Tag Archives: WHO

The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM

This is the first publication to help countries strengthen their data on maternal and neonatal deaths, and stillbirths that the WHO launched in August, 2016. This report presents a standardised system that enables the accurate capture and categorisation of stillbirths and neonatal deaths around the world. The ICD-PM is meant to guide those assisting healthcare providers and those tasked with death certification to accurately classify perinatal deaths.

Three distinct features of the ICD-PM are worth noting:

  • It captures the time of the perinatal death – either before, during or seven days after labour
  • It applies a multi-faceted approach to categorising the cause of death
  • It links a perinatal death to the mother’s condition (e.g. diabetes or hypertension), even if there is no condition to report. This feature aligns with the recommendation of the Every Newborn Action Plan to capture maternal complications with the registration of a perinatal death

The report includes tools and classification codes to facilitate consistent reporting. This is the first time that all stillbirths, and neonatal and maternal deaths can be consistently classified across all low-, middle- and high-income settings.

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Making Every Baby Count: Audit and review of stillbirths and neonatal deaths

This second publication – launched by the WHO in August, 2016 – aims to help countries improve their data on maternal and neonatal deaths, and stillbirths. This document provides guidance on the review and investigation of perinatal deaths to recommend and put into action solutions to avoid future cases of similar causes. The guide and tools have been developed to be used at multiple levels of a health system from a few individuals at a health facility to a national programme. The tools offer a simpler version of the WHO application of ICD-10 (ICD-10) to deaths during the perinatal period (ICD-PM) to be used in low-resource settings to help initiate and build up audit (or review) systems.

Moreover, the guide integrates elements of the ICD-PM classification system to carry out an in-depth review of the causes and factors leading to all stillbirths and neonatal deaths.

The structure of the guide provides an overview of the key components to develop an audit system by:

  • justifying the purpose of the guide and development of an audit system
  • discussing the issues around defining and categorising causes of death, and providing examples of differing systems to classify preventable causes of deaths and near misses
  • defining six necessary approaches to set up and complete an audit cycle at the facility level
  • describing how to integrate community deaths into an established facility-based audit system
  • promoting a supportive atmosphere for the success of an audit system and giving advice on how to create an enabling environment
  • providing guidance on how to extend an audit system to a regional or national level as well as strengthening links to civil registration and community surveillance systems

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Time to Respond: a report on the global implementation of maternal death surveillance and response

This is the third publication that the WHO launched in August 2016 to help countries improve their data on maternal and neonatal deaths, and stillbirths. This document presents the findings of a global survey conducted by the WHO and UNFPA to determine the status of MDSR implementation in countries where there is a national system.

The report helps countries improve their review process for maternal deaths at the facility level (hospitals and clinics). It also gives guidance for developing a safe environment (free of blame) for healthcare providers to improve the quality of care at facilities. Lastly, it offers an approach to capture deaths taking place beyond the health system (e.g. home births).

The document presents implementation and case study insights, which include identifying barriers to successful systems. The next global survey will take place in 2017 and will be repeated every two years.

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Developments in PNDSR in South Africa

Scale of the problem

In South Africa, perinatal deaths are defined as all stillbirths and early neonatal deaths (from live birth to seven full days after birth). While the country has accepted the definition* of reporting and recording all deaths (foetal and neonatal) weighing more than 500 grams, it is uncertain if all hospitals where deliveries take place are correctly reporting all deaths weighing less than 1000 grams, especially stillbirths. This may be influenced by a South African law that requires all defined stillbirths to have a burial and notification of death. In rural areas and busy hospitals, this may be seen as labour intensive for already overworked staff. Continue reading


Global experience with Maternal Death Surveillance and Response: building for the long-term

This briefing note written by Evidence for Action Ethiopia provides a review of the global experience of MDSR at April 2016. It covers the history and current state of national MDSR systems and provides six lessons learnt from countries’ experiences.

To read the briefing, click here.


MDSR in Ethiopia: three years on

E4A has been providing technical assistance for the introduction, implementation and scale-up of Ethiopia’s national Maternal Death Surveillance & Response (MDSR) system since 2012.

At national level, this has involved contributing to the development of the MDSR Guidance, data collection tools and database, and training curriculum, participating as active members of the MDSR task force, and representing the programme internationally.

The Ethiopia E4A team is based in the MNCH department of the WHO Ethiopia country office. In addition to a Programme Director, E4A is supported by five regional Technical Advisors who have been supporting the four large agrarian regions (Amhara, Oromiya, SNNPR and Tigray) as well as Harari, Dire Dawa and Addis Ababa, and a Data Manager working in the EPHI Public Health Emergency Management (PHEM) directorate. The University of Aberdeen’s Immpact programme and Options serve as the E4A Technical Support Unit, providing strategic guidance and 2 advisors based in Ethiopia.

Read our two page summary of our experiences here>

Read our training materials and guidelines here>

Sierra Leone: Introducing Maternal Death Surveillance and Response

The Ministry of Health and Sanitation (MoHS) have developed national MDSR guidelines (see here) in partnership with UNFPA, the World Bank, and the WHO. The Directorate of Reproductive and Child Health are now leading on the national roll-out of these guidelines. Also, the MoHS, in partnership with UNFPA and other health development partners, has developed a three year costed plan to be implemented over the next three years.

In February 2016, the national MDSR committee was inaugurated and an orientation meeting took place in the same month.  This month, an orientation meeting is planned for all MDSR focal point persons, including midwife investigators and other key staff from the districts. All districts will shortly have inaugural meetings for their MDSR committees (building on existing MDR committees).

Update from Bockarie Sesay, Monitoring & Evaluation Advisor for the Partnership Management, Evaluation and Learning (PMEL) programme, and Rosanna le Voir, Technical Assistant for PMEL

Trends in Maternal Mortality: 1990 to 2013

The recent report on MMR estimates for 2013 that was released by the UN agencies – Trends in Maternal Mortality: 1990 to 2013 – shows a 45% decline in global maternal deaths between 1990 and 2013. The burden and risk of maternal death remains the highest in sub-Saharan Africa and South Asia with these regions accounting for 62% and 24% of the deaths, respectively. Whilst absolute numbers show that India and Nigeria account for one third of all global maternal deaths, country level MMR estimates show that Sierra Leone records the highest (1100), and Chad and Somalia have the highest lifetime risk of maternal death. Giving birth is becoming safer, but not yet at the rate at which it should to meet the MDG targets in several countries. Continue reading

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

Latest WHO technical guidance on MDSR

This key document published in October 2013 provides practical guidance to move from maternal death reviews to surveillance and response, emphasising the response component as well as focusing on quality of care improvements.

This key document introduces the critical concepts of MDSR, including goals, objectives, and specific instructions for implementing each surveillance component, as well as outlining how districts can set up MDSR processes to strengthen surveillance and response.

These guidelines have been developed by the MDSR Working Group which includes UN agencies, academics and professional organizations and other partners. It builds on the 2004 WHO publication “Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer” and previous work done in this area by WHO and other partners.

Health-care professionals, health care planners and managers, policy makers working in maternal health, and those who measure maternal mortality will find these guidelines useful as they set up, implement and strengthen MDSR systems in their own settings.

To download the guidance for free, click here!