Community Based Maternal Death Review: Lessons Learned from Ten Districts in Andhra Pradesh, India

Abstract

Maternal death is as much a social phenomenon as a medical event. Maternal death review (MDR), a strategy for monitoring maternal deaths, provides information on medical, social and health system factors that should be addressed to redress gaps in service provision or utilisation. To strengthen MDR implementation in the state of Andhra Pradesh, India. The project involved development of state specific guidelines, technical assistance in operationalization and analysing processes and findings of MDR in ten districts. 284 deaths were recorded over 6 months (April-September 2012) of which 193 (75.4 %) could be reviewed. Post-partum haemorrhage (24 %) and hypertensive disorders (27.4 %) followed by puerperal sepsis in the post-partum period (16.8 %) were the leading causes of maternal deaths. 68.3 % deaths occurred at health facilities. 67 % of mothers dying during the natal or post-natal period, delivered at home, though the death occurred in a health facility. Type 1 delay (58.9 %) was the most common underlying cause of death, followed by type 3 delay (33.3 %). Under or nil reporting from the facilities was observed. Program staff could identify broad areas of intervention but lacked capacity to monitor, analyse, interpret and utilize the generated information to develop feasible actionable plans. Information gathered was incomplete and inaccurate in many cases. Challenges observed showed that it will require more time and continuous committed efforts of health staff for implementation of high quality MDR. Successful implementation will improve the response of the health system and contribute to improved maternal health.

Quality of assessment of women at the time of admission for childbirth in secondary and tertiary public sector referral institutes in southern India

“…[8][9][10][11] Poor quality of intrapartum and immediate post-partum care, compounded by delayed referrals, and third delay at referral centre contribute to most maternal deaths. [12][13][14] In 2012, Health Ministry of India launched 'Dakshata' quality improvement program with an adaptation of WHO SCC supported by extensive mentoring in high delivery load facilities such as District Hospitals (DHs), Community Health Centers (CHCs)/ Block Primary Health Centers (PHCs). 15 A similar coaching based WHO SCC program at CHCs and PHCs, however, reported no improvement in maternal and peri-natal mortality.…”

Transport of pregnant women and obstetric emergencies in India: an analysis of the ‘108’ ambulance service system data

“…Failure to meet these targets is explained by lack of access to appropriate specialist care, poor quality of care and poor systems of transport for high-risk pregnancies or obstetric complications to EmOC- contributing to the failure of timely access [13]. Studies in India reveal that about one-third to one-half of reported maternal deaths occurred at home or on the way to care [14–16]. …”

Uncovering the stories behind the numbers : a case study of maternal death surveillance and response in Goma, Democratic Republic of Congo.

“…Inadequate technical support in implementing MDSR limits understanding and optimal performance of MDSR tasks, affecting the system's quality and effectiveness (Armstrong et al, 2014;Hofman & Mohammed, 2014;Pearson et al, 2009;Singh et al, 2015;Smith, Ameh, et al, 2017b). Thus, the present study confirmed the value of a top-down and bottom-up approach for optimal MDSR implementation (Smith, Ameh, et al, 2017b).…”

“…In rural Tanzania, women waited on average 83 minutes for emergency transportation at a referring facility and were charged up to $150 for ambulance fuel costs, forcing many to utilize alternative means such as motorcycles, bicycles, and foot (Nyamtema et al, 2011). Women incur further delays across multiple referral points before reaching an appropriate facility (Raj et al, 2013;Singh et al, 2015). Obstetric emergencies referred from lower level facilities are often poorly managed and delayed due to limited knowledge, skills, and capacity (Hussein et al, 2016;Munabi-Babigumira et al, 2017).…”

“…Despite these challenges, several studies have reported inadequate administrative support in implementing MDSR, lack of training, and gaps in disseminating MDSR guidelines (Hofman & Mohammed, 2014;Pearson et al, 2009;Singh et al, 2015). Inadequate understanding of MDSR guidelines, goals, and objectives limit the system's functionality (Armstrong et al, 2014;Smith, Ameh, et al, 2017b).…”