Maternal and perinatal death surveillance and response in Ethiopia: Achievements, challenges and prospects

Autoři: Brhane Ayele aff001;  Hailay Gebretnsae aff001;  Tsegay Hadgu aff001;  Degnesh Negash aff001;  Fana G/silassie aff001;  Tesfu Alemu aff002;  Esayas Haregot aff001;  Tewolde Wubayehu aff001;  Hagos Godefay aff003
Působiště autorů: Tigray Health Research Institute, Mekelle, Tigray, Ethiopia aff001;  UNFPA-Tigray, Ethiopia aff002;  Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Maternal and Perinatal Death Surveillance and Response (MPDSR) was a pilot program introduced in Tigray, Ethiopia to monitor maternal and perinatal death. However; its implementation and operation is not evaluated yet. Therefore, this study aimed to assess the implementation and operational status and determinants of MPDSR using a programmatic data and stakeholders involved in the program.


Institutional based cross-sectional study was applied in public health facilities (75 health posts, 50 health centers and 16 hospitals) using both qualitative and quantitative methods. Data were entered in to Epi-info and then transferred to SPSS version 21 for analysis. All variables with a p-value of ≤ 0.25 in the bivariate analysis were included in to multivariable logistic regression model to identify the independent predictors. For the qualitative part, manual thematic content analysis was done following data familiarization (reading and re-reading of the transcripts).


In this study, only 34 (45.3%) of health posts were practicing early identification and notification of maternal/perinatal death. Furthermore, only 36 (54.5%) and 35(53%) of health facilities were practiced good quality of death review and took proper action respectively following maternal/perinatal deaths. Availability of three to four number of Health Extension Workers (HEWs) (Adjusted Odds Ratio (AOR) = 6.09, 95%CI (Confidence Interval): 1.51–24.49), availability of timely Public Health Emergency Management (PHEM) reports (AOR = 4.39, 95%CI: 1.08–17.80) and participation of steering committee’s in death response (AOR = 9.19, 95%CI: 1.31–64.34) were the predictors of early identification and notification of maternal and perinatal death among health posts. Availability of trained nurse (AOR = 3.75, 95%CI: 1.08–12.99) and health facility’s head work experience (AOR = 3.70, 95%CI: 1.04–13.22) were also the predictors of quality of death review among health facilities. Furthermore; availability of at least one cluster review meeting (AOR = 4.87, 95%CI: 1.30–18.26) and uninterrupted pregnant mothers registration (AOR = 6.85, 95%CI: 1.22–38.54) were associated with proper response implementation to maternal and perinatal death. Qualitative findings highlighted that perinatal death report was so neglected. Community participation and intersectoral collaboration were among the facilitators for MPDSR implementation while limited human work force capacity and lack of maternity waiting homes were identified as some of the challenges for proper response implementation.


This study showed that the magnitude of: early death identification and notification, review and response implementation were low. Strengthening active surveillance with active community participation alongside with strengthening capacity building and recruitment of additional HEWs with special focus to improve the quality of health service could enhance the implementation of MPDSR in the region.

Klíčová slova:

Autopsy – Death rates – Ethiopia – Neonates – Nurses – Pregnancy – Qualitative studies – Quality of life


1. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmil A, et al. Global, regional and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 2016.

2. AbouZahr C, Wardlaw T. Maternal mortality at the end of a decade: signs of progress? Bulletin of the World Health Organization, 2001.

3. World Health Organization Unicef. Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank estimates. 2012.

4. Cabero-Roura L, Rushwan H. An update on maternal mortality in low-resource countries. Int J Gynaecol Obstet, 2014.

5. Agan TU, Monjok E, Akpan AB, Omoronyia OE, Ekabua JE. Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010–2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria. Open Access Maced J Med Sci, 2018.

6. Bailey PE, Keyes E, Moran AC, Singh K, Chavane L, Chilundo B. The triple threat of pregnancy, HIV infection and malaria: reported causes of maternal mortality in two nationwide health facility assessments in Mozambique, 2007 and 2012. Bmc Pregnancy and Childbirth, 2015.

7. Baqui AH, Khanam R, Mitra DK, Begum N, Rahman MH, Moin MI, et al. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Global Health,2018.

8. Colbourn T, Lewycka S, Nambiar B, Anwar I, Phoya A. Maternal mortality in Malawi, 1977–2012. BMJ Open, 2013.

9. Boerma T. The magnitude of the maternal mortality problem in Sub-Saharan Africa. Social science and medicine,1987.

10. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health, 2014.

11. Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, et al. Sub-Saharan Africa's mothers, newborns, and children: where and why do they die? PLoS medicine, 2010.

12. Goldenberg RL, Jones B, Griffin JB, Rouse DJ, Kamath-Rayne BD, Trivedi N, et al. Reducing maternal mortality from preeclampsia and eclampsia in low-resource countries—what should work? Acta Obstet Gynecol Scand, 2015.

13. Bates I, Chapotera GK, McKew S, Broek N. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. Bjog-an International Journal of Obstetrics and Gynaecology, 2008.

14. Adu J, Tenkorang E, Banchani E, Allison J, Mulay S. The effects of individual and community-level factors on maternal health outcomes in Ghana. Plos One, 2018.

15. Buor D, Bream K. An analysis of the determinants of maternal mortality in sub-Saharan Africa. Journal of Women's Health, 2004.

16. Jobiba C, Manuela DA, Muula AS, Robberstad B. Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies. Bmc Public Health, 2014.

17. Diallo AH, Meda N, Zabsonré E, Sommerfelt H, Cousens S, Tylleskär T, et al. Perinatal mortality in rural Burkina Faso: a prospective community-based cohort study. Bmc Pregnancy and Childbirth, 2010.

18. Adetola AO, Tongo OO, Orimadegun AE, Osinusi K. Neonatal mortality in an urban population in Ibadan, Nigeria. Pediatr Neonatol, 2011.

19. Akaffou E, Amon F, Tanoh-Dick, Lasme-Guillao B, Yenan J. Neonatal mortality and levels of diagnosis at the University Hospital of Yopougon (Abidjan). Mali Med, 2011.

20. Carlo WA, McClure EM, Chomba E, Chakraborty H, Hartwell T, Harris H, et al. Newborn care training of midwives and neonatal and perinatal mortality rates in a developing country. Pediatrics, 2010.

21. Lawoyin TO, Onadeko MO, Asekun-Olarimoye EO. Neonatal mortality and perinatal risk factors in rural southwestern Nigeria: a community-based prospective study. West African Journal Med, 2010.

22. Pattinson R, Kerber K, Waiswa P, Day LT, Mussell F, Asiruddin SK, et al. Perinatal mortality audit: Counting, accountability, and overcoming challenges in scaling up in low‐ and middle‐income countries. International Journal of Gynecology & Obstetrics, 2009. 107(Supplement).

23. World Health Organization. Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths. Geneva: WHO; 2016. 2017.

24. Biswas A. Shifting paradigm of maternal and perinatal death review system in Bangladesh: A real time approach to address sustainable developmental goal 3 by 2030. F1000Research, 2017.

25. Central Statistical Agency (CSA) [Ethiopia] and ICF 2016. Ethiopia Demographic and Health Survey 2016. 2017: Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF.

26. Federal Democratic Republic of Ethiopia Ministry of Health. Health Sector Transformation Plan (HSTP) 2015/16–2019/20 (2008–2012 EFY); 2015. 2015.

27. Godefay H, Byass P, Kinsman J, Mulugeta A. Understanding maternal mortality from top-down and bottom-up perspectives: Case of Tigray Region, Ethiopia. J Glob Health, 2015.

28. Abebe B, Busza J, Hadush A, Usmael A, Zeleke AB, Sita S, et al. ‘We identify, discuss, act and promise to prevent similar deaths’: a qualitative study of Ethiopia’s Maternal Death Surveillance and Response system. BMJ Global health, 2017.

29. Tigray Regional Health Bureau. Prenatal and Neonatal Death Surveillance and Response (MPDSR) Technical Guideline; 2015. 2015.

30. The Government of Tigray National Regional State, Bureau of Health Tigray Regional Health Bureau 2008 EFY Annual Profile.

31. Ethiopian Public Health Institute. National technical guidance for maternal and prenatal death surveillance and response. 2017.

32. Scott H, Danel I. Accountability for improving maternal and newborn health. Best Practice & Research Clinical Obstetrics & Gynecology, 2016.

33. Okonofua F, Imosemi D, Igboin B, Adeyemi A, Chibuko C, Idowu A, et al. Maternal death review and outcomes: An assessment in Lagos State, Nigeria: PLoS ONE, 2017.

34. Smith H, Ameh C, Roos N, Mathai M, Broek N.Implementing maternal death surveillance and response: a review of lessons from country case studies. BMC Pregnancy Childbirth, 2017.

35. Millimouno TM, Sidibé S, Delamou A, Bello KO, Keugoung B, Dossou JP, et al. Evaluation of the maternal deaths surveillance and response system at the health district level in Guinea in 2017 through digital communication tools. Reproductive Health, 2019.

36. Agaro C, Beyeza-Kashesya J, Waiswa P, Sekandi JN, Tusiime S, Anguzu R, et al. The conduct of maternal and perinatal death reviews in Oyam District, Uganda: a descriptive cross-sectional study. BMC Women’s Health, 2016.

37. Smith H, Ameh C, Godia P, Maua J, Bartilol K, Amoth P, et al. Implementing maternal death surveillance and response in Kenya: incremental progress and lessons learned. Global Health: Science and Practice, 2017.

38. Ndwiga C., Warren CE, Ritter J, Sripad P, Abuya T. Exploring provider perspectives on respectful maternity care in Kenya: "Work with what you have". Reproductive health, 2017.

39. Om’Iniabohs A, Madzima B, Makosa D, Mutseyekwa F, Ajayi G, Varallo J, et al. Assessment of Maternal and Perinatal Death Surveillance and Response Implementation in Zimbabwe. 2017.

40. Charlet D, Moran AC, Madhavan S. Summary findings from a mixed methods study on identifying and responding to maternal and newborn illness in seven countries: implications for programs. J. Heatlh Popul. Nutr. 2017.

41. Halim A, Utz B, Biswas A, Rahman F, Broek N. Cause of and contributing factors to maternal deaths a cross‐sectional study using verbal autopsy in four districts in Bangladesh. 2014.

42. Moshabela M, Sene M, Nanne I, Tankoano Y, Schaefer J, Niang O, et al. Early detection of maternal deaths in Senegal through household-based death notification integrating verbal and social autopsy: a community-level case study. BMC Health Serv. Res., 2015.

43. MDSR Action Network. How legal and policy frame works support MDSR in Jamaica 2011. Available from:

44. Morrison J, Tamang S, Mesko N, Osrin D, Shrestha B, Manandhar M, et al. Women's health groups to improve perinatal care in rural Nepal. 2005.

45. Uneke CJ, Ndukwe CD, Ezeoha AA, Urochukwu HC, Ezeonu CT. Improving maternal and child healthcare programme using community-participatory interventions in Ebonyi State Nigeria.(Policy Brief). International Journal of Health Policy and Management, 2014.

46. Hounton S, Byass P, and Brahima B. Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels. Global health action, 2009.

47. Anwar J, Torvaldsen S, Sheikh M, Taylor R. Under-estimation of maternal and perinatal mortality revealed by an enhanced surveillance system: enumerating all births and deaths in Pakistan: BMC Public Health, 2018.

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden