Abstract
Background To reduce high maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization. All health facilities are supposed to identify, notify and review all maternal deaths inorder to recommend quality improvement actions to prevent 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 cause of deaths and care delays with those assigned by an obstetrician expert panel with additional information from Verbal Autopsy (VA). Methods Our cross-sectional study included 109 reported and reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the recorded underlying medical cause of death and reported delays of care from MDSR system records. We interviewed bereaved families using the standard World Health Organization VA questionnaire. The obstetrician expert panel assigned underlying medical cause of deaths 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 and proportional differences to compare causes of deaths and delays in care categorization. Results Ten deaths were excluded in analysis of underlying medical causes and 25 for delays. Expert panel and MDSR system assigned same underlying medical cause for 64.6% of deaths, K statistic 0.60. The agreement increased (80.8%) when causes were assigned by ICD-MM groups, K statistic 0.76. The obstetrician expert panel identified phase one delays in 67.9%, phase two in 22.0% and phase three delays in 100% of the deaths while MDSR system identified delays in 50.0%, 11.9% and 92.9% respectively. The expert panel found human errors in management in 93.1% while MDSR system reported in 67.9% of deaths. Conclusion The MDSR committees performed reasonably well in assigning the underlying cause of deaths. The obstetrician expert panel found more delays to care than what was reported in MDSR system indicating difficulties within MDSR teams to critically review.
Categorization of medical causes of maternal deaths and delays in care: Comparison between routine Maternal Death Surveillance and Response system and an obstetrician expert panel in Tanzania