Maternal death reviews at Bugando hospital north-western Tanzania: a 2008–2012 retrospective analysis

Magoma, Moke; Massinde, Antony; Majinge, Charles; Rumanyika, Richard; Kihunrwa, Albert; Gomodoka, Balthazar

doi:10.1186/s12884-015-0781-z

Cited by 21 publications

(31 citation statements)

References 8 publications

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“…Documented recommendations or action plans in the MDSR systems were mostly directed to health facility (third delay) targeting directly health care provision such as knowledge and skills of health care providers. This seems to be reasonable as also other studies from Malawi, Tanzania, Kenya and Nigeria indicated that most maternal deaths occur due to substandard care in health facilities (29)(30)(31)(32)(33) while facility delivery in these countries stands at 91%, 63%, 61% and 39% respectively (21,(34)(35)(36).…”

Section: Comprehensiveness Of the Narrative Summaries And Action Planssupporting

confidence: 59%

“…Most of these deaths occur in low resource countries both in and outside health facilities. Maternal death reviews have been done in a lot of countries including Tanzania, to reveal the causes and contributing factors to maternal deaths, with some success and challenges (2)(3)(4)(5)(6)(7). In 2015, Tanzania introduced the Maternal Death Surveillance and Response (MDSR) system in line with World Health Organization (WHO) recommendations (8,9).…”

Section: Introductionmentioning

confidence: 99%

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

Azzoug

Pembe

Massawe

et al. 2020

Preprint

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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.

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Section: Comprehensiveness Of the Narrative Summaries And Action Planssupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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

Azzoug

Pembe

Massawe

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Documented recommendations or action plans in the MDSR systems were mostly directed to health facility (third delay) targeting directly health care provision such as knowledge and skills of health care providers. This seems to be reasonable as also other studies from Malawi, Tanzania, Kenya and Nigeria indicated that most maternal deaths occur due to substandard care in health facilities (25)(26)(27)(28)(29) while facility delivery in these countries stands at 91%, 63%, 61% and 39% respectively (21,(30)(31)(32).…”

Section: Comprehensiveness Of the Narrative Summaries And Action Planssupporting

confidence: 59%

“…Most of these deaths occur in low resource countries. Maternal death reviews have been done in a lot of countries including Tanzania, to reveal the causes and contributing factors to maternal deaths, with some success and challenges (2)(3)(4)(5)(6)(7). In 2015, Tanzania introduced the Maternal Death Surveillance and Response (MDSR) system in line with World Health Organization (WHO) recommendations (8,9).…”

Section: Introductionmentioning

confidence: 99%

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

Azzoug¹,

Pembe²,

Massawe³

et al. 2020

Preprint

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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.

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“…In contrast, the routine MDSR system was less inclined to indicate such errors and did not report errors in management in most cases that led to death. Other studies have proposed that most maternal deaths occur due to delays in medical care while delays in seeking care are less important (23,(30)(31)(32)(33). Since Tanzania is seeing increased facility utilization and facility births, it is imperative for health care providers to identify substandard care that can be addressed to save lives (5).…”

Section: Identifying the Three Delaysmentioning

confidence: 99%

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

Azzoug

Pembe

Massawe

et al. 2020

Preprint

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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.

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Maternal death reviews at Bugando hospital north-western Tanzania: a 2008–2012 retrospective analysis

Cited by 21 publications

References 8 publications

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

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

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

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

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