Ms. Mariyam NazviyaMs. Mariyam NazviyaMinistry of Health & FamilyMinistry of Health & FamilyRepublic of MaldivesRepublic of Maldives

ESA/STAT/AC.219/21ESA/STAT/AC.219/21

Background Information on MaldivesBackground Information on MaldivesDefinitionsDefinitionsMMR TrendsMMR TrendsMeasurement of MMRMeasurement of MMR

Sources Sources MethodologyMethodology

Maternal Death Review processMaternal Death Review processProgress towards achieving MDG Goal 5Progress towards achieving MDG Goal 5Issues & ChallengesIssues & Challenges

Consist of 1190 tiny coral IslandsConsist of 1190 tiny coral IslandsSpread over 90,000sq km of the Spread over 90,000sq km of the Indian ocean. Indian ocean. Inhabited 200 islandsInhabited 200 islandsIslands grouped to 20 atollsIslands grouped to 20 atollsThe total population of the country is The total population of the country is 31,454231,4542Small dispersed populations with difficult Small dispersed populations with difficult and expensive transport system cause and expensive transport system cause delays in timely exchange of information.delays in timely exchange of information.

However development in However development in telecommunication has brought about telecommunication has brought about positive changespositive changes

WHO standard definitions are followed in the country:WHO standard definitions are followed in the country:

Maternal DeathMaternal Death::The death of a woman while pregnant or within 42 days of termination of The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.not from accidental or incidental causes.

Direct Obstetric cause:Direct Obstetric cause:Those resulting from obstetric complications of the pregnant state Those resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium) from interventions, omissions, (pregnancy, labour and puerperium) from interventions, omissions, incorrect treatment or from a chain of events resulting from any of the incorrect treatment or from a chain of events resulting from any of the aboveabove

Indirect Obstetric cause:Indirect Obstetric cause:Those resulting from previous existing disease or disease that developed Those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancywhich was aggravated by physiologic effects of pregnancy

Institutional level (Facility)

investigation

Central level (MOHF)

investigationMethods

Coverage National - All maternal deaths are reviewed

1997Started Maternal Death Review committee 1999

Death Reporting

Notification of death mandatory within 24 hrs of occurrence

Reporting through death forms - VRS

Institutional (facility) level

Case Review (MOHF)

Maternal and Perinatal Maternal and Perinatal Morbidity and Mortality Morbidity and Mortality

CommitteeCommittee

Analysis of case

Detailed information (within 7-14 days)

Reviews forms/ questionnaires / Patient

Medical Record / Past Records

Maternal Death Review Committee

Analysis of case

Confirms cause of death / identifies faults/ factors

Directs to additional investigation /information

Recommends preventive actions

Source of information

Medical recordsNursing care recordsANC/PNC recordsPrescription recordsInterviews with attending staff

ANC recordsOther health care recordsInterviews - health workersInterviews - family members

Information analysis & reporting

Maternal Death Review Committee

Ministry of Health, Health Information and Research Section

Review & analyze the information

Prepares a case report of each death; Compiles an annual report

Every Five Years, a Synthesis Report is

compiled

200075/

100000lb

200981/

100000lb

2015125/

100000lb

Reduce maternal mortality ratio by three quarters, between 1990 and 2015

1990500/

100000lb

FLUCTUATING TREND … On Track

Improvement in health care services

Expansion of obstetric/gynecological

services

Improved antenatal care services

High proportion of institutional deliveries

High proportion of skilled attendance at birth

With the decline

in mortality,

direct causes are declining

Strengthening and expansion of Maternal and Strengthening and expansion of Maternal and Child health servicesChild health services

Strengthening of essential obstetric careStrengthening of essential obstetric care

Ensure quality of careEnsure quality of care

Proper supervision and monitoring of servicesProper supervision and monitoring of services

Implementation of target oriented awareness Implementation of target oriented awareness programmesprogrammes

Population size very small Population size very small Statistically brings a large variation to MMR with just one or Statistically brings a large variation to MMR with just one or two deathstwo deaths

Over 90 Percent of Institutional deliveriesOver 90 Percent of Institutional deliveriesHowever, not all hospitals in atolls are equipped with However, not all hospitals in atolls are equipped with Emergency Obstetric / Neonatal care Emergency Obstetric / Neonatal care

Service Delivery and timely referral a challenge Service Delivery and timely referral a challenge due to geographical dispersed nature of islandsdue to geographical dispersed nature of islands

Establishing a public transport mechanism – one of Establishing a public transport mechanism – one of the priorities of the current governmentthe priorities of the current government

Quality of Care needs to be improvedQuality of Care needs to be improved

Limitation of capacity (institutional / HR)Limitation of capacity (institutional / HR)

Maldives has made significant achievements in reduction of Maldives has made significant achievements in reduction of Maternal Mortality since 1990 and currently the country's Maternal Mortality since 1990 and currently the country's MMR stands at 81 / 100,000 live births in the year 2009. MMR stands at 81 / 100,000 live births in the year 2009.

Maternal death reviews are conducted for all Maternal deathsMaternal death reviews are conducted for all Maternal deaths

More than one source of reporting (through VRS as well as More than one source of reporting (through VRS as well as Maternal Death Review Process)Maternal Death Review Process)

Due to the small population, an increase or decrease in just one Due to the small population, an increase or decrease in just one maternal death brings a significant change to the MMR. As maternal death brings a significant change to the MMR. As such, the trends over the past few years is seen to fluctuate, such, the trends over the past few years is seen to fluctuate, although generally it can be said that country is on track to although generally it can be said that country is on track to achieving MDG Goal 5. achieving MDG Goal 5.