopsies entail a high training cost, with large numbers of community health workers each covering relatively small geographical areas. Their low skill, high turnover and infrequency of conducting verbal autopsies generate poor quality information and limited new insights. The collection of data with limited use at a sensitive time also raises ethical concerns.
  • In low resource settings, other strategies could be considered to achieve the primary purposes of maternal death surveillance and response, for example strengthening community based vital registration systems for better notification of deaths; strengthening facility-based maternal death reviews with a focus on the community delays contributing to facility-based deaths; and intermittent qualitative research by skilled researchers.

Continue reading

Local knowledge to reduce under-five mortality: Initiating participatory action research in rural South Africa

We asked Dr Lucia D’Ambruoso, Deputy Director of the Centre for Global Development, University of Aberdeen and co-author of this recent publication, to tell us about using participatory approaches to strengthen mortality surveillance and reporting systems. The process addresses deaths of children under five years of age, which includes newborn deaths. The approaches can be applied to surveillance of perinatal mortality. Continue reading

Mortality surveillance report in South Africa: Focus on neonatal population

The fifth Rapid Mortality Surveillance Report, 2015 by the Burden of Disease Research Unit of the South African Medical Research Council was published in December, 2016. This report provides a national picture of the trends and causes of death of the newborn population.

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This summary, written by Dr Natasha R Rhoda, Senior Neonatal Consultant at Groote Schuur Hospital in Cape Town and the chairperson of the National Perinatal Mortality and Morbidity Committee in South Africa, concentrates on data for the period 2012 to 2015 and presents the key findings of the Rapid Mortality Surveillance (RMS) report 2015 in relation to perinatal and neonatal mortality. For further reading, browse the report Perinatal Deaths in South Africa, 2015, which was published in July 2017. Continue reading

Legal and policy frameworks supporting MDSR in Latin America and the Caribbean

Synthesis of case studies from Brazil, Mexico, Jamaica, El Salvador and Colombia

Background

According to the World Health Organisation (WHO),

Taking a human-rights based approach to health, making maternal death a notifiable event in law, and supporting this with policies for maternal death review, analysis and follow-up action, creates the preconditions necessary for successful implementation [of maternal death surveillance and response (MDSR)]”1 (p.31).

While death review systems may draw from international guidance and be standardised to an extent across countries, legal regulations can vary and can support or hinder access to information, the conduct of an audit and the response to findings2. Fear of litigation, can prevent the objective review of maternal deaths3, so having legal protection in place and ensuring an anonymous environment can encourage the sharing of information and involvement of health care workers in the MDSR system3. Similar principles can also support the investigation of stillbirths and neonatal deaths 2. Continue reading