This is the first national report on data from Ethiopia’s Maternal Death Surveillance and Response (MDSR) system. The report includes data from 387 maternal deaths between 2006 and 2007 Ethiopian Financial Year (2013-15). It is intended to be used to guide Ethiopia’s efforts to reduce maternal mortality.
The national Maternal Death Surveillance and Response (MDSR) system was established in 2006 Ethiopian Financial Year (EFY) (2013-14) and formally integrated into the Public Health Emergency Management (PHEM) data collection systems in 2007 EFY (2014-15). The objective of the MDSR system is to document, count and review maternal deaths in order to identify causes and contributing factors, and to put in place interventions to prevent future deaths.
In the Ethiopian MDSR system, community-based and facility-based maternal deaths are noted in weekly reports. Community-based deaths are then investigated further through a Verbal Autopsy (an interview with someone close to the woman to establish the circumstances and symptoms leading up to her death) and reviewed at health centre level by a committee. Maternal deaths in facilities are also investigated then reviewed by a team. During each review, a case-based Maternal Death Reporting Form is completed, summarising key information from the Verbal Autopsy or facility review and noting the woman’s cause of death.
This report represents the first time MDSR data has been compiled at national level. It covers 387 anonymised deaths occurring during a 20 month period across 2006 and 2007 EFY (2013-15). The data come from five regions (Amhara, Oromiya, Tigray, SNNP and Harari) and two city administrations (Addis Ababa and Dire Dawa). It presents a summary of progress in implementing the MDSR system, the results of the data analysis, and recommendations for preventing future maternal deaths.
The integration of the MDSR into the PHEM system is a good example of collaboration within the health system
Early lessons from the MDSR experience in Ethiopia show that the information gained from the MDSR system gives communities and health workers real information about maternal death and encourages focused change to improve maternity services
Over half of the reviewed deaths occurred in health facilities (54%) while 25% died at home and 19% on the way to a facility. This reflects both the fact that data collection on maternal deaths is easier in facilities, and also the fact that women are more likely to be taken to a facility after becoming critically ill at home
69% of deaths occurred to women with no education
60% of deaths occurred after labour/delivery, while 20% occurred prior to labour/delivery and 15% occurred during labour/delivery period.
83% of deaths were caused by direct obstetric causes, 15% were indirect causes and 2% were unknown
Haemorrhage (excessive bleeding) was the major cause of death (accounting for 58% of the causes listed), accounting for about half of maternal deaths, followed by other causes such as hypertension (high blood pressure) , sepsis (from infections), obstructed labour (when the baby’s head gets stuck during delivery) and anaemia (low levels of iron in the blood, putting women at risk of haemorrhage)
Delay 1 (deciding to seek care) was reported for 66% of maternal deaths, delay 2 (accessing care) was reported for 38% of deaths and delay 3 (receiving care at a facility) was reported for 36% of cases. In around half of cases the death had multiple delays.
Haemorrhage was more common in women who had more than four children – women with more than for children accounted for 46% of haemorrhage deaths
Delays in making the decision to seek care were linked to the majority of haemorrhage deaths
For the MDSR system:
The strengthening and scale up of the MDSR system is needed
The MDSR system needs to be embedded in the PHEM to further improve communication
MDSR support should be integrated with the supportive supervision system for health workers at all levels
Regular performance monitoring of the MDSR system at regional and zonal is required
A regional annual meeting to feedback to communities and facilities and showcase good practice should be planned
MDSR data should be used to inform the community, health workers and decision makers to improve the health status of the population of Ethiopia.
All health facilities should be active participants in the system by setting up an MDSR committee
To address obstetric haemorrhage:
All health facilities should have trained staff and equipment to deal with obstetric haemorrhage
All women should be encouraged to access antenatal care and should be offered iron in pregnancy
Women with more than four children should be offered family planning, particularly long-acting reversible methods (like the implant or intrauterine device) or a permanent method (sterilisation)
Whilst the deaths included in this report represent the tip of the iceberg, it is hoped that the lessons learnt from the loss of these 387 women can help guide Ethiopia’s efforts to reduce maternal mortality.
“This short film highlights the value of Ethiopia’s maternal death surveillance and response – MDSR – system by bringing to life the benefits this can generate for pregnant women and all in our society.
In the Ethiopian Ministry of Health MDSR is one of our flagship programmes. Using the data generated by the MDSR system, we have the power to make evidence-based decisions that improve quality of care and target responses to where they will be most effective in saving lives. We support a no-blame culture necessary for successful MDSR. A no-blame culture is important because we need everybody to feel supported in reporting maternal deaths when they occur whether it is in a facility or at home. Then our teams will review and report into the system on each death.
Most importantly, we are taking action in response to every death – from the community to the national level. This nationwide system has the power to save maternal lives now and for generations to come.”
Prof Yifru Berhan,
Minister of Ministry of Health of Ethiopia
Global Financing Facility (GFF): the Country Powered Investments report supporting Every Woman, Every Child, was launched 20 September. Four new countries – Guatemala, Guinea, Myanmar and Sierra Leone – have also recently become eligible to access GFF funding. For more information about the GFF, visit the website here.
On 18 September, The Lancet launched the 2016 maternal health series in New York City on the opening day of the United Nations’ General Assembly, following a decade since the maternal survival Series was published. The new Series comprises of six papers discussing the diversity and divergence of poor maternal health, the extremes of maternal care (too little, too late and too soon, too much), childbirth care, women centred care in high-income countries, future external factors and health-system innovations, and a call to action to presenting five key targets to ensure that the Sustainable Development Goals are met.