Assessment of Maternal Death and Factors Affecting Maternal Death Surveillance and Response System in Dire Dawa, Ethiopia
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Date
2015
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Addis Ababa University
Abstract
Background: Reducing maternal deaths is one of the key goals of Millennium Development
Goals (NDGs). Programs and policies aiming to reduce maternal deaths need reliable and valid
information. Maternal Death Surveillance and Response (MDSR) system is a method of
collecting information on the level and causes of maternal death in order to provide accurate
information to improve quality of maternal health care.
Objective: The study aims to assess causes of maternal deaths and factors affecting MDSR
system in public health facilities in Dire Dawa
Methods: A cross sectional facility based study design including quantitative and qualitative
methods was conducted in nine health facilities of Dire Dawa where an MDSR system was
introduced. The quantitative method assessed maternal deaths and complications for causes and
avoidable factors before the introduction of MDSR from 8 June 2013 to 7 June 2014 and after
the introduction of MDSR from 8 June 2014 to 9 March 2015 by reviewing patient and facility
records and interviewing with health care providers. Factors which affect the implementation of
MDSR assessed qualitatively through in-depth interview with 24 purposively selected health
care providers working in the nine public health facilities.
Results: A total of 45 maternal deaths, 247 maternal complications and 8,857 deliveries were
recorded during the two study periods. Maternal mortality ratios for the two periods were 511
and 505 per 100,000 live births in the baseline and implementation period respectively. Of the
total maternal deaths 33 (73.3%) were avoidable. The direct obstetric causes were responsible
for 41 (91%) of the deaths, of which hemorrhage 27%, hypertension during pregnancy 22% and
obstructed labour 18% are the leading causes. MDSR is implementing in the nine public health
facilities. Knowledge, attitude, support and supervision, training, staff turnover, and community
participation are the main factors which affect the program implementation.
Conclusions and recommendations: The identified maternal death is very high and most of
them are avoidable and caused by direct obstetric causes of maternal death. MDSR system is
implementing and accepted by most of the care providers. Improving care, capacity building,
support and supervision and community awareness is crucial to reduce the number of maternal
death and to strengthen and sustain the program implementations
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Keywords
Reducing maternal deaths