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Table 1 Characteristics of country case studies on MDSR

From: Implementing maternal death surveillance and response: a review of lessons from country case studies

Source article Country Case study title Political context Key actors Type of maternal death review and scale of coverage
Countries with an established national level MDSR system
Ravichandran 2014 [19] Malaysia Lessons from the confidential enquiry into maternal deaths, Malaysia Government scaled up the existing system of maternal mortality audit and introduced the National Confidential Enquiry into Maternal Deaths (CEMD) in 1991. Director-General of Health
State Director of Health and State Obstetricians
The MoH absorbs the cost of the CEMD and the Family Health Division (FHD) acts as Secretariat.
National confidential enquiry
All deaths in facilities and communities
Moodley 2014 [17] South Africa The confidential enquiry into maternal deaths in South Africa: a case study Free health care for pregnant women and children (1994).
Maternal deaths became notifiable by law (1997).
National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD) established (1998).
NCCEMD is a ministerial committee, with representatives from obstetrics, gynaecology and midwifery cross South Africa’s nine provinces.
The Department of Health provides financial and administrative support to the NCCEMD.
National confidential enquiry
Deaths in all facilities
Kurinczuk 2014 [16] UK Experiences with maternal and perinatal death reviews in the UK - the MBRRACE - UK programme Original CEMD established (1954)
Confidential Enquiries into Maternal and Child Health (CEMACH) (2003)
Maternal Newborn and Infant Clinical Outcome Review Programme (MNI-CORP) (2012)
MBRRACE-UK is a collaboration which assesses the process.
Led by the National Perinatal Epidemiology Unit at University of Oxford (members from the Universities of Leicester, Liverpool and Birmingham; University College London and the Stillbirth and Neonatal Death charity (SANDS)).
MBRRACE is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to oversee MNI-CORP.
National confidential enquiry
All deaths in facilities and communities
Countries where MDR is ongoing
Paily 2014 [18] India Confidential review of maternal deaths in Kerala: a country case study Facility-based maternal death audit initiated by the Director of Health Services (2000)
Kerala Federation of Obstetrics and Gynaecology (KFOG) assumed leadership for maternal death review (2002).
KFOG implemented a Confidential Review of Maternal Deaths (CRMD) based upon the UK system of CEMD (2004).
KFOG provides the central secretariat.
The Department of Health (DoH) of the Government of Kerala supports the programme.
State level confidential enquiry
Facility deaths only
Ameh 2015 [12] Kenya DFID programme experience implementing MDSR Government of Kenya made maternal death notification mandatory (2004).
Maternal death review (MDR) system established (2004).
Free maternity services were introduced in Kenya (2013).
Support from the Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine (LSTM)
Kenya Ministry of Health (MoH)
Facility-based
National coverage
Hodorogea 2014 [20] Moldova The Moldovan experience of maternal death reviews Recognising the deficiencies in the death review system, the MoH implemented a new model similar to the UK (2003). Support from World Health Organization and UNICEF
Ministry of Health (MoH)
National CEMD Committee.
National confidential enquiry
All deaths in facilities and communities
Countries where MDR is being introduced
Halim 2014 [15] Bangladesh Cause of and contributing factors to maternal deaths; a cross-sectional study using verbal autopsy in four districts in Bangladesh Verbal autopsy (VA) part of the Demographic and Health Survey in Bangladesh (1990)
Introduced across four districts as a method to be used to review all maternal deaths in these districts (2010)
Government of Bangladesh
The Directorate General of Health Services
Centre for Injury Prevention, Health Development and Research
UNICEF Bangladesh provided funding through a Joint UN-Government project.
Verbal autopsy
Sample of districts
de Brouwere 2014 [13] Cameroon Achievements and lessons learnt from facility-based maternal death reviews in Cameroon Cameroon adopted the Campaign on the Accelerated Reduction of Maternal Mortality in Africa (CARMMA) as its guiding strategy (2010).
This included the introduction of maternal death review (MDR) at facility and community levels.
Society of Gynaecologists and Obstetricians of Cameroon (SOGOC) via the International Federation of Gynaecology and Obstetrics - Leadership in Obstetrics and Gynaecology for Impact and Change (FIGO-LOGIC) project
Ministry of Public Health
Facility-based
Urban hospitals
Owolabi 2014 [14] Malawi Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification WHO developed a standard method for classifying maternal and pregnancy-related deaths.
Quality improvement programme at four referral hospitals and four health centres in one district applied the ICD-MM in facility-based maternal death reviews (2011).
Collaboration between the Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine (LSTM), the Ministry of Health MoH Malawi and UNICEF Malawi Facility-based
Sample of districts
Achem 2014 [11] Nigeria Setting up facility-based maternal deaths reviews in Nigeria Government of Nigeria has increased funding and instated policies and programmes directed at improving maternal health.
After a previously unsuccessful attempt (2003), MDR was approved as part of the national strategy for improving maternal health care (2013).
Society of Gynaecology and Obstetrics of Nigeria (SOGON) via the International Federation of Gynaecology and Obstetrics - Leadership in Obstetrics and Gynaecology for Impact and Change (FIGO-LOGIC) project
Technical assistance from the UK and South Africa
National Council on Health
Facility-based
National coverage