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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

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

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.

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

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

The power of communities: strengthening maternal death reporting…and much more!

  • Doubling the number of maternal deaths identified.
  • Accurate and cost-efficient method of measuring the maternal mortality ratio.
  • Strengthened relationships and trust between health facilities and communities they serve.
  • Community actions to prevent future deaths: establishing mobile antenatal care clinics, arranging community meetings to explore traditional beliefs and mobilising funds for bicycle ambulances.

9931220574_d3c293d629_cThese are some of the key results from a community-linked maternal death review (CLMDR) pilot that ran from 2011-2012 in Mchinji district, Malawi.  Presented by Dr Tim Colbourn, Lecturer in Global Health Epidemiology and Evaluation at the University College London (UCL) Institute for Global Heath, the results of the study show the importance of involving communities in the process of identifying maternal death and acting on the recommendations of maternal death review and surveillance (MDSR) systems. Continue reading