Women’s Health
Evaluation of the Maternal Death Surveillance and Response (MDSR) System in the Kigoma Region, Tanzania Sifang Kathy Zhao* Sifang Kathy Zhao Carly Malburg Carrie Shapiro-Mendoza Florina Serbanescu
Background: In 2020, about 287,000 women died worldwide during or after pregnancy and childbirth. Most of these deaths occurred in low-income countries and are preventable. To reduce maternal mortality, many countries use Maternal Death Surveillance and Response (MDSR). Since 2015, Tanzania has used MDSR for monitoring deaths, reviewing causes, and implementing interventions. Kigoma, the Tanzanian region with the greatest need for improved maternal services, has not evaluated their MDSR.
Methods: Leveraging an ongoing collaborative evaluation with the Tanzania Ministry of Health, we visited all 11 hospitals and 29 health centers that provided maternity care in Kigoma during May 2023. We interviewed facility staff using a standardized questionnaire to assess how the 2019 Tanzania MDSR Guidelines were being implemented (Figure). We compared facility activities to national guidelines and assessed the regional MDSR system using the US Centers for Disease Control and Prevention guidelines for evaluating surveillance systems, specifically the attributes of acceptability (actual engagement in MDSR activities) and timeliness (reviews conducted within 7 days of death required by the national guidelines).
Results: All hospitals (100%) and most health centers (93%) had an MDSR coordinator, a review committee, and a formal system for reviewing maternal deaths. Only 36% of hospitals and 28% of health centers documented and reviewed community-occurring deaths. Reviews within 7 days of death were held in 73% of all hospitals and 66% of all health centers. Others held reviews monthly (27% of hospitals; 3% of health centers) or quarterly (24% of health centers).
Conclusion: In Kigoma, acceptability of MDSR is high in hospitals and health centers. However, about 1 in 4 committees did not hold reviews within 7 days, and most committees did not review community deaths. Improving timeliness and community reporting processes may strengthen MDSR and help reduce preventable maternal deaths.
