Improving Measurement and Quality: The Case of Maternal Death Surveillance and Response in Botswana

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Maternal death surveillance and response (MDSR), promotes routine identification of maternal deaths linking health information system and quality improvement processes. MDSR counts every maternal death and provides information to inform immediate and longer term actions to reduce maternal mortality. This presentation will describe how MDSR has been implemented in Sub-Saharan Africa, with examples from Botswana.

Methodology: In 1990, Botswana reporting and auditing of maternal deaths; in 2013, the country initiated Maternal Mortality Reduction Initiative in 77% of facilities providing maternity services. Maternal audits are conducted internally by facility-based personnel and by an external auditors by the National Maternal Mortality Audit Committee (NMMAC). The NMMAC audits each maternal death and provides targeted recommendations to improve health services, management and referral systems, and to provide information to clinic staff and the community.

Results: In 2014, a preliminary analysis of 78% of maternal deaths identified 65% of deaths due to direct obstetric, 29% due to indirect causes and 6% not assessed. The leading direct cause of maternal death was sepsis/septic abortion (41% direct causes (18%), followed by PPH (20%), PE-E (26%) and other direct (14%)). HIV/AIDS accounted for 35% of deaths due to indirect causes. At health clinics factors leading to deaths included failure to recognize a disease (27%) followed by the failure to initiate treatment or providing the wrong treatment (22%). At hospitals factors leading to deaths include delay in provision of services in 44% and lack of provider skills in 54%. Stockouts were reported in 12% of deaths.

Conclusions: Botswana MMRI is seeking opportunities to integrate quality improvement performance data with outcome routine reporting and to strengthen the routine monitoring and reporting system through an electronic format. The MDSR will inform the existence of knowledge gaps and will provide valuable information to improve the quality of care to reduce preventable maternal mortality.