Maternal Deaths & Maternal Death Surveillance and Response (MDSR): Definitions, the National Guidelines and Action Plan

Midwife in Sudan. UNFPA www.evidence4action.net/wp-content/uploads/2011/09/en_SOWMR_ExecSum.pdf

Learning objectivesBy the end of this session, participants will be able to:

• Define and classify maternal deaths• Describe global patterns of maternal

mortality• Describe the structure of the Ethiopian

MDSR• Identify the review committees and their

composition at each level• Explain how data will flow through the

system

Definitions (1)

A Maternal death is the death of a woman while pregnant or within 42 days of the end of

pregnancy (irrespective of duration and site of pregnancy)

from any cause related to or aggravated by the pregnancy or its management

but not from accidental or incidental causes

(Source: ICD-10)

Definitions (2)

• Direct obstetric deaths are maternal deaths resulting from complications in pregnancy, labour or postpartum or from omissions or incorrect treatment.

• Indirect obstetric deaths are maternal deaths resulting

from previously existing or newly developed medical conditions aggravated by the physiologic effects of pregnancy.

• Late maternal deaths are deaths from direct or

indirect causes that occur from 42 to 365 days after the end of pregnancy (Source: ICD-10)

Definitions (3)

A Pregnancy related death is all deaths of women during or within 42 days of the end of pregnancy regardless of cause.

Useful in settings where it is difficult to determine cause, and in many low resource contexts, the cause of death is highly likely to be related to pregnancy

Definitions (4)A maternal near-miss is defined as “a woman who nearly died but survived a complication during pregnancy, childbirth or within 42 days of end of the pregnancy”

“Near misses” occur when women survive life-threatening conditions (i.e. organ dysfunction)

Use of Near Misses provides a positive approach (analysing survivals rather than deaths)

Appropriate for review when there are too few deaths to support regular review meetings

Review of ClassificationsDirect Causes (75%)

Obstetric causes during pregnancy, childbirth and the post-partum period, such as:

• Haemorrhage• Hypertensive

disorders• Infection• Obstructed labour• Abortion

Indirect Causes (25%)Medical conditions that can be aggravated through pregnancy, such as:• HIV (including TB

and pneumonia)• Malaria• Anaemia• Heart conditions

Social, cultural & environmental factors across a woman’s life course affect risk for direct & indirect causes of death

Purpose of the MDSR Guidelines

To provide guidance for the set-up and sustained functioning of Ethiopia’s MDSR for:ohealth professionalsohealth care planners and managersopolicy makers who take action based on

MDSR findings To ensure use of emerging information in

improving maternal health outcomes

Goal and Objectives of Guidelines

Goal:

To guide effective implementation and scale up of MDSR in a systematic, standardized and integrated manner

Objectiveso Strengthen capacity of program managers & providers in

analysis & interpretation of maternal death data

o Facilitate standardization & harmonization of the MDSR process at community, facility, district & regional levels

o Guide program managers in timely implementation, monitoring and supervision of MDSR at different levels

o Serve as a basic tool to guide service providers in MDSR

o Improve use of information to produce local solutions to the root causes of maternal death

Committee StructureNational Task Force

RHB Review Committee

Zonal Level Reporting

Woreda Level Reporting

Health Centre Committee:Reviews Verbal Autopsies for

community & HC deaths

Hospital Committee:Reviews deaths occurring

within the premises

Referral Hospitals

Committee MembershipChair, MSD, HPDP, FMHACA, HRNI,

Midwives Assoc., Anaethetists, ESOG, H4, partners

Zonal Level Reporting

Woreda Level Reporting

HC Director, HEW Supervisor, Midwives, Nurses, 2 Comm reps, Pharmacists, Woreda MNH Lead

OB/GYN, IESO, Snr. Midwives, Anaethetists, CEO, Med Dir, Quality of

Care Lead

RHB Deputy Head, MNH focal person, Senior Midwife, ESOG,

Partner representative

OB/GYN, IESO, Snr. Midwives, Anaethetists, CEO, Med Dir,

Quality of Care Lead

Culture of no blameThe man in the boat needs help managing his appetite, a reminder of good nutrition, and assistance to stop sinking, but NOT a lecture on his poor eating habits!• Healthcare providers are vulnerable to self

blame, which does not improve care• Support and training are better solutions

for preventing future deaths• “No blame” is NOT “no accountability”

National MDSR Action Plan• May: National training & dissemination of

guidelines• June – September : Regional Committees

established• June - September: Phase I implementation

(committees established at Facilities & Health Centres, with woreda support)

• September : Orientation for Health Facilities, Health Centres and HEW

• October ‘13 – March ‘14: Phase II• April – September ‘14: Phase III• Monthly monitoring throughout