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

Abstract

who provided insightful feedback and scholarly guidance throughout this process. They committed their time to reviewing my work and posed critical questions that challenged me to reflect more deeply. I am forever grateful to Dr. Ryan Combs, who welcomed me into his research team from the beginning of my doctoral program. His mentorship and guidance honed my skills and led to my passion for qualitative research, which was fundamental in completing this study. I also appreciate the Department of Health Promotion and its Chair, Dr. Monica Wendel, for the financial and logistical support towards my data collection in Goma. My sincere gratitude to Dr. Robert Vutsopire from Goma Health Zone, who authorized my research, provided valuable insights, and facilitated my entry into the v study sites for data collection. I am equally grateful to the Ethics Committee at the Université Libre des Pays des Grands Lacs, who conducted an expedited ethical review of this study, in addition to the University of Louisville Institutional Review Board. I also extend my sincere gratitude to all the key informants who participated in this study. My family and friends have been a special part of this journey. I am forever grateful to my dad, Dr. Kambale Karafuli; my mom, Dr. Muteho Kasongo; and my brother, Taji Vuruka, for all they have sacrificed for me to achieve this significant milestone. My parents have instilled in me the passion for learning and invested in my dreams, supporting me every step of the way. To my loving husband, Steven Nwaokolo "SJ", who has shown me unconditional love, endless support, and extraordinary patience over the years. He has encouraged me to dream big and has always seen the glass half full when I saw it half empty. Finally, I am thankful for my friends and colleagues who have made this doctoral journey fun and unforgettable.

Maternal and perinatal death surveillance and response: a systematic review of qualitative studies

“…This learning, and the review process itself, were reported to make health workers more vigilant in their daily practice, because they knew that if a patient died, their actions and records would be reviewed. 44 , 53 , 75 …”

“…3 ), where people feel safe to honestly report deaths, disclose accurate information and openly discuss the cases, including any mistakes in their management. 47 , 53 , 56 , 74 Learning environments assure confidentiality, anonymity and separation from blame or any disciplinary process. Although several respondents recommended legal protection at the national level to prevent data from maternal and perinatal death surveillance and response being used in litigation, only South Africa had enacted this protection which “has been ratified by relevant judicial bodies.” 81 …”

“…Fear of blame usually resulted from insufficient confidentiality or anonymity, and the death review process not being separated from disciplinary procedures. 76 Telling participants that the process was blame-free was insufficient to allay fears when senior managers were present who would also be in charge of disciplinary procedures 53 , 76 or when litigation against health workers was increasing. 73 …”

“…Under-reporting of deaths was often due to fear of blame or other negative consequences, such as reduced funding, 21 , 53 , 73 , 76 but also resulted from social stigma, 33 cultural beliefs, non-mandatory reporting 53 and political pressure. 51 , 72 , 73 …”

“…Inaccurate and/or incomplete information undermines the review process. Although poor record-keeping was common, 42 , 53 several reports noted deliberate falsification of records 25 , 57 , 70 , 73 or misclassification of deaths 70 , 76 to avoid blame or reputational damage. Sometimes staff did not collect the information because they simply did not have time 45 or the correct forms, 60 or did not understand the purpose of maternal and perinatal death surveillance and response.…”