Table 1 Characteristics of country case studies on MDSR
From: Implementing maternal death surveillance and response: a review of lessons from country case studies
Source article | Country | Case study title | Political context | Key actors | Type of maternal death review and scale of coverage |
|---|---|---|---|---|---|
Countries with an established national level MDSR system | |||||
Ravichandran 2014 [19] | Malaysia | Lessons from the confidential enquiry into maternal deaths, Malaysia | Government scaled up the existing system of maternal mortality audit and introduced the National Confidential Enquiry into Maternal Deaths (CEMD) in 1991. | Director-General of Health State Director of Health and State Obstetricians The MoH absorbs the cost of the CEMD and the Family Health Division (FHD) acts as Secretariat. | National confidential enquiry All deaths in facilities and communities |
Moodley 2014 [17] | South Africa | The confidential enquiry into maternal deaths in South Africa: a case study | Free health care for pregnant women and children (1994). Maternal deaths became notifiable by law (1997). National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD) established (1998). | NCCEMD is a ministerial committee, with representatives from obstetrics, gynaecology and midwifery cross South Africa’s nine provinces. The Department of Health provides financial and administrative support to the NCCEMD. | National confidential enquiry Deaths in all facilities |
Kurinczuk 2014 [16] | UK | Experiences with maternal and perinatal death reviews in the UK - the MBRRACE - UK programme | Original CEMD established (1954) Confidential Enquiries into Maternal and Child Health (CEMACH) (2003) Maternal Newborn and Infant Clinical Outcome Review Programme (MNI-CORP) (2012) | MBRRACE-UK is a collaboration which assesses the process. Led by the National Perinatal Epidemiology Unit at University of Oxford (members from the Universities of Leicester, Liverpool and Birmingham; University College London and the Stillbirth and Neonatal Death charity (SANDS)). MBRRACE is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to oversee MNI-CORP. | National confidential enquiry All deaths in facilities and communities |
Countries where MDR is ongoing | |||||
Paily 2014 [18] | India | Confidential review of maternal deaths in Kerala: a country case study | Facility-based maternal death audit initiated by the Director of Health Services (2000) Kerala Federation of Obstetrics and Gynaecology (KFOG) assumed leadership for maternal death review (2002). KFOG implemented a Confidential Review of Maternal Deaths (CRMD) based upon the UK system of CEMD (2004). | KFOG provides the central secretariat. The Department of Health (DoH) of the Government of Kerala supports the programme. | State level confidential enquiry Facility deaths only |
Ameh 2015 [12] | Kenya | DFID programme experience implementing MDSR | Government of Kenya made maternal death notification mandatory (2004). Maternal death review (MDR) system established (2004). Free maternity services were introduced in Kenya (2013). | Support from the Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine (LSTM) Kenya Ministry of Health (MoH) | Facility-based National coverage |
Hodorogea 2014 [20] | Moldova | The Moldovan experience of maternal death reviews | Recognising the deficiencies in the death review system, the MoH implemented a new model similar to the UK (2003). | Support from World Health Organization and UNICEF Ministry of Health (MoH) National CEMD Committee. | National confidential enquiry All deaths in facilities and communities |
Countries where MDR is being introduced | |||||
Halim 2014 [15] | Bangladesh | Cause of and contributing factors to maternal deaths; a cross-sectional study using verbal autopsy in four districts in Bangladesh | Verbal autopsy (VA) part of the Demographic and Health Survey in Bangladesh (1990) Introduced across four districts as a method to be used to review all maternal deaths in these districts (2010) | Government of Bangladesh The Directorate General of Health Services Centre for Injury Prevention, Health Development and Research UNICEF Bangladesh provided funding through a Joint UN-Government project. | Verbal autopsy Sample of districts |
de Brouwere 2014 [13] | Cameroon | Achievements and lessons learnt from facility-based maternal death reviews in Cameroon | Cameroon adopted the Campaign on the Accelerated Reduction of Maternal Mortality in Africa (CARMMA) as its guiding strategy (2010). This included the introduction of maternal death review (MDR) at facility and community levels. | Society of Gynaecologists and Obstetricians of Cameroon (SOGOC) via the International Federation of Gynaecology and Obstetrics - Leadership in Obstetrics and Gynaecology for Impact and Change (FIGO-LOGIC) project Ministry of Public Health | Facility-based Urban hospitals |
Owolabi 2014 [14] | Malawi | Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification | WHO developed a standard method for classifying maternal and pregnancy-related deaths. Quality improvement programme at four referral hospitals and four health centres in one district applied the ICD-MM in facility-based maternal death reviews (2011). | Collaboration between the Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine (LSTM), the Ministry of Health MoH Malawi and UNICEF Malawi | Facility-based Sample of districts |
Achem 2014 [11] | Nigeria | Setting up facility-based maternal deaths reviews in Nigeria | Government of Nigeria has increased funding and instated policies and programmes directed at improving maternal health. After a previously unsuccessful attempt (2003), MDR was approved as part of the national strategy for improving maternal health care (2013). | Society of Gynaecology and Obstetrics of Nigeria (SOGON) via the International Federation of Gynaecology and Obstetrics - Leadership in Obstetrics and Gynaecology for Impact and Change (FIGO-LOGIC) project Technical assistance from the UK and South Africa National Council on Health | Facility-based National coverage |