Maternal and neonatal death surveillance and response in Liberia: An assessment of the implementation process in five counties

Abstract

Objective To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia. Methods Secondary analysis of data from a cross‐sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis. Results Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death. Conclusion The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system.

Implementing maternal death surveillance and response in Sub‐Saharan Africa: The way forward

“…Notification of maternal death is incorporated into routine health management information systems via integrated disease surveillance and response systems in Benin, 7 Burkina Faso, 8,9 Cameroon, 10 Central African Republic, 11 Chad, 12 Ghana, 13 and Liberia. 14 However, most of the countries continue to underreport maternal and neonatal deaths 12 and many countries do not include neonatal deaths in the notification system. 15 Community deaths also go unreported.…”

“…Review of maternal death is a key part of MDSR. Maternal death reviews were not carried out routinely and were irregular in most countries [7][8][9][10][11][13][14][15][16] or stopped completely. 12 One healthcare provider noted that financial resources were not available to conduct reviews, which prevented them from happening.…”

Maternal Mortality in Africa: Regional Trends (2000–2017)

“…Many African countries participated [ 17 , 18 ]. There were some difficulties with maternal death surveillance and response implementation in several African countries [ 19 , 20 , 21 , 22 ] due to several causes, including communication problems at district or community levels, recommendations that were poorly addressed, highly political issues, low accountability, and organizational problems. Estimating maternal mortality is very difficult, especially if nobody knew about the deceased woman’s pregnancy or if the delivery was outside a health facility or attended by unskilled people who could not identify the correct cause.…”

Maternal Mortality in Africa (Part I), Regional Trends (1990-2015)

“…Many African countries participated [17,18]. There were some difficulties with maternal death surveillance and response implementation in several African countries [19][20][21][22] from several causes, including communication problems at district or community levels, recommendations poorly addressed, highly political issues, low accountability, and organizational problems. This study aims to compare the evolution of maternal mortality rates in different regions of Africa.…”