midwife in sudan. unfpa
DESCRIPTION
Maternal Deaths & Maternal Death Surveillance and Response (MDSR) : Definitions, the National Guidelines and Action Plan. Midwife in Sudan. UNFPA www.evidence4action.net/wp-content/uploads/2011/09/en_SOWMR_ExecSum.pdf. - PowerPoint PPT PresentationTRANSCRIPT
Maternal Deaths & Maternal Death Surveillance and Response (MDSR): Definitions, the National Guidelines and Action Plan
Midwife in Sudan. UNFPA www.evidence4action.net/wp-content/uploads/2011/09/en_SOWMR_ExecSum.pdf
Learning objectivesBy the end of this session, participants will be able to:
• Define and classify maternal deaths• Describe global patterns of maternal
mortality• Describe the structure of the Ethiopian
MDSR• Identify the review committees and their
composition at each level• Explain how data will flow through the
system
Definitions (1)
A Maternal death is the death of a woman while pregnant or within 42 days of the end of
pregnancy (irrespective of duration and site of pregnancy)
from any cause related to or aggravated by the pregnancy or its management
but not from accidental or incidental causes
(Source: ICD-10)
Definitions (2)
• Direct obstetric deaths are maternal deaths resulting from complications in pregnancy, labour or postpartum or from omissions or incorrect treatment.
• Indirect obstetric deaths are maternal deaths resulting
from previously existing or newly developed medical conditions aggravated by the physiologic effects of pregnancy.
• Late maternal deaths are deaths from direct or
indirect causes that occur from 42 to 365 days after the end of pregnancy (Source: ICD-10)
Definitions (3)
A Pregnancy related death is all deaths of women during or within 42 days of the end of pregnancy regardless of cause.
Useful in settings where it is difficult to determine cause, and in many low resource contexts, the cause of death is highly likely to be related to pregnancy
Definitions (4)A maternal near-miss is defined as “a woman who nearly died but survived a complication during pregnancy, childbirth or within 42 days of end of the pregnancy”
“Near misses” occur when women survive life-threatening conditions (i.e. organ dysfunction)
Use of Near Misses provides a positive approach (analysing survivals rather than deaths)
Appropriate for review when there are too few deaths to support regular review meetings
Review of ClassificationsDirect Causes (75%)
Obstetric causes during pregnancy, childbirth and the post-partum period, such as:
• Haemorrhage• Hypertensive
disorders• Infection• Obstructed labour• Abortion
Indirect Causes (25%)Medical conditions that can be aggravated through pregnancy, such as:• HIV (including TB
and pneumonia)• Malaria• Anaemia• Heart conditions
Social, cultural & environmental factors across a woman’s life course affect risk for direct & indirect causes of death
Purpose of the MDSR Guidelines
To provide guidance for the set-up and sustained functioning of Ethiopia’s MDSR for:ohealth professionalsohealth care planners and managersopolicy makers who take action based on
MDSR findings To ensure use of emerging information in
improving maternal health outcomes
Goal and Objectives of Guidelines
Goal:
To guide effective implementation and scale up of MDSR in a systematic, standardized and integrated manner
Objectiveso Strengthen capacity of program managers & providers in
analysis & interpretation of maternal death data
o Facilitate standardization & harmonization of the MDSR process at community, facility, district & regional levels
o Guide program managers in timely implementation, monitoring and supervision of MDSR at different levels
o Serve as a basic tool to guide service providers in MDSR
o Improve use of information to produce local solutions to the root causes of maternal death
Committee StructureNational Task Force
RHB Review Committee
Zonal Level Reporting
Woreda Level Reporting
Health Centre Committee:Reviews Verbal Autopsies for
community & HC deaths
Hospital Committee:Reviews deaths occurring
within the premises
Referral Hospitals
Committee MembershipChair, MSD, HPDP, FMHACA, HRNI,
Midwives Assoc., Anaethetists, ESOG, H4, partners
Zonal Level Reporting
Woreda Level Reporting
HC Director, HEW Supervisor, Midwives, Nurses, 2 Comm reps, Pharmacists, Woreda MNH Lead
OB/GYN, IESO, Snr. Midwives, Anaethetists, CEO, Med Dir, Quality of
Care Lead
RHB Deputy Head, MNH focal person, Senior Midwife, ESOG,
Partner representative
OB/GYN, IESO, Snr. Midwives, Anaethetists, CEO, Med Dir,
Quality of Care Lead
Culture of no blameThe man in the boat needs help managing his appetite, a reminder of good nutrition, and assistance to stop sinking, but NOT a lecture on his poor eating habits!• Healthcare providers are vulnerable to self
blame, which does not improve care• Support and training are better solutions
for preventing future deaths• “No blame” is NOT “no accountability”
National MDSR Action Plan• May: National training & dissemination of
guidelines• June – September : Regional Committees
established• June - September: Phase I implementation
(committees established at Facilities & Health Centres, with woreda support)
• September : Orientation for Health Facilities, Health Centres and HEW
• October ‘13 – March ‘14: Phase II• April – September ‘14: Phase III• Monthly monitoring throughout