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. 2023 Feb 20;13(2):e066990.
doi: 10.1136/bmjopen-2022-066990.

Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015-2019

Florina Serbanescu  1 , Jean-Pierre Monet  2 , Lillian Whiting-Collins  3 , A C Moran  4 , Jason Hsia  5 , Michel Brun  2
Affiliations

Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015-2019

Florina Serbanescu et al. BMJ Open. .

Abstract

Objective: Performance of maternal death surveillance and response (MDSR) relies on the system's ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a committee. Unified definitions for indicators to assess these functions are lacking. We aim to estimate notification and review coverage rates in 30 countries between 2015 and 2019 using standardised definitions.

Design: Repeat cross-sectional surveys provided the numerators for the coverage indicators; United Nations (UN)-modelled expected country maternal deaths provided the denominators.

Setting: 30 low-income and middle-income countries responding to the Maternal Health Thematic Fund annual surveys conducted by the UN Population Fund between 2015 and 2019.

Outcome measures: Notification coverage rate ([Formula: see text]) was calculated as the proportion of expected maternal deaths that were notified at the national level annually; review coverage rate ([Formula: see text]) was calculated as the proportion of expected maternal deaths that were reviewed annually.

Results: The average annual [Formula: see text] for all countries increased from 17% in 2015 to 28% in 2019; the average annual [Formula: see text] increased from 8% to 13%. Between 2015 and 2019, 22 countries (73%) reported increases in the [Formula: see text]-with an average increase of 20 (SD 18) percentage points-and 24 countries (80%) reported increases in [Formula: see text] by 7 (SD 11) percentage points. Low values of [Formula: see text] contrasts with country-published review rates, ranging from 46% to 51%.

Conclusion: MDSR systems that count and review all maternal deaths can deliver real-time information that could prompt immediate actions and may improve maternal health. Consistent and systematic documentation of MDSR efforts may improve national and global monitoring. Assessing the notification and review functions using coverage indicators is feasible, not affected by fluctuations in data completeness and reporting, and can objectively capture progress.

Keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; International health services; Maternal medicine; PUBLIC HEALTH.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trends in the average maternal death notification coverage rate (CRn), coverage review rate (CRr) and review rate (Rr) for 30 countries from 2015 to 2019.
Figure 2
Figure 2
Maternal death notification coverage rate (CRn) for 30 countries, 2015–2019, with and without average rate of reduction (ARR).
Figure 3
Figure 3
Maternal death review coverage rate (CRr) for 30 countries, 2015–2019, with and without average rate of reduction (ARR). *No reviews were reported by the country in the 2019 annual survey, presumably because of late reporting to the central level.
Figure 4
Figure 4
Range of maternal death notification coverage rate (CRn) for 2015 and 2019 for 30 countries.
Figure 5
Figure 5
Range of maternal death review coverage rate (CRr) for 2015 and 2019 for 30 countries.
Figure 6
Figure 6
An incomplete picture: trends in maternal death notification over time in Burkina Faso.
See this image and copyright information in PMC

References

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