Expert opinion

tb image_VA expert opinion_MDSR Sept 2017 newsletter

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.

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Perinatal death surveillance and response to improve survival of babies

The mortality audit (or review) process is an established tool to assess the events around a death. Applying an audit cycle can highlight breakdowns from local to national levels and ultimately improve civil registration and vital statistic (CRVS) systems and quality of care. Maternal death surveillance and response (MDSR) is a form of this strategy that has been used by many countries[1].

Less information, however, has been captured and assessed on stillbirths and neonatal deaths[2]. In 2014, 51 priority countries reported having a policy on maternal death notification, and only 17 countries had a policy for reporting and reviewing stillbirths and neonatal deaths[3].

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Expert opinions from around the world: The role of the multi-disciplinary team in MDSR

We asked six experts from Malaysia, Ireland, Ethiopia and India about the importance of multi-disciplinary teams in maternal death surveillance and response (MDSR) systems. Here are the insights they shared with us.

Our contributors have all worked closely with MDSR (or maternal death review also known as MDR, which is a component of MDSR) in various guises, contexts and parts of the world. We have drawn together common themes from their insights to draw out lessons learned for the successful implementation of multi-disciplinary health actor involvement in MDSR.

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Dr Matthews Mathai (WHO) on maternal death surveillance and response

In this video put together by the Health & Education Advice & Resource Team (HEART),  Dr Matthews Mathai from the World Health Organization introduces maternal death surveillance and response. 

Dr Matthews Mathai is Coordinator, Epidemiology, Monitoring and Evaluation & Focal Point, Maternal and Perinatal Health at the Department of Maternal, Newborn, Child & Adolescent Health at the World Health Organization. Continue reading