Identification
and Notification
of Maternal
Deaths
Learning objectives
By the end of this session, participants will be able to:
• Identify a maternal death using the
screening tool (part of Annex 1)
• Know how notification forms are used
within the Ethiopian MDSR
• Explain zero reporting and how it
should be implemented
REMINDER!
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)
REMINDER 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)
Individual Exercise: Death Scenarios
 Which are maternal deaths?
 Why or why not?
 How would you classify
them?
 Should it be reported to the
MDSR committee?
Who should notify maternal deaths at
community level?
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Religious Leaders
Health Development Army
Community authorities
Administrative leaders
Health Extension Workers
Members of the community
 HEW have formal responsibility for
reporting deaths within the MDSR system
.
HEW identify ALL deaths to women of
reproductive age
HEW notify all identified deaths to HC within
ONE WEEK
Key staff at HC determine classification of
death within 3- 4 weeks of notification
Verbal Autopsy conducted for ALL confirmed
maternal deaths, regardless of where they
occurred, and report provided to HC Director
The HC Director assigns 2 independent
reviewers to produce a summary
HC committee:
•Reviews the summary report
•Draws up a response plan
•Submits monthly report to woreda focal person
How will identification occur in facilities?
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Referral forms
Medical records
Log books (maternity, OR, OPD, anaesthesia)
Attending health workers (maternity, OPD,
OR)
 Other ... E.g. mortuary
Facility System of Identification
 Dedicated staff member responsible for
checking death logs and other records from
the previous 24 hours on a daily basis.
 Any death of a woman of reproductive age
should trigger a review of her medical
record to assess whether there was any
evidence the woman was pregnant or
within 42 days of the end of a pregnancy
 Head nurse of the ward reports to Medical
Director within 24 hours of identification
Notification of maternal deaths to Medical
Director by the maternity/ labour/ other
ward head midwife/ nurse within 24 HOURS
of death.
Medical Director assigns two independent
reviewers to review and produce summary
reports within 1 WEEK of death
The review committee at the health facility
reviews the summary reports and produces
response action monthly
Medical director submits summary reports to
the next level
Data collection
 Many sources involved
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family cards
antenatal care records
medical records from health facilities
interviews with family members, community members/
leaders, traditional healers and health care workers
 Each data sources provide different information
 For community deaths, HC staff will be trained to
use the VA tool
 The HC Medical Director responsible for that kebele
will supervise the process
 Data collectors for both facility and community
level should be fluent in the local language
Data
Collection
• Speed is essential
• Notes will
disappear
• People will be
unavailable
• Establish who was
around as soon as
possible
How can duplication be avoided?
There is a risk that a death that occurs at a facility
(or on the way) might be reported TWICE to the
woreda, from BOTH the facility review committee
AND HC committee reviewing verbal autopsies
WOMAN DIES SOON
AFTER ARRIVAL AT
DISTRICT HOSPITAL
Hospital
Committee
reviews death,
identifies action
re:quality ,
reports to woreda
HEW HEARS ABOUT
DEATH FROM FAMILY
AND NOTIFIES HC
HOW DOES
WOREDA
AVOID
REPORTING
THE SAME
DEATH TWICE
TO ZONE OR
RHB?
HC sends midwife
to conduct VA,
reviews death,
identifies action
re: community and
reports to woreda
How can duplication be avoided?
 MDSR Guidelines recommend that ALL maternal
deaths should be counted through the VA process
 The Facility deaths are to assist in identifying
actions NOT for contributing to aggregate figures
HOW DOES
WOREDA
AVOID
REPORTING
THE SAME
DEATH TWICE
TO ZONE OR
RHB?
This will require careful
data management
practices to avoid
confusion!
What is “Zero reporting”
 ZERO Reporting refers to ensuring all data
abstraction and aggregation tools are filled out
and sent on time, EVEN when no maternal
deaths have occurred
 Reporting ZERO shows attention to the issue
and proactive tracking of maternal mortality
 NO reports suggests that the MDSR is not
functioning or the issue is neglected
 Reporting should be an active process even
when there have been NO deaths
Watching out for silent areas
 Silent areas are geographical locations
(woredas, zones) or facilities at any level that
do not report or consistently report NO
maternal deaths
 Silent areas could mean no deaths occurred
 BUT silent areas also are a potential warning
sign of poor compliance with MDSR
 Woreda or regional review committees are
responsible for further investigation
 Additional support or training may be required
Group Activity
 Work in groups of 5 people each
 Use Appendix 1 to fill out a maternal
death notification form
 Don’t worry if your group doesn’t have
time to get through all 4 scenarios!
Summary Points
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ALL deaths of women of reproductive age
should be notified in communities
HEW are responsible for reporting deaths to
HC, where classification occurs and further
investigations are authorised (VA)
Facilities must ensure identification occurs
through data collection in all departments
Rapid extraction and summary of raw data
crucial to ensure accurate information
At woreda level, data are checked for
duplication, zero reporting and “silent areas”