identification and notification of maternal deaths
TRANSCRIPT
Identification and Notification of Maternal Deaths
Learning objectivesBy the end of this session, participants will be able to:
• Identify a maternal death using the screening tool (part of Annex 1)• Know how notification forms are used
within the Ethiopian MDSR• Explain zero reporting and how it
should be implemented
REMINDER!
A Maternal death is the death of a woman while pregnant or within 42 days of the end of
pregnancy (irrespective of duration and site of pregnancy)
from any cause related to or aggravated by the pregnancy or its management
but not from accidental or incidental causes
(Source: ICD-10)
REMINDER 2!
• Direct obstetric deaths are maternal deaths resulting from complications in pregnancy, labour or postpartum or from omissions or incorrect treatment.
• Indirect obstetric deaths are maternal deaths
resulting from previously existing or newly developed medical conditions aggravated by the physiologic effects of pregnancy.
• Late maternal deaths are deaths from direct or
indirect causes that occur from 42 to 365 days after the end of pregnancy
(Source: ICD-10)
Individual Exercise: Death Scenarios
Which are maternal deaths? Why or why not? How would you classify
them? Should it be reported to the
MDSR committee?
Who should notify maternal deaths at community level?
Religious Leaders Health Development Army Community authorities Administrative leaders Health Extension Workers Members of the community
HEW have formal responsibility for reporting deaths within the MDSR system
Verbal Autopsy conducted for ALL confirmed maternal deaths, regardless of where they
occurred, and report provided to HC Director
Key staff at HC determine classification of death within 3- 4 weeks of notification
HEW notify all identified deaths to HC within ONE WEEK
The HC Director assigns 2 independent reviewers to produce a summary
HC committee:• Reviews the summary report • Draws up a response plan• Submits monthly report to woreda focal person
HEW identify ALL deaths to women of reproductive age
.
How will identification occur in facilities?
Referral forms Medical records Log books (maternity, OR, OPD, anaesthesia) Attending health workers (maternity, OPD,
OR) Other ... E.g. mortuary
Facility System of Identification Dedicated staff member responsible for
checking death logs and other records from the previous 24 hours on a daily basis.
Any death of a woman of reproductive age should trigger a review of her medical record to assess whether there was any evidence the woman was pregnant or within 42 days of the end of a pregnancy
Head nurse of the ward reports to Medical Director within 24 hours of identification
Notification of maternal deaths to Medical Director by the maternity/ labour/ other
ward head midwife/ nurse within 24 HOURS of death.
Medical director submits summary reports to the next level
The review committee at the health facility reviews the summary reports and produces
response action monthly
Medical Director assigns two independent reviewers to review and produce summary
reports within 1 WEEK of death
Data collection Many sources involved
family cards antenatal care records medical records from health facilities interviews with family members, community members/
leaders, traditional healers and health care workers Each data sources provide different information For community deaths, HC staff will be trained to use
the VA tool The HC Medical Director responsible for that kebele
will supervise the process Data collectors for both facility and community level
should be fluent in the local language
Data Collection
• Speed is essential• Notes will
disappear• People will be
unavailable• Establish who was
around as soon as possible
How can duplication be avoided?There is a risk that a death that occurs at a facility
(or on the way) might be reported TWICE to the woreda, from BOTH the facility review committee AND HC committee reviewing verbal autopsies
HOW DOES WOREDA
AVOID REPORTING THE SAME
DEATH TWICE TO ZONE OR
RHB?
HEW HEARS ABOUT DEATH FROM FAMILY
AND NOTIFIES HC
HC sends midwife to conduct VA, reviews death,
identifies action re: community and reports to woreda
WOMAN DIES SOON AFTER ARRIVAL AT DISTRICT HOSPITAL
Hospital Committee
reviews death, identifies action
re:quality , reports to woreda
How can duplication be avoided? MDSR Guidelines recommend that ALL maternal
deaths should be counted through the VA process The Facility deaths are to assist in identifying
actions NOT for contributing to aggregate figures
HOW DOES WOREDA
AVOID REPORTING THE SAME
DEATH TWICE TO ZONE OR
RHB?
This will require careful data management practices to avoid
confusion!
What is “Zero reporting” ZERO Reporting refers to ensuring all data
abstraction and aggregation tools are filled out and sent on time, EVEN when no maternal deaths have occurred
Reporting ZERO shows attention to the issue and proactive tracking of maternal mortality
NO reports suggests that the MDSR is not functioning or the issue is neglected
Reporting should be an active process even when there have been NO deaths
Watching out for silent areas Silent areas are geographical locations
(woredas, zones) or facilities at any level that do not report or consistently report NO maternal deaths
Silent areas could mean no deaths occurred BUT silent areas also are a potential warning
sign of poor compliance with MDSR Woreda or regional review committees are
responsible for further investigation Additional support or training may be required
Group Activity Work in groups of 5 people each Use Appendix 1 to fill out a maternal
death notification form Don’t worry if your group doesn’t have
time to get through all 4 scenarios!
Summary Points
ALL deaths of women of reproductive age should be notified in communities
HEW are responsible for reporting deaths to HC, where classification occurs and further investigations are authorised (VA)
Facilities must ensure identification occurs through data collection in all departments
Rapid extraction and summary of raw data crucial to ensure accurate information
At woreda level, data are checked for duplication, zero reporting and “silent areas”