Author Archives: Network Coordinator

MPDSR: a supportive process for midwives to boost morale

This blog, written for International Day of the Midwife on 5th May 2017, illustrates how the maternal and perinatal death surveillance and response (MPDSR) process in Kenya helped to lift the morale of midwives working in extremely challenging conditions.

The Maternal and Newborn Health Improvement (MANI) project has trained eight midwives from Lugulu hospital since September 2015 in MPDSR. Since then the facility has regularly conducted maternal and perinatal death reviews (M/PDRs). The primary objective of MPDSR is to identify areas where quality and access to emergency obstetric and newborn health care services can be improved to help prevent future deaths. However, in Lugulu hospital, the midwives found that MPDSR equipped them with strategies to cope during an exceptionally difficult period.

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Like many faith-based facilities across Kenya, health providers in Lugulu Hospital in Bungoma County felt unable to turn maternity clients away during the four-month strike by Government doctors. During the strike, from November 2016 to February 2017, Lugulu Hospital experienced:

  • An increase in maternity in-referrals from an average of two per month to over 100, including many cases from facilities in neighbouring counties
  • A sudden six-fold increase in the number of deliveries and a seven-fold increase in the number of caesarean sections

Ordinarily, these additional clients would have used the free government maternity services, and lacked the resources to pay Lugulu’s standard fees. With clients unable to pay, Lugulu struggled to cover the additional demands on staffing, drugs and supplies, leaving the facility in a compromising situation. Midwives experienced a huge increase in their workload, typically working over 12-hour days, often for seven-consecutive days, leaving them both “physically and mentally drained” (Matron in-charge). Postnatal wards were grossly overcrowded. Emergency clients had to queue for caesarean sections in the hospital’s only operating theatre, with staff having to make difficult decisions regarding which emergency case was most critical. For some emergency patients arriving from elsewhere, delays in the weak referral system proved to be fatal.

The increased caseload and detrimental impact on quality of care resulted in midwives witnessing over 20 perinatal deaths a month at its peak, compared to an average of one per month before the strike. No maternal deaths had occurred at the facility between January and November 2017, but five occurred during the strike, leaving staff to feel “upset and demotivated seeing so many lives lost just because of money” (Maternity-in-charge).

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Despite the excessive strain already placed on their workload by the doctor’s strike, midwives and other health personnel at Lugulu continued to meet to review all of the maternal and perinatal deaths that occurred during the course of the strike, and found that this was “a positive experience at a time when morale was low” (Matron-in-charge). The Maternity-in-charge went on to explain:

“Midwives see MPDSR as a learning experience and an important process for identifying and addressing preventable factors contributing to deaths. The review process helps us to see our weakness. We identify gaps in the management of difficult cases. We then take action, such as internal continuous medical education and training in emergency obstetric and newborn care.”

What was especially important during this crisis was that midwives found the meetings were an opportunity to “sit together as a team” (Matron-in-charge). During the doctors’ strike they felt determined to continue the M/PDR process as it helped them at a truly difficult time emotionally. Akin to a peer-support counselling session “some midwives even came to attend review meetings after working a night shift,” (Health Record Information Officer).

The MPDSR process was thus a pivotal mechanism enabling the midwives to cope in this difficult context. It confirmed MPDSR as a valuable process that strengthened their team work, reinforcing the need and appreciation of their collaborative efforts.

Acknowledgements: This blog was written by Sarah Barnett, Technical Specialist at Options.

To learn more about the experiences of midwives conducting confidential enquiries in Ireland, including the importance of having a peer-support system within the process, read our expert opinion piece on the role of the multi-disciplinary team in MDSR or similar models.

National MDSR Annual Report 2008 EFY (2015-16)

This is the second national report on maternal death surveillance and response (MDSR) data from Ethiopia. It presents data reported to the national MDSR database in the Ethiopian Financial Year (EFY) 2008 (2015-16). In 2008 EFY, 633 maternal deaths were reported; this is 6% of the expected maternal deaths and an increase from 387 deaths between 2006 and 2007 EFY (2013-15).
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The MDSR system has now been rolled-out to all regions in the country and includes data on deaths in the community and in facilities. In 2008 EFY the number of hospitals in Ethiopia grew significantly. Health-facility deaths now make up nearly 40% of investigated cases, which has contributed to an increase of reported events for 2008.

This expansion of the system leading to a larger number of community and facility data in 2008 makes it too early to compare the data from both reporting periods. This report should, therefore, be considered on its own. However, for future reports it is expected that the data will be used to determine patterns and trends in maternal mortality over time.

The feature of this report is a new response section with examples of actions from community level to national level in response to the review of maternal deaths and the data contained in the 2008 EFY MDSR Report.

Haemorrhage continues to be the leading cause of death with 42% of maternal deaths due to obstetric haemorrhage. The provision of trained staff and appropriate equipment is necessary to manage obstetric haemorrhage. All women should also be encouraged to use antenatal care services and be offered iron during their pregnancy to help prevent haemorrhage.

National MDSR Annual Report 2008 EFY_Box 1

Click here to download the report (PDF).

Value of data: Sexual and reproductive health and rights in crisis settings

Summary_Rajat Khosla presentation_IDMHR_11.4.17The World Health Organization (WHO) says it is crucial for women to have access to quality health care throughout their pregnancy, childbirth and postpartum period and overall life course at any time and in any place, including humanitarian and crisis settings. Enabling environments that are rights-based, equitable and legally protective can help ensure quality health care is available to women and girls.

Last month, Rajat Khosla, a trained lawyer and Human Rights Adviser in Sexual and Reproductive Health and Rights (SRHR) at the WHO, gave a compelling presentation about sexual and reproductive health, and the value of maternal death surveillance and response (MDSR) data and systems in crisis settings, at a seminar we co-organised at the London School of Hygiene and Tropical Medicine (LSHTM). Watch the live recording here. Continue reading

Report on perinatal deaths in South Africa

In late 2016, two reports reflecting perinatal population statistics were released in South Africa: April newsletter_Evidence summary_image 1Perinatal Deaths in South Africa, 2014, which is
the second annual report by Statistics South Africa (the government department mandated to produce statistical information) and the fifth Rapid Mortality Surveillance Report, 2015 by the Burden of Disease Research Unit of the South African Medical Research Council. These reports provide the most recent national picture of the trends and causes of death of the perinatal population.

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 the most recent data for the period 2012 to 2014 and will summarise the findings of the Perinatal Deaths in South Africa, 2014 report. Continue reading

Seminar 1: Innovations to improve maternal and newborn death surveillance to respond to future Ebola outbreaks

Event information

Date and Time: Tuesday 17 January 2017, 5:30 pm – 7:00 pm

Location: John Snow Lecture Theatre, LSHTM, Keppel Street, London, WC1E 7HT, UK

seminar-1-photoRecently, the Ebola outbreak in West Africa hit the poorest hardest. The three countries most affected by the crisis were amongst the top 11 countries in Africa with the highest maternal mortality (click here to see data).

In Sierra Leone, which holds the highest maternal mortality in the world, systems to count and investigate maternal deaths were hampered.

This seminar will explore:

  • limited data availability affecting operations in maternal and newborn health through a donor lens;
  • an innovative method to quantify the indirect mortality effects of the crisis; and the
  • changing landscape of maternal health response, including implications for maternal death surveillance and response and how will we react in the future.

Speakers:

Moderator: Dr Sara L Nam, Global MDSR Action Network – Evidence for Action, Options

Admission and registration: It is free to attend this seminar, but registration is required. Registration is now closed.

To learn more about the seminar series, Innovations in Maternal and Perinatal Health in Humanitarian Settings: Exploring Evidence and Innovations to Improve Maternal and Newborn Survival among Populations Affected by Humanitarian Crises, click here.

Email: mdsr@evidence4action.net

Twitter: @E4AMamaYeAfrica #MDSR

The seminar will be filmed. The recording will be available on this page after the event.


Please watch this space for updates on Seminar 1.

Click here to read a blog on the seminar, click here.

Click on the links below to read and download:

  • A presentation by Dr Chris Lewis about the UK Government’s response to Ebola in Sierra Leone and what opportunities there are to strengthen resilience of the health system, available here.
  • A method to estimate maternal and newborn mortality during a crisis, as presented by Laura Sochas, click here.
  • A presentation by Dr Benjamin Black on how MSF’s maternal health programme adapted to respond to Ebola and his reflections on MDSRs, available here.

Read more about the seminar series here.

Find out more about the second seminar: Applying maternal death surveillance and response in crisis settings here.

Seminar 2: Applying maternal death surveillance and response in crisis settings

Watch the live recording of the seminar here!

Read our blog on the event, Using Data to Prevent Maternal Deaths in Crisis Settings.

Event information

Date and Time: Thursday 23rd March 2017, 5:30 pm – 7:00 pm, followed by refreshments

Location: John Snow Lecture Theatre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK

LSHTM & MDSR AN Seminar 2_event advert_imageOverview:

Mothers and their babies face greater risks to their survival during humanitarian crises. However, there is a dearth of evidence about how best to apply reproductive health interventions effectively in crisis settings. Understanding why women and their babies die in these specific circumstances is pivotal to designing appropriate interventions to prevent deaths from similar causes.

This seminar will explore tools and approaches to maternal death surveillance and response (MDSR) in crisis settings with presentations on the following:

  • Value of MDSR data and systems in crisis settings, and in contributing to achieving  sexual and reproductive health rights
  • Approaches to measuring maternal mortality in refugee settings and responding to findings
  • Participatory ethnographic evaluation research (PEER) as a tool to triangulate MDSR findings in crisis settings

Speakers:

  • Rajat Khosla, Human Rights Adviser – Sexual and Reproductive Health and Rights, World Health Organization, Geneva
  • Nadine Cornier, Humanitarian Adviser – Reproductive Health & Head of Office, UNFPA, Turkey
  • Eleanor Brown, Technical Specialist – Options, London

Moderator: Sarah Moxon, Research Fellow, the March Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM

This event is a collaboration between the Health in Humanitarian Crises Centre, the Global MDSR Action Network and the MARCH Centre for Maternal, Adolescent, Reproductive and Child Health

Admission and registration: It is free to attend this seminar, but registration is required. Registration is now closed.

To learn more about the seminar series, Innovations in Maternal and Perinatal Health in Humanitarian Settings: Exploring Evidence and Innovations to Improve Maternal and Newborn Survival among Populations Affected by Humanitarian Crises, click here.

Email: mdsr@evidence4action.net

Twitter: @E4AMamaYeAfrica #MDSR

The live stream recording is available here.

Watch this space for additional recordings of the event and access to supplementary materials.


Read more about the seminar series here.

Find out more about the first seminar of the series: Innovations to improve maternal and newborn death surveillance to respond to future Ebola outbreaks here.

How legal and policy frameworks support MDSR in Jamaica

Image_map of JamaicaProfessor Affette McCaw-Binns, a Reproductive Health Epidemiologist at the University of the West Indies (Mona) and Dr Simone Spence, Director of Family Health Services at the Ministry of Health in Jamaica explain how legislation and policy strengthened the reporting of maternal deaths in Jamaica. This case study describes how the policy framework was amended to improve the reporting of maternal deaths and how other interventions implemented simultaneously together strengthen the maternal death surveillance and response (MDSR) system. Continue reading

Feedback from Evidence for Action about ESOG and AFOG conferences

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Evidence for Action (E4A) Ethiopia were honoured to take part in the Second Annual Conference of the African Federation of Obstetrics and Gynaecology (AFOG), and 25th Annual Conference and Silver Jubilee Celebration of the Ethiopian Society of Obstetricians and Gynaecologists (ESOG) on 2-4 February, 2017 in Addis Ababa, Ethiopia.

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They were joined by Dr Tunde Segun, the E4A Country Director in Nigeria. Collectively, the E4A team provided support to a satellite session, gave five presentations and hosted a booth on behalf of the MDSR Action network. We share some reflections on the event here.

The conference was attended by around 400 participants from across Africa and included representatives from Ministries of Health, United Nations partners and non-governmental organisations. Continue reading

Nigeria | MPDSR scorecard from Lagos State

In Nigeria, the Evidence for Action (E4A)-MamaYe programme has continued to provide extensive support to the iImage_Cover of scorecardmplementation of maternal and perinatal death surveillance and response (MPDSR) at sub-national levels from October to December 2016.

The programme assisted the Lagos State MPDSR Committee and the Lagos State Accountability Mechanism for maternal, newborn and child health (LASAM) to develop the State-level Facility MPDSR Scorecard. Data from May to July, 2016 from 17 general hospitals with MNCH services were submitted and presented in the scorecard (see excerpt, below). Continue reading

State-level updates in northern Nigeria

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), 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. Here are some examples: Continue reading