Abstract:

Background: Combating maternal mortality requires a functional Maternal Death Surveillance and Response system (MDSR). In Zimbabwe, maternal mortality ratio was 651 deaths per 100 000 live births in 2015. Only five out of 25 deaths were notified on time in Sanyati District 2015-2016. We evaluated the system to determine if it was serving its intended purpose.

Methods: We conducted a descriptive cross sectional study using the MDSR technical guidance and the updated CDC guidelines for evaluating public health surveillance systems. Data were collected using interviewer administered questionnaires, key informant interviews, focused group discussions and records review. Medians, proportions and frequencies were calculated using Epi Info 7. Qualitative data was analysed using word cloud.

Results: We interviewed 216 health workers out of 230 involved in MDSR. Ninety-nine percent were nurses. Sixty-two percent correctly defined a maternal death. Ninety-eight percent found the system useful. Those confident to notify a maternal death were 139(68%). Easy access to case information was reported by 91(62%). Data was analysed by 138(80%) and used to monitor maternal mortality trends. Information sharing with stakeholders was reported by 59(31%). Ninety-seven percent were willing to continue participating. The cost of notifying a single death was USD$ 246.09. All community deaths were not being captured by the system as reported by 128(59%). Key informants and focused group discussions outcomes highlighted concerns of unreported community deaths. There was no zero reporting of community maternal deaths.

Conclusion: The MDSR system was useful, acceptable, simple and not costly. The system was also unstable, unrepresentative and not timely. Minimal stakeholder and community involvement, inadequate human resources and training, hampered the systems performance. We recommend health worker training and conducting an interventional study to assess the effectiveness of community involvement in reporting maternal deaths.

Keywords: Maternal Death, Surveillance, Response, Sanyati, Zimbabwe.

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