“It might be a statistic to me, but every death matters.”: An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries

Abstract

Background Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016–2017, the US Agency for International Development’s Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. Methods A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0–30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 (‘evidence of MPDSR practice’). Results The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75–27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation. Conclusion This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.

Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

“…Among the 195 countries analysed, based on point estimates, 115 countries reduced their stillbirth rate by at least 25•0% from 2000 to 2019 and, among these, 14 more than halved their stillbirth rate. Among the other 80 countries with a reduction of less than 25•0% in stillbirth rate since 2000, the largest group (n=32) were located in subSaharan Africa (appendix pp [18][19][20][21][22][23][24][25][26][27]. Based on the lower bound of the 90% UIs, we estimated that 114 countries had a decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50•0%, 28 having a decrease of 25•0-49•9%, 50 having a decrease of 10•0-24•9%, and 32 having a decrease of less than 10•0%.…”

“…Perinatal audits are a potential useful tool to improve the suboptimal care that contributes to many stillbirths, but these audits need to be implemented as part of an intervention package that includes training and adequate resources, supervision, and mentorship. 26 , 27

Timing of stillbirth Globally, an estimated 832 000 stillborn babies (95% uncertainty interval [UI] 811 000–990 000) died during labour (intrapartum) in 2019, accounting for an estimated 42·3% (95% UI 41·3–46·1) of all stillbirths. 6 About half of all stillbirths in the two regions of sub-Saharan Africa (47·7% in eastern and southern Asia and 50·7% in west and central Africa) and in south Asia (49·5%) were intrapartum, compared with about 6·4% in western Europe and North America.

…”

Global, Regional, and National Estimates and Trends in Stillbirths From 2000 to 2019: A Systematic Assessment

“…For the remaining 81 countries, we found no decrease in stillbirth rate since 2000 after taking the lower bound of uncertainty into account. Of these countries, 34 were in sub Saharan Africa, 16 were in east Asia and the Pacific, 15 were in Latin America and the Caribbean, and 16 were located across the remaining regions (appendix pp [18][19][20][21][22][23][24][25][26][27].…”

“…This share for south Asia decreased from 44•3% (39•7 to 48•5) to 33•1% (31•5 to 37 •8). At the country level, more than a third of all stillbirths in 2019 occurred in three countries: India (17•3% [16•4-22•4]), Pakistan (9•7% [7•8-11•1]), and Nigeria (8•7% [5•7-12•3]; appendix pp [18][19][20][21][22][23][24][25][26][27].…”

“…Based on point estimates, only 14 countries reduced stillbirth rate by 50% or more during 2000-19, compared with 117 countries that at least halved mortality rate among children aged 1-59 months, and 49 countries that at least halved neonatal mortality rate. Based on the lower bound of the 90% UIs, only four countries reduced stillbirth rate by at least half, compared with 59 countries that at least halved mortality rate among children aged 1-59 months, and 19 countries that at least halved neonatal mortality rate (appendix pp [18][19][20][21][22][23][24][25][26][27].…”