Abstract
IntroductionIn Zimbabwe the integrated disease surveillance and response guidelines include maternal mortality as a notifiable event reported through the Maternal Mortality Surveillance System (MMSS). A preliminary review of the MMSS data for Mutare district for the period January to June 2014 revealed that there were some discrepancies in cases notified and those captured on the T5 monthly return form. There were also delays in reporting of some maternal deaths. Poor reporting indicated shortcomings in the MMSS in Mutare district and we therefore sought to assess the performance of the maternal mortality surveillance system in Mutare district.MethodsA descriptive cross sectional study was conducted using Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. A total of 64 health workers were enrolled into the study from 19 selected health facilities in Mutare district and 32 maternal death notification forms submitted in 2014 to the provincial office were reviewed to assess the quality of information on the forms. Interviewer administered questionnaires were used to collect information from enrolled health workers, the system's attributes namely usefulness, acceptability, simplicity, stability, data quality, timeliness and completeness were assessed and a checklist was used to assess availability of resources for the implementation of the maternal mortality surveillance. We also determined the cost of reporting each maternal death in Mutare district.ResultsHalf of the study participants gave the correct definition of a maternal death. All health workers participated and were willing to continue participating in the maternal mortality surveillance. Majority of health workers, 79.7% used data generated from the surveillance system and 59.5% found it easy to implement the system. A total of 32 death notification forms were reviewed and of these, 31 forms were forwarded to the national office and all did not reach the national office on time. Average completeness of notification forms was 76.0% and 53.1% of the forms had all the necessary accompanying documents. Reporting each maternal death was estimated to cost $28.65 in Mutare district.ConclusionThe strongest components of the maternal mortality surveillance system in Mutare district were usefulness and acceptability. Timeliness and completeness were the weaker components of the system. The system was found to be simple; however, resources were not adequately available in all health facilities.
Highlights
In Zimbabwe the integrated disease surveillance and response guidelines include maternal mortality as a notifiable event reported through the Maternal Mortality Surveillance System (MMSS)
Uses of this information were; making informed decisions on maternal health as stated by 35.3% of health workers, 25.5% used it for monitoring performance of public health interventions and 23.5% for capturing maternal mortality statistics
40.6% said it was difficult and the challenge mentioned by most, 13(50%), was the issue of religious objectors of the Apostolic sect in Mutare district who do not use health facilities for maternal health services and if a death occurs in their communities they do not report it
Summary
In Zimbabwe the integrated disease surveillance and response guidelines include maternal mortality as a notifiable event reported through the Maternal Mortality Surveillance System (MMSS). A total of 64 health workers were enrolled into the study from 19 selected health facilities in Mutare district and 32 maternal death notification forms submitted in 2014 to the provincial office were reviewed to assess the quality of information on the forms. Interviewer administered questionnaires were used to collect information from enrolled health workers, the system's attributes namely usefulness, acceptability, simplicity, stability, data quality, timeliness and completeness were assessed and a checklist was used to assess availability of resources for the implementation of the maternal mortality surveillance. We determined the cost of reporting each maternal death in Mutare district. Reporting each maternal death was estimated to cost $28.65 in Mutare district. In 2012 the United Nations Commission on the status of women passed on a resolution calling for the elimination of preventable maternal mortality. Reporting of maternal deaths is critical if the MDSR system is to be successful-memories of such events and the surrounding circumstances becomes less clear as time passes [5]
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