Tag Archives: Post-partum haemorrhage

Nigeria | Updates on MPDSR in Katsina, Yobe and Zamfara

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), maternal death review (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. Following the country update from March 2017, which featured updates from Kaduna, Kano and Jigawa States, here are some further examples from Katsina, Yobe and Zamfara States:

Katsina State

Discussions in the State MDR Committee led to the development of a training in the use of non-pneumatic anti-shock garments for nurses and midwives working at maternity units in ten secondary health centres. Medical Directors, Medical Officers and Maternity personnel in charge of 18 secondary health facilities contributed to this development.

Twenty nurses and midwives were trained in October 2016 on the application of anti-shock garments. Within a month, these training participants trained other maternity staff from the same secondary health facilities to use anti-shock garments. To ensure that the training is cascaded to all general hospitals, the State is mentoring facility-MDR committees on a monthly basis.

Yobe State

A MPDSR Scorecard was developed in collaboration with the State-MPDSR Committee and the Yobe State Accountability Mechanism for MNCH (YoSAMM) with support from the MNCH2 programme. Data from April to December 2016 was collected from ten government general hospitals with MNCH services. The findings are available in box 1.

MNCH2 update_Text box

The State organised a meeting in January 2017 to review the evidence from the MPDSR scorecard. The meeting was chaired by the Honourable Commissioner of Health, Dr Mohammed Bello Kawuwa and attended by the Chief Medical Directors of the ten general hospitals, and other members of the State MPDSR Steering Committee. The key issues discussed during the meeting were:

  • Facility MDR Committees irregularly meet to review maternal deaths and take actions.
    • Proposed recommendation: YoSAMM, with support from the Advocacy sub-committee, is to visit health facilities where reviews of maternal deaths are not regularly conducted as planned. Progress in this area will be discussed at the next YoSAMM quarterly meeting in June 2017.
  • Completion of MPDSR tools not meeting national standards.
    • Proposed recommendation: Health-care providers should receive a refresher training in the completion of MPDSR forms. A training was conducted in February 2017.
  • Pregnant women are reluctant to deliver at a facility.
    • Proposed recommendation: Local government health promotion officers should conduct community mobilisation activities on the importance of antenatal care (ANC) visits and delivery by a skilled birth attendant.

MNCH2_May MDSR newsletter_image 1

Zamfara State

MDR findings from a secondary facility led to the identification of a number of medical equipment and infrastructure features that were lacking. In response to this, the facility MDR committee called on the local government to build an ultrasound centre and provide ultrasound machines. The facility received these provisions in June 2016. Community MPDSR findings led to further action from the local government in the provision of a renovated labour room, a newly built ANC waiting room with a capacity of 250, and ten beds for the maternity ward.

Acknowledgements: This update was prepared based on feedback from:

  • Mohammad Anka – Evidence and Advocacy coordinator, MNCH2 Zamfara state office
  • Garba Haruna Idris – Evidence and Advocacy coordinator,MNCH2 Katsina state office
  • Musa Mohammad- Evidence and Advocacy coordinator, MNCH2 Yobe state office.

National Report EFY 2006-7 (2013-15)

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.

Background

Image_National Report_PostThe 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.

Methods

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.

Key findings

  • 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

Recommendations

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.

Click here to download the report (PDF).