The national Maternal Death Surveillance and Response (MDSR) system was established in Sierra Leone in 2015. The objective of the MDSR system is to count and review maternal deaths, in order to identify causes and contributing factors, and to inform interventions to prevent future deaths.
This first national MDSR report highlights progress towards institutionalisation of MDSR; presents an overview of maternal deaths from January to December 2016; and includes recommendations for improving MDSR implementation and to address the main causes of maternal deaths.
MDSR structures and systems
National and District MDSR committees were established in each district, although only a few were trained. Every district, except one (Western Rural, where the MDSR committee was formed later) have a functional MDSR Committee, and although inconsistent, MDSR meetings were happening in every district. Progress was reported in setting up facility MDSR committees in district hospitals, with community health centres expected to follow. The national MDSR committee was revitalised, and MDSR was embedded in the regular EmONC/MDSR technical working groups.
The Ministry of Health and Sanitation (MOHS) designated maternal death as a notifiable event, to be reported through the weekly surveillance system. Despite this, reporting was low, due to reluctance to report maternal deaths at both community and health centre level, and limited verification of deaths among women of child-bearing age to rule out maternal deaths.
Integration of the MDSR system with the Civil Registration and Vital Statistics and the “call 117” system to report maternal deaths needs strengthening at national and district level, as does coordination between District-level and District Hospital MDSR Committees. Response to findings and recommendations of MDSR committees at national and district level was also among the identified challenges.
Maternal deaths analysis
Between January and December 2016, a total of 706 maternal deaths were reported and 663 (94%) were reviewed by district MDSR committees, a 56% improvement in reporting from 2015. However, this represents only 20-29% of the expected number of deaths signalling the need to further improve maternal death reporting.
Most of the reported maternal deaths were from facilities (80%), while 13.5% occurred in the community, and 5.6% of deaths in transit. The report states that this reflects the challenge of maternal death underreporting at community level.
The main direct causes of maternal deaths were postpartum haemorrhage (33%), pregnancy induced hypertension (16%) and sepsis (11%). The main indirect causes of death were mainly anaemia and malaria in pregnancy.
Quality of care factors were identified as having contributed to maternal deaths in 67% of cases, combined with delays in seeking and accessing care.
Image: Causes of maternal deaths; Source: Sierra Leone MDSR Annual Report 2016
The report offers several recommendations to improve the MDSR system, including:
- enhancing community mobilisation to improve community reporting of maternal deaths;
- removing bylaws or conditions that hinder the system;
- improving the quality of MDSR investigations through training and capacity building of MDSR committees; and
- strengthening institutional coordination.
In relation to preventing maternal deaths, key recommendations include:
- improving quality of care during pregnancy and childbirth;
- enhancing access to blood transfusions; and
- strengthening targeted feedback and dissemination of MDSR findings to relevant stakeholders.
Click here to freely access the full report in the UNFPA website.
Click here to read a blog about the release.
Reference: Directorate of Reproductive & Child Health, Ministry of Health and Sanitation [Sierra Leone]. (2017). Maternal Death Surveillance and Response: Annual Report 2016. Freetown: MoHS.