Community-based surveillance of maternal deaths in rural Ghana

Adomako, Joseph; Asare, Gloria Quansah; Ofosu, Anthony; Iott, Bradley; Anthony, Tiffany; Momoh, Andrea S; Warner, Elisa; Idrovo, Judy P; Ward, Rachel E.; Anderson, Frank W.

doi:10.2471/blt.15.154849

Cited by 14 publications

(17 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other studies were: case-control (n = 1) [ 38 ], Confidential Enquiries into Maternal Deaths (CEMD) or Maternal Death Surveillance and Response (MDSR) audits (n = 4) [ 39 - 42 ], cross-sectional facility and community surveys (n = 4) [ 43 - 46 ], prospective facility and community studies (n = 2) [ 47 , 48 ], Reproductive Age Mortality Study (RAMOS) (n = 2) [ 49 , 50 ], pre and post evaluation (n = 1) [ 51 ], and step-wedge randomised controlled trials (RCT) (n = 1) [ 52 ]. The methods of assigning the causes of death were: study expert panels (n = 21) [ 17 , 18 , 21 , 22 , 24 , 26 , 28 , 29 , 33 - 35 , 37 , 39 , 43 - 46 , 48 - 50 , 52 ], facility/MDSR audit teams (n = 8) [ 16 , 23 , 25 , 31 , 41 , 42 , 51 , 53 ], routine clinical assessments (n = 5) [ 19 , 20 , 27 , 30 , 32 ], physician verbal autopsy coders (n = 1) [ 47 ], and not stated (n = 3) [ 15 , 36 , 38 ]. South Africa contributed 21% of the deaths from 2 studies [ 22 , 41 ], Nigeria 18% from 13 studies [ 15 , 21 , 23 - 25 , 28 - 31 , 35 , 37 , 46 , 48 ], Tanzania 15% from 3 studies [ 16 , 18 , 39 ], and Zimbabwe 9% from 2 studies [ 20 , 42…”

Section: Resultsmentioning

confidence: 99%

“…Studies in our review may have reported fewer deaths in the unknown/undetermined cause group because they mainly analysed institutional deaths. Even so, a few studies reported 30% to 45% deaths in the unknown/undetermined group [ 50 , 63 ]. Community studies such as demographic and health surveys typically report deaths in the unknown/undetermined group because they cannot identify death causes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

et al. 2021

View full text Add to dashboard Cite

Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease – 10 th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words “maternal mortality”, “maternal death”, “pregnancy-related death”, “reproductive age mortality” and “causes” as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data s...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, this assessment shows that more could be done to promote the no name, no blame principle. Among barriers and challenges to implement MPDSR identified in the global implementation of Maternal Death Surveillance and Response report [24], a blame culture in some places inhibits health professionals and others from participating fully in the MPDSR process [3,34,35]. Adopting clear codes of conduct differentiating between the mortality audit and disciplinary processes and emphasizing confidentiality may create a better atmosphere for staff to share information without fear of blame or punishment [25,30].…”

Section: Discussionmentioning

confidence: 99%

Assessing Implementation of Maternal and Perinatal Death Surveillance and Response in Rwanda

Tayebwa

Sayinzoga

Umunyana

et al. 2020

IJERPH

View full text Add to dashboard Cite

Maternal deaths remain a major public health concern in low- and middle-income countries. Implementation of maternal and perinatal deaths surveillance and response (MPDSR) is vital to reduce preventable deaths. The study aimed to assess implementation of MPDSR in Rwanda. We applied mixed methods following the six-step audit cycle for MPDSR to determine the level of implementation at 10 hospitals and three health centers. Results showed various stages of implementation of MPDSR across facilities. Maternal death audits were conducted regularly, and facilities had action plans to address modifiable factors. However, perinatal death audits were not formally done. Implementation was challenged by lack of enough motivated staff, heavy workload, lack of community engagement, no linkages with existing quality improvement efforts, no guidelines for review of stillbirths, incomplete medical records, poor classification of cause of death, and no sharing of feedback among others. Implementation of MPDSR varied from facility to facility indicating varying capacity gaps. There is need to integrate perinatal death audits with maternal death audits and ensure the process is part of other quality improvement initiatives at the facility level. More efforts are needed to support health facilities to improve implementation of MPDSR and contribute to achieving sustainable development goal (SDG) 3.

show abstract

“…Our literature review indicated that few countries had estimated MMR using RAMOS methods and CRVS data in SSA [ 46 ]. Adomako in Ghana and Mgawadere in Malawi used the RAMOS method to estimate MMR for a district [ 47 , 48 ]. Mohammed in Sudan, Walraven in Gambia and Zakariah and Geynisman in Ghana used the method to estimate MMR in urban and rural communities [ 49 – 52 ].…”

Section: Discussionmentioning

confidence: 99%

Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study

et al. 2021

View full text Add to dashboard Cite

Background Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe—an SSA country. Methods In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007–2008 and 2018–2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. Discussion This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007–2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.

show abstract

Community-based surveillance of maternal deaths in rural Ghana

Abstract: ResearchBull World Health Organ 2016;94:86-91| doi: http://dx.

Cited by 14 publications

References 5 publications

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020

Assessing Implementation of Maternal and Perinatal Death Surveillance and Response in Rwanda

Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study

Contact Info

Product

Resources

About