Evaluation of the Maternal Death Surveillance and Response System, Sanyati, Zimbabwe 2017
Background: Combating maternal mortality requires
a functional Maternal Death Surveillance and Response system (MDSR). In Zimbabwe, maternal mortality ratio
was 651 deaths per 100 000 live births in 2015. Only five out of 25 deaths were
notified on time in Sanyati District 2015-2016. We evaluated the system to determine
if it was serving its intended purpose.
Methods: We conducted a descriptive cross sectional study using the MDSR technical guidance and the
updated CDC guidelines for evaluating public health surveillance systems. Data were
collected using interviewer administered questionnaires, key informant
interviews, focused group discussions and records review. Medians, proportions and
frequencies were calculated using Epi Info 7. Qualitative data was analysed using
Results: We interviewed 216 health workers out of 230 involved in MDSR.
Ninety-nine percent were nurses. Sixty-two percent correctly
defined a maternal death. Ninety-eight percent found the system useful. Those confident
to notify a maternal death were 139(68%). Easy access to case information was reported
by 91(62%). Data was analysed by 138(80%) and used to monitor maternal mortality
trends. Information sharing with stakeholders was reported by 59(31%). Ninety-seven
percent were willing to continue participating. The cost of notifying a single death was USD$ 246.09. All
community deaths were not being captured by the system as reported by 128(59%).
Key informants and focused group discussions outcomes highlighted concerns of unreported
community deaths. There was no zero reporting of community maternal deaths.
Conclusion: The MDSR system was useful, acceptable, simple and not costly.
The system was also unstable, unrepresentative and not timely. Minimal stakeholder
and community involvement, inadequate human resources and training, hampered the
systems performance. We recommend health worker training and conducting
an interventional study to assess the effectiveness of community involvement in
reporting maternal deaths.
Keywords: Maternal Death, Surveillance, Response, Sanyati, Zimbabwe.
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