Maternal death surveillance and response in Tanzania: comprehensiveness of narrative summaries and action points from maternal death reviews

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.

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

“…It also confirms the findings from another study which showed that written summaries used in MDSR were not comprehensive. 15 …”

“…It also confirms the findings from another study which showed that written summaries used in MDSR were not comprehensive. 15 The most important step of the MDSR system is the implementation of action plans. Even though the system did not have a systematic way of tracking implementation of each action plan, health providers and managers reported that most were implemented.…”

“Death audit is a fight” – provider perspectives on the ethics of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Ethiopia

“…These experiences challenge the purpose of the MPDSR system and could put both patient and clinician safety at risk. Few other studies on the topic are available to date, and generally, the focus has been on maternal death reporting practices [14, 16,17]. Our study has sought to focus on the perinatal aspect of MPDSR, as perinatal deaths are perceived differently than maternal deaths [39].…”

“…Barriers to implementation and the process of maternal death review have been subject to some research in Sub-Saharan African countries, including Ethiopia [10, [13][14][15][16][17][18]. The process of auditing and reviewing perinatal deaths has, however, received less attention.…”

Implementation of maternal and perinatal death surveillance and response system among health facilities in Morogoro Region: a descriptive cross-sectional study

“…Every health facility in Tanzania that provides reproductive and child health services,, including assisting childbirth, implements the MPDSR system [ 14 ]. The standard procedures for MPDSR require that every maternal death and perinatal death occurring either at the facility or in the community be reported to the regional level through respective councils, followed by a detailed review of the cause of death [ 10 ].…”