Author Archives: Network Coordinator

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

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 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 Morality 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

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Sierra Leone Maternal Death Surveillance and Response: Annual Report 2016

This is the first national report on data from Sierra Leone’s Maternal Death Surveillance and Response (MDSR) system since it was established in 2015. It includes data from 663 maternal deaths between January and December 2016.

This report highlights progress in institutionalising MDSR, gives an overview of maternal deaths from 2016 and includes recommendations for improving MDSR implementation as well as solutions to address the main causes of maternal deaths.

To download the full report for free, click here.

To read a summary of the key findings and recommendations, click here.

To read a blog about the release, click here.

Nigeria | Updates on MPDSR in Katsina, Yobe and Zamfara

The Maternal Neonatal and Child health programme (MNCH2) is a five year country led programme which aims to reduce maternal and child mortality in northern Nigeria.  The programme works across six states: Jigawa, Kaduna, Kano, Katsina, Yobe and Zamfara.

Image_Map of Nigeria_MNCH2Since 2014, MNCH2 has been supporting maternal and perinatal death surveillance and response (MPDSR) across its six states.  At secondary level facilities (which often have a high number of deliveries), maternal death review (MDR) committees have been set up to review the causes of maternal death and take action to prevent similar deaths in the future.  MNCH2 also supports State MDR Committees to mentor and monitor facility-level committees.

MNCH2’s support to MPDSR across northern Nigeria has resulted in a number of achievements. Following the country update from March 2017, which featured updates from Kaduna, Kano and Jigawa States, here are some further examples from Katsina, Yobe and Zamfara States:

Katsina State

Discussions in the State MDR Committee led to the development of a training in the use of non-pneumatic anti-shock garments for nurses and midwives working at maternity units in ten secondary health centres. Medical Directors, Medical Officers and Maternity personnel in charge of 18 secondary health facilities contributed to this development.

Twenty nurses and midwives were trained in October 2016 on the application of anti-shock garments. Within a month, these training participants trained other maternity staff from the same secondary health facilities to use anti-shock garments. To ensure that the training is cascaded to all general hospitals, the State is mentoring facility-MDR committees on a monthly basis.

Yobe State

A MPDSR Scorecard was developed in collaboration with the State-MPDSR Committee and the Yobe State Accountability Mechanism for MNCH (YoSAMM) with support from the MNCH2 programme. Data from April to December 2016 was collected from ten government general hospitals with MNCH services. The findings are available in box 1.

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The State organised a meeting in January 2017 to review the evidence from the MPDSR scorecard. The meeting was chaired by the Honourable Commissioner of Health, Dr Mohammed Bello Kawuwa and attended by the Chief Medical Directors of the ten general hospitals, and other members of the State MPDSR Steering Committee. The key issues discussed during the meeting were:

  • Facility MDR Committees irregularly meet to review maternal deaths and take actions.
    • Proposed recommendation: YoSAMM, with support from the Advocacy sub-committee, is to visit health facilities where reviews of maternal deaths are not regularly conducted as planned. Progress in this area will be discussed at the next YoSAMM quarterly meeting in June 2017.
  • Completion of MPDSR tools not meeting national standards.
    • Proposed recommendation: Health-care providers should receive a refresher training in the completion of MPDSR forms. A training was conducted in February 2017.
  • Pregnant women are reluctant to deliver at a facility.
    • Proposed recommendation: Local government health promotion officers should conduct community mobilisation activities on the importance of antenatal care (ANC) visits and delivery by a skilled birth attendant.

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Zamfara State

MDR findings from a secondary facility led to the identification of a number of medical equipment and infrastructure features that were lacking. In response to this, the facility MDR committee called on the local government to build an ultrasound centre and provide ultrasound machines. The facility received these provisions in June 2016. Community MPDSR findings led to further action from the local government in the provision of a renovated labour room, a newly built ANC waiting room with a capacity of 250, and ten beds for the maternity ward.

Acknowledgements: This update was prepared based on feedback from:

  • Mohammad Anka – Evidence and Advocacy coordinator, MNCH2 Zamfara state office
  • Garba Haruna Idris – Evidence and Advocacy coordinator,MNCH2 Katsina state office
  • Musa Mohammad- Evidence and Advocacy coordinator, MNCH2 Yobe state office.

Ebola, and maternal and newborn health and mortality

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It was an honour to have hosted a seminar co-organised by the Global MDSR Action Network and the London School of Hygiene and Tropical Medicine’s Centre for Maternal, Adolescent, Reproductive, and Child Health and Health in Humanitarian Crises Centre where three speakers shared their experiences working in maternal health during the Ebola outbreak in Sierra Leone: Dr Chris Lewis, a general practitioner by training and Health Advisor with Department for International Development during the outbreak; Laura Sochas, a Global Health Researcher with the London School of Economics  formerly with Options;  and Dr Benjamin Black, an obstetrician and gynaecologist with vast experience in crisis settings, who was working with Médecins Sans Frontières in Sierra Leone at the time of the crisis. Continue reading

Midwives: Unique contributors to MDSR

Midwives are vital to ensuring women and their babies not only survive pregnancy and childbirth, but live healthy lives.

We know from the Lancet Midwifery series that:

What do we know about the role of midwives in maternal death surveillance and response (MDSR) systems? Continue reading