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Cited by 22Global Maternal and Child HealthMaternal and fetal healthcareMaternal and Neonatal Healthcare

Maternal death surveillance and response in Tanzania: comprehensiveness of narrative summaries and action points from maternal death reviews

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Said, Ali, Pembe, Andrea B., Massawe, Siriel, Hanson, Claudia, Malqvist, Mats·2021·BMC Health Services Research
DOI 10.1186/s12913-020-06036-1PMC PMC7802180

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Abstract

Background: Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable, Relevant and Time bound (SMART). To identify gaps in documenting information and developing recommendations, comprehensiveness of written narrative summaries and action plans were assessed. Methods: A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were included for analysis. Using a prepared checklist from Tanzania 2015 MDSR guideline, we assessed comprehensiveness by presence or absence of items in four domains, each with several attributes. These were socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less than 75% completeness of attributes in all domains was considered poor while 95% and above were good/comprehensive. Action plans were assessed by application of SMART criteria and according to the place of planned implementation (community, facility or higher level of health system). Results: Almost half of narrative summaries (49%) scored poor, and only1% scored good/comprehensive. Summaries missed key information such as demographic characteristics, time between diagnosis of complication and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral information (47%). A total of 285 action points were analysed. Most action points, 242(85%), recommended strategies to be implemented at health facilities and were mostly about service delivery, 120(42%). Only 42% (32/76) of the action points were deemed to be SMART. Conclusions: Abstraction of information to prepare narrative summaries used in the MDSR system is inadequately done. Most recommendations were unspecific with a focus on improving quality of care in health facilities.

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  • Already overburdened healthcare systems face competing priorities when it comes to the implementation and follow-up of MDSR.

    “Additionally, already overburdened healthcare systems face competing priorities when it comes to the implementation and follow‐up of MDSR. 4 , 5 , 6 , 7”

    From Review of maternal death audits in refugee camps in <scp>UNHCR</scp> East and Horn of Africa and Great Lakes Region, 2017–2019 (2023) · cites this paper as [6]

    The Discussion (page unavailable) reports that many MDSR action points were nonspecific and that most facilities lacked a systematic way to track their implementation, supporting difficulties with implementation and follow-up. It does not attribute those difficulties to overburdened healthcare systems or competing priorities. (LLM, conf=0.84)

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1 of the 27 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [13]Danladi Garba K. Significance and chalenges of medical records: A systematic literature review ISST. Journal of Advances In Librarianship. 2016;9(1):26–31. https://www.researchgate.net/publication/309034245.
  2. [30]Muchemi O Gichogo A Maternal Mortality in Central Province, Kenya, 2009–2010 The Pan African medical journal 2014 17 201 25396027 PMC4229002

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Authors
Said, A., Pembe, A. B., Massawe, S., Hanson, C., & Malqvist, M.
Affiliations
  • Uppsala University (SE)
  • Muhimbili University of Health and Allied Sciences (TZ)
  • Karolinska Institutet (SE)
Corresponding author
Said, Ali
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2021-01-11
Volume
21
Issue
1
Pages
52-52
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-020-06036-1
PMC
PMC7802180
OpenAlex
W3118723642
Cited by
22
References
27
Citations by year
2026: 6 · 2025: 1 · 2024: 6 · 2023: 4 · 2022: 2 · 2021: 3
FWCI
3.71
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Sida
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
maternal death review, narrative summary, action plan, SMART criteria, prenatal care, referral information, care gaps, health service quality, Tanzania
MeSH terms
Female, Health Facilities, Humans, Maternal Mortality, Pregnancy, Tanzania, Global Health, Maternal Death

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