Maternal death review in Africa.
OBJECTIVE
WHO, UNICEF, and UNFPA with other development partners have supported African Ministries of Health to institutionalize maternal death review (MDR) since 2003. To evaluate the program, its status, lessons learned, and the challenges to success were reviewed in 2007.


METHODS
A standard self-administered questionnaire was sent to Ministries of Health in 46 Sub-Saharan African countries in May 2007. Completed questionnaires were returned by e-mail, processed, and analyzed.


RESULTS
Thirty countries completed the survey questionnaire. Maternal death is a notifiable condition in 21 (67%) counties. A national committee has been set up to plan, coordinate, and implement MDR activities in 7 countries. Fifteen countries stated that facility-based MDR is the main method selected for conducting reviews of the causes of maternal death. Fourteen (47%) countries reported that national MDR guidelines had been developed and 12 (40%) had implemented the guidelines. Fifteen (50%) countries reported that maternal deaths were reviewed and analyzed. Only 7 countries reported that the government had allocated a budget for MDR. Implementation of MDR has led to local policy changes and improvement in quality of maternal health services in several countries. Ten of the 15 countries in which analysis has been conducted reported that recommendations have been implemented at least at the health facility level.


CONCLUSIONS
Although use of MDR is increasing in African countries, effective coverage is still low. The institutionalization of MDR requires political commitment, legal and administrative back-up, financial support, capacity development, simplified reporting forms and procedures, coordinated support of development partners, involvement of professional bodies, and regular supportive follow-up.
Pearson
Luwei
L
UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya. lpearson@unicef.org
deBernis
Luc
L
Shoo
Rumishael
R
D017954:Africa South of the Sahara / Q000453:epidemiology; D002017:Budgets / Q000706:statistics & numerical data; D002423:Cause of Death; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D006291:Health Policy; D006801:Humans; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires