scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of Maternal Deaths Narrative Summaries and Action Points from Death Reviews

2020 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Medical Records ◽  
Causes Of Death ◽  
Demographic Characteristics ◽  
Standards Of Care ◽  
Action Plans ◽  
Maternal Deaths ◽  
Sequence Of Events ◽  
Surveillance And Response ◽  
Community Facility

Abstract BackgroundReview of maternal deaths relies on comprehensive documentation of medical records that can reveal sequence of events that led to death. Maternal Death and Surveillance (MDSR) system recommends the use of narrative summaries during maternal death reviews to discuss the case and categorize medical causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and planning recommendations, comprehensiveness of written narrative summaries and adequacy of action plans according the MDSR guideline were assessed. MethodsA total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. We assessed the comprehensiveness of narrative summaries and action plans using a prepared checklist from MDSR guideline of 2015. Presence or absence of items in four domains each with several attributes was recorded on the checklist. The domains were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while >94% was good/comprehensive. Action plans were assessed by application of SMART criteria and according to place of planned implementation (community, facility or higher level of health system). Results Two-thirds of summaries (66%) scored poor, and none were scored as good/comprehensive. Summaries missed key information such as demographic characteristics, information of events that occurred in community (16%), time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action plans were analysed. Most action plans 242(85%) were allocated to health facilities for implementation and they were mostly 42(42%) on service delivery. Only 42% (32/76) of the action plans were deemed to be SMART.ConclusionsAbstraction of information to prepare narrative summaries used in MDSR system is inadequately done. Action plans and recommendations in MDSR system are mostly for facility sub standards of care and are not specific on the issues to be addressed.

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2020 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths in Tanzania and other low and middle income countries occur both in and outside health facilities. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. We assessed the comprehensiveness of summaries and action plans using a prepared checklist from Tanzania MDSR guideline of 2015. Presence or absence of items in four domains each with several attributes was recorded. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above was good/comprehensive. Action plans were assessed by application of SMART criteria and according to place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only 1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points 242(85%) recommended strategies to be implemented at health facilities and they were mostly 42(42%) on service delivery. Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in MDSR system is inadequately done. Action plans in MDSR system are mostly recommended to sub standard care in health facilities but are not specific on the issues to be addressed.

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2020 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. Using a prepared checklist from Tanzania 2015 MDSR guideline, we assessed comprehensiveness by presence or absence of items in four domains, each with several attributes. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above were good/comprehensive. Action plans were assessed by application of SMART criteria and according to the place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points, 242(85%), recommended strategies to be implemented at health facilities and were mostly about service delivery, 120(42%). Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in the MDSR system is inadequately done. Most recommendations were unspecific with a focus on improving quality of care in health facilities

scholarly journals Maternal Death Surveillance and Response in Tanzania: Comprehensiveness of narrative summaries and action points from maternal death reviews

2021 ◽  
Author(s):  
Ali Said ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Mats Malqvist
Keyword(s):  
Maternal Death ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
World Health ◽  
Action Plans ◽  
Maternal Deaths ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sequence Of Events ◽  
Surveillance And Response

Abstract Background Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. Using a prepared checklist from Tanzania 2015 MDSR guideline, we assessed comprehensiveness by presence or absence of items in four domains, each with several attributes. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above were good/comprehensive. Action plans were assessed by application of SMART criteria and according to the place of planned implementation (community, facility or higher level of health system).Results Almost half of narrative summaries (49%) scored poor, and only1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points, 242(85%), recommended strategies to be implemented at health facilities and were mostly about service delivery, 120(42%). Only 42% (32/76) of the action points were deemed to be SMART.Conclusions Abstraction of information to prepare narrative summaries used in the MDSR system is inadequately done. Most recommendations were unspecific with a focus on improving quality of care in health facilities

scholarly journals Causes of maternal deaths and delays in care: Comparison between routine Maternal Death Surveillance and Response system and an obstetrician expert panel in Tanzania

2020 ◽  
Author(s):  
Ali Said ◽  
Mats Malqvist ◽  
Andrea B. Pembe ◽  
Siriel Massawe ◽  
Claudia Hanson
Keyword(s):  
Maternal Death ◽  
Causes Of Death ◽  
Expert Panel ◽  
World Health ◽  
Cross Sectional ◽  
Maternal Deaths ◽  
Surveillance And Response ◽  
Independent Expert ◽  
Underlying Causes ◽  
Three Phases

Abstract Background To reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA). Methods Our cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM).They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen`s K statistic to compare causes of deaths and delays categorization.Results Comparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80(80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74(67.9%), phase two in 24(22.0%) and phase three delays in all 101(100%) deaths that were assessed for this delay while MDSR system identified delays in 42(50.0%), 10(11.9%) and 78(92.9%).The expert panel found human errors in management in 94(93.1%) while MDSR system reported in 53(67.9%) deaths.Conclusions MDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths.

scholarly journals From Passive Surveillance to Response: Suriname's Steady Efforts to Implement Maternal Death Surveillance and Response (MDSR)

2020 ◽  
Author(s):  
Lachmi R. Kodan ◽  
Kim J.C. Verschueren ◽  
Geertje E. Boerstra ◽  
Inder Gajadien ◽  
Robert S. Mohamed ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Maternal Death ◽  
Maternal Mortality Ratio ◽  
Lessons Learned ◽  
Local Health ◽  
Care Providers ◽  
Maternal Deaths ◽  
Surveillance And Response ◽  
Shame Culture ◽  
Maternal Death Review

Abstract Background Maternal death surveillance and response (MDSR) is essential in preventing avoidable maternal deaths. The cycle starts by accurately capturing maternal deaths with a surveillance system, followed by an audit to give insight into the underlying causes and "lessons learned." Subsequently, recommendations are formulated and targeted multisectoral responses such as quality of care improvement strategies, including clinical guidelines update, health promotion interventions, research to fulfill knowledge gaps, enabling policies and legislation and interventions addressing social determinants. Finally, continuous evaluation and monitoring close the MDSR cycle. We aim to describe the MDSR implementation process in Suriname to share valuable lessons with other countries.Methods We provide an overview of the evolvement from improved maternal death surveillance, toward review, response, and monitoring to fulfill the MDSR cycle in Suriname. Findings Middle-income country Suriname called for many years for improved surveillance and review, and in 2000 the first action was commenced by extension of maternal death case capturing from death certificates to active hospital surveillance. Consequently, the maternal mortality ratio increased in the following years. However, not the full MDSR cycle was completed in 2015, and local health care providers initiated the next step of the MDSR cycle with the installation of a national maternal death review committee (MaMS). Since then, the committee reviews each maternal death applying the "no blame, no shame" culture, formulates, and disseminates recommendations. Collaboration with the Ministry of Health (MOH), Bureau of Public Health (BOG), and the Pan American Health Organization (PAHO) should ensure progress to the sustainable implementation of MDSR. Committee MaMS demonstrates that maternal death review and recommended high impact interventions can only be effectively implemented and sustained, through strong professional and government commitment and practical, solution-oriented responses. Conclusions Crucial elements for a successful MDSR implementation are Commitment, "no blame, no shame" Culture, Coordination, Collaboration, and Communication (5 C's).We hope that describing this process toward successful nationwide MDSR implementation, with its facilitators and barriers, is helpful for other countries with similar ambitions.

scholarly journals Temporal Evolution of Maternal Mortality: 1980-2019

2021 ◽  
Vol 43 (09) ◽  
pp. 662-668
Author(s):  
Janete Vettorazzi ◽  
Edimárlei Gonsales Valério ◽  
Maria Alexandrina Zanatta ◽  
Mariana Hollmann Scheffler ◽  
Sergio Hofmeister de Almeida Martins Costa ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Medical Records ◽  
Causes Of Death ◽  
Maternal Mortality Ratio ◽  
Liver Steatosis ◽  
Reproductive Age ◽  
Porto Alegre ◽  
Maternal Deaths ◽  
Live Births ◽  
Mortality Ratio

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

scholarly journals Maternal Mortality: A Review from Eastern Nepal

2014 ◽  
Vol 9 (1) ◽  
pp. 33-36 ◽  
Author(s):  
P Rijal ◽  
A Agrawal ◽  
H Pokharel ◽  
T Pradhan ◽  
MC Regmi
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Causes Of Death ◽  
University Teaching ◽  
Unsafe Abortion ◽  
Rural Residence ◽  
Maternal Deaths ◽  
Case Record ◽  
Puerperal Sepsis ◽  
Significant Factors

Aims: This study was done to assess the main causes of maternal mortality and other co-morbid factors contributing to maternal death at a university teaching hospital. Methods: A retrospective study was carried out in the department of Obstetrics and Gynecology analyzing all case record of maternal deaths from April 2008 to April 2011. Results: Eclampsia, unsafe abortion, puerperal sepsis, hemorrhages were the leading causes of death. Majority of the patients were unbooked. Conclusions: Eclampsia, sepsis and hemorrhage were the main causes of maternal deaths. Elderly ages, illiterate status, rural residence, presence of prior medical disease were statistically significant factors contributing to maternal death. DOI: http://dx.doi.org/10.3126/njog.v9i1.11185 NJOG 2014 Jan-Jun; 2(1):33-36

scholarly journals Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania

2021 ◽  
Vol 6 (5) ◽  
pp. e005040
Author(s):  
Ali Said ◽  
Nathanael Sirili ◽  
Siriel Massawe ◽  
Andrea B Pembe ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Maternal Death ◽  
Health Providers ◽  
Quality Improvements ◽  
Group Discussions ◽  
Maternal Deaths ◽  
Surveillance And Response ◽  
Key Informant ◽  
Analyse Data ◽  
Inductive Thematic Analysis

BackgroundSince 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system.MethodsAn exploratory qualitative study was carried out with 30 purposively selected health providers and 30 health managers in four councils from the Mtwara region between June and July 2020. Key informant interviews and focus group discussions were used to collect data. Inductive thematic analysis was used to analyse data.ResultsTwo main themes emerged from this study: ‘Accomplishing by ambitions’ and ‘A flawed system’. The themes suggest that health providers and managers have a strong desire to make the MDSR system work by making deliberate efforts to implement it. They reported working hard to timely notify, review death and implement action plans from meetings. Health providers and managers reported that MDSR has produced changes in care provision such as behavioural changes towards maternal care, increased accountability and policy changes. The system was however flawed by lack of training, organisational problems, poor coordination with other reporting and quality improvements systems, assigning blame and lack of motivation.ConclusionThe implementation of the MDSR system in Tanzania faces systemic, contextual and individual challenges. However, our results indicate that health providers and managers are willing and committed to improve service delivery to avoid maternal deaths. Empowering health providers and managers by training and addressing the flaws will improve the system and quality of care.

scholarly journals Community Perceptions and Experiences on the Events Leading to Facility Maternal Death; A Verbal Autopsy Qualitative Study

2021 ◽  
Author(s):  
Ali Said ◽  
Mats Malqvist ◽  
Siriel Massawe ◽  
Claudia Hanson ◽  
Andrea B Pembe
Keyword(s):  
Maternal Death ◽  
Community Involvement ◽  
Verbal Autopsy ◽  
Family Members ◽  
Economic Consequences ◽  
Birth Preparedness ◽  
Care Seeking ◽  
Maternal Deaths ◽  
Surveillance And Response ◽  
The Family

Abstract BackgroundTanzania Maternal Death Surveillance and Response (MDSR) system introduced in 2015 emphasizes review of facility maternal deaths with little community involvement. Involving the community in deaths enquiry can help to make better strategies to prevent future deaths. We aimed to explore family members (caregivers) perceptions and experiences on the events leading to facility maternal deaths to inform future community involvement in MDSRMethodsNarrative interviews were conducted with 20 caregivers who cared for women who died in childbirth to investigate into delays and health care seeking experience. The unstructured questions on perceptions and experiences of events leading to death were administered together with standard verbal autopsy questionnaire. Two regions, Lindi and Mtwara of Southern Tanzania were selected for the study in 2018. Narrative thematic analysis was used for data analysis.ResultsThree main themes evolved: ‘Prepared for birth but not ready for complications’, ‘Disconnect between caregivers and providers’ and ‘The bitter impact of maternal deaths’. Caregivers made efforts to prepare for birth but their preparation were severely inadequate when complications that necessitated referral occurred. Decision to seek care was made jointly between the pregnant woman, husband and other family members. Caregivers tried with little success in communicating with heath providers regarding their admitted patients. They also experienced emotions of grief such as denial, anger, depression, bargaining and acceptance once maternal deaths occurred. Caregivers (mostly old women) were left with the burden of caring for the newborns and other children left by the deceased mother. ConclusionCaregivers` perceptions and experiences of maternal deaths events provide valuable information for community interventions on birth preparedness, decision making, communication and providers` accountability. Maternal deaths bring far reaching mental, social and economic consequences to the family and society

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