Vital Statistics in Midwifery

Vital Statistics • Definition -Vital statistics

By the end of the session the learner - statistics relating to births, deaths,
will be able to: marriages, health, and disease.
• Define vital statistics Definition by the United Nations
• Identify definition of terms used in vital • Vital statistics is the total process
statistics of (a) collecting information by civil
• Discuss situational analysis of maternal registration or enumeration on the
and infant mortality-rates and causes frequency or occurrence of specified
and defined, as well as relevant
• Explain documentation in midwifery
characteristics of the events
• Describe maternal audit-verbal autopsy themselves and the person or persons
concerned,
Vital Statistics in Midwifery

• and (b) compiling, processing, • and other civil status events pertaining
analyzing, evaluating, presenting, and to the population as provided by decree,
disseminating these data in statistical law or regulation, in accordance with
form the legal requirements in each country.
• Civil registration is defined by the • Another Def: Civil registration is an
United Nations as the" continuous, administrative system used by
permanent, compulsory, and universal governments to record vital events
recording of the occurrence and which occur in their populations.
characteristics of vital events (live • Efforts to improve the quality of vital
births, deaths, fetal deaths, marriages, statistics will therefore be closely
and divorces) related to the development of civil
registration systems in countries
Vital Statistics in Midwifery

• For instance, the importance of birth • United nations children's

registration as the first legal fund (UNICEF) and a number of non-
recognition of the child is emphasized governmental organizations (Plan
in Article 7 of the Convention on the International, Save the Children Fund,
Rights of the Child which states that World Vision, etc.) have particularly
promoted the human rights aspects of
• "the child shall be registered
registration
immediately after birth and shall have
the right from birth to a name, the • while the United Nations Statistics
right to acquire a nationality and, as Division (UNSD), United Nations
far as possible, the right to know and Population Fund (UNFPA) and World
be cared for by his or her parents".. Health Organization (WHO) have
focused more on the statistical aspects
of civil registration.
Vital Statistics in Midwifery

Convention on Rights of the Child • Birth registration is also part of a

• Countries which are signatories to broader strategy to ensure that
children are less vulnerable to abuse
the Convention on the Rights of the and exploitation, especially if
Child are therefore expected to set separated from their parents.
up systems to register the births of
all children. • In the absence of a functioning birth
registration system, it is difficult to see
• Non-registration of a child can have how a country can enforce age-related
negative consequences on the wider legal concerns such as schooling, child
enjoyment of a child’s fundamental labour, juvenile justice, early
rights to benefits such as identity, marriage, sexual exploitation and
inheritance, education, health and military recruitment
other social services.
Vital Statistics in Midwifery

 Recent natural disasters and • health for identifying the magnitude

calamities have also demonstrated the and distribution of major disease
utility of a birth certificate for problems, and are essential for the:
reuniting lost children with their • design
families.
• implementation
Records of death and cause of death
• monitoring
Many civil registration systems also
collect information on causes of death. • and assessment of health programmes
and policies.
Statistics based on these death records
are of particular importance in public
Vital Statistics in Midwifery

Global health records • of 51.7 million deaths in 2005, which

• Despite the importance of tracking is the latest year for which the largest
causes of death and the tradition since number of countries reported deaths
1893 of standardization of definitions from a vital registration system.
and coding for causes of death in the • Even for these deaths, the
International Classification of Diseases comparability of findings on the
and Injuries (ICD), global assessments leading causes of death is affected by
of causes of death are a major analytical variation in certification skills among
challenge physicians,
• Vital registration systems that include • the diagnostic and pathological data
medical certification of the cause of available at the time of completing a
death captured about 18.8 million death certificate,
deaths of an estimated annual total
Vital Statistics in Midwifery

• variations in medical culture in populations.

choosing the underlying cause, and • Because of the variety of data sources
legal and institutional frameworks for
and their associated biases, causes of
governing mortality reporting.
death assessments are inherently
• For the remaining deaths that are not uncertain and subject to vigorous
medically certified, many different data debate.
sources and diagnostic approaches must
be used from surveillance systems, Vital statistics in Kenya
• demographic research sites, surveys, • A well developed and functioning civil
censuses, disease registries, and police registration system ensures the
records to construct a consolidated registration of all vital events
picture of causes of death in various including births, marriages and deaths
and issues relevant certificates as
Vital Statistics in Midwifery
proof of such registration. • The law governing registration of
Civil registration promotes: births/deaths in Kenya is known as the
Births and Deaths Registration Act
 efficient government planning Cap. 149 Laws of Kenya. It came into
effective use of resources and aid force in l928 .
and more accurate monitoring of • In respect of births and deaths in a
progress towards achieving the hospital, health center, maternity or
Sustainable Development Goals. nursing home or other like institutions,
responsibility of informing the events
 Registrars have been appointed for
to the registrar is by the Institution as
each local area under Section 7 of the per Registration of Birth and Death
RBD Act, 1969 for registration of Act, 1969.(See the attached Caps 149
births and deaths occurring in their laws of Kenya)
jurisdiction.
Vital Statistics in Midwifery
Issuance of Birth Certificate
 A Birth Certificate provides proof that • Application for birth Certificate can be
one is a Kenyan done at any Huduma Centre
 Similarly it is required by pupils and countrywide or Civil Registration
students applying to sit for their Department offices near you.
National Examinations
• Useful when applying for a National
Identification Card when one turns 18
• Used in application for a Kenyan
passport when in need to travel out of
the country
Vital Statistics in Midwifery

Requirements for a Birth Certificate Current Cost:

include the following;
• Birth certificate with no amendments -
• 1. Birth notification Ksh 60
• 2. ID's for both parents/Death • Birth certificate with amendments on
Certificate if parents are deceased the child's names - Ksh 100
Persons who qualify for this service • Birth certificate with amendments on
include: the parent's names - Ksh 100
• 1. Parents/ guardians of a newly born • Birth certificate with amendments on
baby the child's and parent's names-Ksh 140
• 2. Rescue centers/ children’s homes • Timelines: 10 days
taking charge of the child
Vital Statistics in Midwifery

Late registration of birth Components of Vital Statistics

requirements
Vital statistics involves:
• Clinic Card.
• Quantities and rates of births,
• Parents Original ID
Card/Passport/Births Certificate. • Important characteristics of
• Additional Documents may be births, such as births by sex,
requested e.g Antenatal records or location and maternal age,
letter from Lawyer or Chief. • Deaths by essential
characteristics such as age, sex,
location and cause of death
Vital Statistics in Midwifery

• Vital statistics comprises a number of • Births and deaths directly determine

important events in human life changes in the size of a population
including birth, death, fetal death, • Marriages and divorces create and
marriage, divorce, annulment, dissolve, respectively, the conditions
judicial separation, adoption, under which most births occur.
legitimation, and recognition.
Importance of vital statistics
• The term “vital statistics” is also
applied to individual measures of Provide insight into important trends in
these vital events. health, including the impact of changes
in the incidence of non-medically
• They are compilations of data indicated cesarean deliveries
on marriage, divorce, birth, and death.
Vital Statistics in Midwifery

• Number of deliveries, their outcome • Marriages and divorces.

and preterm birth, chronic conditions, • National Maternal and Infant Health
progress on reducing deaths due to Survey.
motor vehicle accidents, and the
evolving challenge of substance abuse. • National Mortality Follow back
Survey
Key vital statistics
Methods of data collecting in Vital
• Birth data. statistics
• Mortality data. • Vital statistics is accumulated data
• Fetal death data. gathered on live births, deaths,
• Linked birth and death data. migration, foetal deaths, marriages and
divorces.
Vital Statistics in Midwifery

• The most common way of collecting • Civil registration followed the practice
information on these events is through of churches keeping such records
civil registration since the 19th century.
• Civil registration is an Methods of vital statistics data
administrative system used by collection
governments to record vital events • While the number of births and deaths
which occur in their populations. can be obtained by enumeration at
• Efforts to improve the quality of certain points in time (e.g. censuses
vital statistics will therefore be and surveys), civil registration collects
closely related to the development this information on a continuous basis
of civil registration systems in and is the only source that provides
countries. individuals with a legal document.
Vital Statistics in Maternal death and Neonatal Health

Definitions in Vital Statistics: • Direct deaths: resulting from

• Maternal death: death of a woman obstetric complications of the pregnant
while pregnant, or within 42 days of state (pregnancy, labour and
termination of pregnancy, from any puerperium) , from interventions,
cause related to, or aggravated by, the omissions, incorrect treatment or from
pregnancy or its management, but not a chain of events resulting from any of
from accidental or incidental causes. the above (e.g. death from major
postpartum haemorrhage in a
Types of Maternal Death previously well woman).
Direct
Indirect
Coincidental (Fortuitous)
Vital Statistics in Midwifery

A suspected maternal death is Maternal deaths often indicate

defined here as the death of any weaknesses in the health-care system.
woman while pregnant or within 42
days of the termination of pregnancy
This is reported so because in many
settings, a pregnancy is not confirmed
until the second trimester or until it is
physically evident.
Therefore, any death where there is a
suggestion of a pregnancy should be
notified as a suspected maternal death
Vital Statistics in Midwifery

Indirect deaths: resulting from Coincidental (fortuitous) deaths: from

previous existing disease, or disease unrelated causes that happen to occur in
that developed during pregnancy and pregnancy or the puerperium (e.g. road
was not due to direct obstetric causes, traffic accident)
but was aggravated by the physiologic Vital statistics in obstetric/midwifery
effects of pregnancy (e.g. death from a
 Maternal mortality rate
cardiac lesion).
 Maternal mortality ratio
Late deaths: occurring between 42
days and 1 year after abortion,  Perinatal mortality
miscarriage or delivery that are due to  Conception rates
direct or indirect maternal causes.
 Fertility Rates
 Birth Rates
Vital Statistics in Midwifery

• Infant Mortality Rates • These relate to women of childbearing

Maternal Mortality Rate (age 15–44 years old), who could give
The WHO, defines the maternal birth in any year
mortality rate as the number of maternal Fertility rates
deaths per women of reproductive age. • The General Fertility Rate (GFR)
Conception rates equates to ‘ . . . the number of children
• Conception statistics include per 1000 women born to a population
pregnancies that result in one or more or sub-population’.
live births, stillbirths or a legal • For example, a GFR of 56 in 2007 for
abortion. They do not include the UK means that for every 1000
miscarriages or illegal abortions. women of childbearing age in the UK,
56 babies were born.
Vital Statistics -Situational analysis

Situational analysis maternal and complications. Current report as per

neonatal , infant mortality rates. region.
Kenya current info on MMR Region Per 100,000 live births

• The maternal mortality rate North Eastern 2000

is 414/100,000 live births, with only
Nyanza 546
42 percent of births attended by skilled
health-care personnel while 53 percent Eastern 400
attend antenatal care at least four Rift valley 377
times
Central 287
• Given the current annual births, this
means that there are nearly 5000 Nairobi 212
women and girls dying annually due to
pregnancy and childbirth
Maternal Mortality Rates

• However, despite reports as shown in the table

in addition.
• Mandera County has the most alarming level
at about 3,800 deaths per 100,000 live births
followed by Wajir (1,683), Turukana (1,594)
and Marsabit (1,127). The other counties with
an MMR above the national average are
mainly from Coast and Nyanza regions.
• Of the 47 counties in the country, • At the county level, the proportion of
fifteen contribute to 98 per cent of live births delivered by a skilled
maternal mortality in the country. provider is lowest in Turkana (53%),
• Among those, Turkana County faces Mandera (55%), Wajir (57%),
challenges and barriers in reporting Samburu (57%), and Tana River
maternal and perinatal mortality data (59%)
in the Kenya Health Information
System (KHIS).
• According to the just concluded
Kenya demographic health survey of
2022, the report indicted that:
Vital Statistics in Midwifery

Kenya Maternal Mortality Rate - Historical Data

Year Per 100K Live Births Annual % Change

2017 342.00 -1.16%

2016 346.00 -1.98%

2015 353.00 -1.40%

Vital Statistics in Midwifery

The top 3 contributors to maternal Causes of maternal death are classified

mortality as:
• Infections Direct
• Blood pressure disorders of Indirect Maternal Deaths
pregnancy, including preeclampsia and
eclampsia.
• Complications of labor and delivery.
(Report of 14 May 2020).
Vital Statistics in Midwifery

Causes of Direct and Indirect Legal termination of pregnancy

Maternal Deaths: Genital tract trauma
Direct Deaths:
Anaesthesia
• Thrombosis and thromboembolism
Fatty liver
• Hypertensive disease
Indirect deaths:
• Haemorrhage
Cardiac disease
• Sepsis
Psychiatric disorder
• Amniotic fluid embolism
Other indirect causes
• Ectopic pregnancy
Indirect malignancies
• Spontaneous miscarriage
Vital Statistics in Midwifery

Definition of other terms;

• Neonatal deaths -neonatal death under 28 days.

• Live birth refers to a baby born, showing spontaneous signs of life after birth
regardless of gestational period (WHO 2013).
Perinatal Mortality comprises of:
Stillbirth
Early neonatal death
Late neonatal death
Vital Statistics in Midwifery

Definitions Early neonatal death (END): death in

• Stillbirth: (SB)any fetus born with no the first week after birth.
signs of life after 24 weeks of END rate = death in the 1st week of life
gestation. ×1000live births
• Of particular importance in the Perinatal death: all stillbirth plus death
definition is that it is delivery of the in the first week after birth.
baby which dates the stillbirth and not Perinatal mortality rate (PMR): the
the point in the pregnancy at which the number of stillbirths and early neonatal
baby was known to die deaths per 1000 live births and
stillbirths.
Vital Statistics in Midwifery

PMR = END + stillbirth ×1000 • Late neonatal death: (LND) death of

PMR is widely used as an indicator of a neonate from age 7 days to 27
the quality of obstetric care and completed days of life.
enables comparisons to be made • Post neonatal death: death of a baby
among nations, regions and indeed at age 28 days and over, but under 1
individual hospitals. year.
Late fetal loss: deaths occurring • Infant death: death at age under 1
between 20+0 weeks and 23 weeks+6 year but born alive.
days. If gestation is not sure, all birth
• Infant deaths therefore include early
of at least 300g are reported.
and late neonatal death and post-
neonatal death .
Vital Statistics in Midwifery

Rates of neonatal and infant death Antepartum haemorrhage

are expressed as rates per 1000 live Maternal hypertension
births (while late fetal loss rate,
stillbirths rate and PMR is per 1000 Intrapartum asphyxia
live and stillbirth) Infection
Classification of Perinatal Mortality Trauma
causes
Hemolytic disease
Fetal abnormality
Preterm delivery
Intrauterine growth retardation
Unexplained intrauterine death
Vital Statistics Infant mortality rate in Kenya

The statistic shows the infant 2021

mortality rate in Kenya from 2010 to • In 2020, child mortality rate for Kenya
2020. was 41.9 deaths per 1,000 live births.
In 2020, the infant mortality rate in • Child mortality rate of Kenya fell
Kenya was at about 31.2 deaths per gradually from 147.3 deaths per 1,000 live
1,000 live births. births in 1971 to 41.9 deaths per 1,000
live births in 2020.
• The infant mortality rate for Kenya in
2021 was 32.913 deaths per 1000 live • The current birth rate for Kenya in 2022
is 27.667 births per 1000 people, a 1.1%
births, a 3.36% decline from 2020.
decline from 2021.
• The current infant mortality rate for • The birth rate for Kenya in 2021 was
Kenya in 2022 is 31.771 deaths per 27.976 births per 1000 people, a 1.1%
1000 live births, a 3.47% decline decline from 2020.
from.
Vital Statistics Infant mortality rate in Kenya

Common causes of neonatal mortality • between maternal health and neonatal

include: survival
 pre-term birth complications, Leading causes of child mortality
intrapartum growth restrictions, Globally
infections such as tetanus • infectious diseases including
pneumonia,
 low birth weight
• diarrhoea and malaria,
 congenital malformations
• along with pre-term birth
and neonatal sepsis among other complications, birth asphyxia
factors
In addition, there exists a relationship
Vital Statistics Infant mortality rate in Kenya

• and trauma and congenital anomalies • Be on the look out of these dangers
remain the leading causes of death for signs in newborns Wheezing,
children under five grunting, or whistling sounds while
• The first 28 days of life – the neonatal breathing. Odor, drainage, or bleeding
period – is the most vulnerable time from the umbilical cord. Yellow
for a child's survival. Children face the coloring of the eyes, chest, or
highest risk of dying in their first extremities. Crying, irritability, or
month of life at an average global rate twitching which does not improve
of 17 deaths per 1,000 live births in with cuddling and comfort.
2020, down by 54 per cent from 37
deaths per 1,000 in 1990.
Vital Statistics Infant mortality rate in Kenya

• How can we prevent infant mortality? • Using Newborn Screening to Detect

Are there ways to reduce the risk of Hidden Conditions.
infant mortality? • Universal Immunization Programme
• Preventing Birth Defects. (UIP): vaccination protects children
against many life-threatening diseases
• Addressing Preterm Birth, Low Birth such as Tuberculosis, Diphtheria,
Weight, and Their Outcomes. Pertussis [whooping cough], Polio,
• Getting timely Pre-Pregnancy and Tetanus, Hepatitis B and Measles
Prenatal Care.
• Creating a Safe Infant Sleep
Environment.
Vital Statistics Infant mortality rate in Kenya

What is the difference between infant • Sudden unexpected infant deaths

and child mortality include:
• In demography, child mortality refers • Sudden infant death syndrome
to the death of children under the age (SIDS)- Accidental suffocation in a
of five while infant mortality refers to sleeping environment, and other
the death of those under the age of one deaths from unknown causes.
year.
• What is it called when a baby dies in
their sleep?
Vital Statistics neonatal mortality rate in Kenya

Neonatal mortality rate Causes

• Def: Neonatal mortality rate is the • Preterm birth has been reported to be
number of neonates dying before the leading cause of neonatal death
reaching 28 days of age, per 1,000 live [1,2,3,4,5]. Infants born preterm are
births in a given population. four times more likely than term
• In 2020, neonatal mortality rate for infants to die during the neonatal
Kenya was 20.5 deaths per 1,000 live period (first 28 days) and infancy (first
births. Neonatal mortality rate of year
Kenya fell gradually from 38.6 deaths • The Pie chart next slide shows the
per 1,000 live births in 1971 to 20.5 Causes of preterm and low birth
deaths per 1,000 live births in 2020. weight neonatal mortality in Kenya
• Published: 29 July 2021
Vital Statistics neonatal mortality rate in Kenya

• The World Health Organization

(WHO) estimates that 15 million
babies are born preterm annually and
approximately one million succumb to
death in their first 4 weeks of life due
to complications of prematurity
Vital Statistics neonatal mortality rate in Kenya

• Mortality rates increase Common causes of neonatal mortality

proportionally with decreasing include:
gestational age or birth weight. • Pre-term birth complications,
• Preterm babies born in developed • Intrapartum growth restrictions
countries have almost ten times better
survival rates compared to those born • Infections such as tetanus
in low-resource settings • Low birth weight
• Congenital malformations
• Neonatal sepsis among other factors.
Vital Statistics neonatal mortality rate in Kenya

However, reports indicate that the three

main causes of neonatal mortality are:
• Preterm birth
• Intrapartum-related complications
(birth asphyxia or inability to breathe
at birth)
• Infections and birth defects
Maternal and Perinatal Death Surveillance and Review

Introduction: • Maternal and Neonatal Death

• In 2015, the Ministry of Health and Review (MNDR) is an evidence-based
Sanitation with the support of the in- tervention that first examines
World Health Organization and other causal factors, either medical or social,
partners developed national Maternal and follows up with appropriate
Death Surveillance and actions to reduce maternal and
Response (MDSR) guidelines that led neonatal deaths. Surveillance of
to the establishment of national and maternal deaths involves the :
district level MDSR committees • Systematic collection
nationwide • Collation
• Analysis, interpretation
Maternal and Perinatal Death Surveillance and Review

• and dissemination of all information  It constitutes a quality improvement

related to maternal deaths approach to identify how many
 Maternal and Perinatal Death maternal deaths occur,
Surveillance and Response  what are the underlying causes of
(MPDSR) death and associated factors
 MPDSR systems provide information  how to implement actions to reduce
on the magnitude of and factors the number of preventable stillbirths
leading to these deaths, with the aim and maternal and neonatal deaths.
of identifying preventable actions to
avoid further mortalities
Maternal and Perinatal Death Surveillance and Review

 This requires a coordinated approach, Underreporting of data

ensuring both national- and co-level Difficulties with reviewing the data
stakeholders are enabled and
supported and can implement MDSR Suboptimal aggregation of data on
in a “no name, no blame” environment cause of death
• . Brief report on experiences and To ensure progress toward a full
challenges faced by maternal death national enquiry of all maternal deaths,
assessors and Ministry of Health recommendations were made as follows
representatives in implementing
MDSR.
• Challenges encountered included:
Maternal and Perinatal Death Surveillance and Review

Improving the notification of maternal Maternal Death Verbal Autopsy and

deaths Audit
Ensuring regular audits and feedback Verbal autopsy (VA) is a method of
at referral hospitals determining individuals' causes of death
and cause-specific mortality fractions in
Strengthening community linkages populations without a complete vital
with health facilities to expedite registration system.
maternal death reporting Functions of VA
 Ultimately, both a top-down and • Is a practical method for determining
bottom-up approach is needed to probable causes of death at the
ensure success of an MDSR system population level in places where systems
for medical certification of cause of death
are weak.
Vital Statistics in Midwifery

• VAs are written records of the events and

leading up to a person's death, 2) To evaluate the effectiveness of
collected by interviewing the family of therapeutic procedures for the benefit of
the deceased, patient families, staff, and the future
• In situations where there was no practice of medicine
physical autopsy and the cause of
death was not determined by a
physician.
Purpose
The purpose of an autopsy is two-fold:
1) To thoroughly evaluate the presence
and extent of human disease in patients
Vital Statistics in Midwifery

• Interactive Autopsy Introduction. ... Importance

• Step 1 - External Examination Autopsies are diagnostic by nature,
• Step 2 - Internal Examination and can help a family learn more
information about the disease
• Step 3 - Viewing the internal organs processes that caused a patient's
Step 4 - Removal of the organs demise. For example, an autopsy could
• Step 5 - Removing the brain identify an unknown primary cancer, or
it can allow doctors to perform
• Step 6 - Examining the organs
examinations that were not feasible
when the patient was alive.
Vital Statistics in Maternal Death

A maternal death review provides an For effective review of maternal death,

opportunity for health staff, family and there is guideline in existence which
communities to learn from a tragic – outlines the following:
and often preventable - event. • A) The process of reviewing a
Maternal death reviews should be maternal death
conducted as learning exercises that do • B) The requirements for reporting a
not include blaming, finger-pointing or maternal death
punishment
Process of Reviewing Maternal Death

• A) The process of reviewing a • Yes. Every maternal death that occurs

maternal death within a refugee camp (of a refugee or a
national), at home or at a referral health
• As seen earlier, maternal death is facility should be systematically reviewed
death of a woman while pregnant or
within 42 days of the end of What is the purpose of reviewing a
maternal death?
pregnancy, irrespective of the duration
and the site of the pregnancy, from any • provides a rare opportunity for a group of
cause related to or aggravated by the health staff and community members to
pregnancy or its management, but not learn from a tragic – and often
from accidental or incidental causes. preventable - event.
• Is conducted as learning exercises that do
Should each maternal death be not include finger-pointing or punishment
reviewed?
•
Process of Reviewing Maternal Death

• To improve the quality of safe Community-Based Maternal Death

motherhood programming to prevent Review / Verbal Autopsy
future maternal and neonatal Facility-Based Maternal Death
morbidity and mortality. Review
What process should be used to review Community-Based Maternal Death
a maternal death? Review / Verbal Autopsy
• There are 2 main methodologies for Definition: A method of finding out the
reviewing maternal deaths that are medical causes of death and ascertaining
relevant to a refugee setting: the personal, family or community
factors that may have contributed to the
death of a woman who died outside of a
medical facility
Process of Reviewing Maternal Death

Requirements • Allows both medical and non-medical

• Cooperation from the family of the factors to be explored
woman who died and sensitivity is • Provides the opportunity to include the
needed in discussing the family’s perspective on health services
circumstances of the death Disadvantages:
Advantages: • Different assessors may arrive at
• Provides means to arrive at medical different causes of death
cause of death when a woman dies at • Deaths from indirect causes may be
home overlooked / underreported
Process of Reviewing Maternal Death

Facility-Based Maternal Death Review Requirements:

• Definition: A qualitative, in-depth • Cooperation from those who provided
investigation of the causes of and care to the woman who died, and their
circumstances surrounding a maternal willingness to report accurately on the
death at a health facility; management of the case
• the death is initially identified at the Advantages:
facility level but such reviews are also • Is a well-understood process in some
concerned with identifying the settings
combination of factors at the facility
and in the community that contributed • Allows for complete review of
to the death, and which ones were medical aspects
avoidable
Process of Reviewing Maternal Death

• Provides a learning opportunity for all the necessary capacity:

staff, and can stimulate improvements “Near Miss” Review
to medical care
Definition: The identification and
Disadvantages: assessment of cases in which a pregnant
• Requires committed leadership at the woman survives an obstetric
facility level complication;
• Does not provide information about • there is no universally acceptable
deaths occurring in the community definition for such cases and it is
A 3rd, additional methodology for important that the definition used be
improving safe motherhood programs is appropriate to local circumstances to
optional for country programs with enable local improvements in maternal
care
Process of Reviewing Maternal Death

Requirements: • it is possible to interview the woman

• Good-quality medical record system herself during the review process,
• Management culture where life- • Can reduce the likelihood of future
threatening events can be discussed maternal deaths through quality
freely without fear of blame improvement
• Commitment from management and Disadvantages:
clinical staff to act upon findings • Requires clear definition of severe
Advantages: maternal morbidity
A “near-miss” may occur more • Selection criteria are required for
frequently than a maternal death settings with a high volume of life-
threatening events
Process of Reviewing Maternal Death

• B) The Process of Reporting a • The County Reproductive Health

Maternal Death Officer, and
Should each maternal death be • Other relevant staff (e.g. IP Health
reported? Coordinator, other partner agencies,
• Yes. The accompanying report form etc.)
(or a substitute format available in • How do I complete the REVIEWERS
your location) should be completed section of the form?
electronically for each maternal death • It is important to include multiple
review and e-mailed (at minimum) to: people in the process of reviewing a
• The Sub-County Health Coordinator maternal death, regardless of whether
and the death occurred in the community
or in a health facility.
Process of Reviewing Maternal Death

Some examples of people you might • How do I complete the INFORMATION

want to include are: sections of the form?
• Relevant family members (sister, • Fill in three sections (summary
husband, boyfriend, parent(s), information, information on pregnancy,
friend(s), etc.) information on death)
• Relevant • This allows the service provider to
health staff (TBAs,
document basic information pertaining to
midwives, doctors, managers, the woman who died.
coordinators, etc.)
• additional factors specific to location of
• Relevant community leaders discussion during the review (e.g. the
(religious, elders, women’s woman’s address, her religion, etc.) that
association, youth, etc.) do not need to be documented in the
summary report.
Process of Reviewing Maternal Death

How do I complete the • Timeline of relevant events that have

SUMMARIZED HISTORY section of not already been documented
the form? • Summary of the interventions
• This section summarizes the story of treatment provided prior to the death
what happened • Relevant patient history not already
• It is intentionally open-ended so that documented
one can include the immediate events
surrounding different types of
maternal deaths
• Some elements one might want to
include (in both the review process
and the report) are
Process of Reviewing Maternal Death

• How do I complete the RELEVANT • may be important facility-level in the

DELAY FACTORS section of the community.
form?
• This section encourages one to review
and document the relevant delay
factors by using the Three Delay
Model for maternal mortality.
• Remember that there may be
important community-level factors
related to a death in a health facility,
factors related to a death just as there
Process of Reviewing Maternal Death

• Some examples of direct causes of maternal death are:

Ectopic pregnancy Eclampsia Sepsis

Obstructed labour Antepartum hemorrhage Post-partum hemorrhage

Abortion complications Anaesthetic complications Embolism

Process of Reviewing Maternal Death

• Some examples of indirect causes of maternal death are: :

Anaemia Malaria HIV/AIDS

Heart disease Substance abuse Substance abuse

Vital Statistics in Midwifery

How do I complete the LESSONS • It is important to consider lessons and

LEARNED & ACTION TO BE action related to both the community
TAKEN section of the form? and to the health facility.
• This will likely be the most important
component of maternal death review.
• After analyzing all of the relevant
information, individuals involved need
to agree on key lessons learned from
the process and commit to action that
will improve these areas in the future.
Example of Formulation of Maternal Death Review
Committees
Three Delays Model and our Integrated Approach

The Three Delays Model and • This is based on the Three

our Integrated Approach Delays Model* which identifies
• Maternity Worldwide uses an three groups of factors which
integrated approach to address may stop women and girls
each of the issues women face accessing the maternal health
when trying to access safe care they need:
childbirth.
Three Delays Model and our Integrated
Approach
• The "Three Delays" model • (3) receiving adequate care
proposes that pregnancy-related when a facility is reached.
mortality is overwhelmingly due
to delays in:
• (1) deciding to seek appropriate
medical help for an obstetric
emergency
• (2) reaching an appropriate
obstetric facility
Three Delays Model and our Integrated Approach

• 1: Delay in decision to seek care • 2. Delay in reaching care due to;

due to;
• Distance to health centres and
• The low status of women hospitals
• Poor understanding of complications • Availability of and cost of
and risk factors in pregnancy and
when to seek medical help
transportation
• Previous poor experience of health • Poor roads and infrastructure
care • Geography e.g. mountainous
• Acceptance of maternal death terrain, rivers
• Financial implications
Three Delays Model and our Integrated Approach

• 2. Delay in receiving adequate • END END

health care due to;

• Poor facilities and lack of medical

supplies Thank you for your
• Inadequately trained and poorly participation
motivated medical staff
• Inadequate referral systems

END