"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.

Autor: Kinney MV; Save the Children US, Washington, DC, United States of America.; University of the Western Cape, Cape Town, South Africa., Ajayi G; US Agency for International Development (USAID)'s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America.; Jhpiego, Baltimore, Maryland, United States of America., de Graft-Johnson J; Save the Children US, Washington, DC, United States of America.; US Agency for International Development (USAID)'s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America., Hill K; US Agency for International Development (USAID)'s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America.; Jhpiego, Baltimore, Maryland, United States of America., Khadka N; Save the Children US, Washington, DC, United States of America.; US Agency for International Development (USAID)'s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America., Om'Iniabohs A; Save the Children US, Washington, DC, United States of America.; US Agency for International Development (USAID)'s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America., Mukora-Mutseyekwa F; USAID's Maternal and Child Health Integrated Program/John Snow Inc., Harare, Zimbabwe., Tayebwa E; USAID's MCSP/Jhpiego, Kigali, Rwanda., Shittu O; Ahmadu Bello University, Zaria, Kaduna State, Nigeria., Lipingu C; Bukoba Regional Referral Hospital, Kagera, Tanzania., Kerber K; Save the Children US, Washington, DC, United States of America., Nyakina JD; Bukoba Regional Referral Hospital, Kagera, Tanzania., Ibekwe PC; Maternal and perinatal death surveillance and response, Abakaliki, Ebonyi State, Nigeria., Sayinzoga F; Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda., Madzima B; Family Health Directorate, Ministry of Health and Child Care, Harare, Zimbabwe., George AS; University of the Western Cape, Cape Town, South Africa., Thapa K; US Agency for International Development (USAID)'s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America.; Jhpiego, Baltimore, Maryland, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Dec 18; Vol. 15 (12), pp. e0243722. Date of Electronic Publication: 2020 Dec 18 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0243722
Abstrakt: 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.
Competing Interests: The authors declare that they have no competing interests.
Databáze: MEDLINE
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