title: Community based maternal death review: lessons learned from ten districts in Andhra Pradesh, India.
abstract: Maternal death is as much a social phenomenon as a medical event. Maternal death review (MDR), a strategy for monitoring maternal deaths, provides information on medical, social and health system factors that should be addressed to redress gaps in service provision or utilisation. To strengthen MDR implementation in the state of Andhra Pradesh, India. The project involved development of state specific guidelines, technical assistance in operationalization and analysing processes and findings of MDR in ten districts. 284 deaths were recorded over 6 months (April-September 2012) of which 193 (75.4 %) could be reviewed. Post-partum haemorrhage (24 %) and hypertensive disorders (27.4 %) followed by puerperal sepsis in the post-partum period (16.8 %) were the leading causes of maternal deaths. 68.3 % deaths occurred at health facilities. 67 % of mothers dying during the natal or post-natal period, delivered at home, though the death occurred in a health facility. Type 1 delay (58.9 %) was the most common underlying cause of death, followed by type 3 delay (33.3 %). Under or nil reporting from the facilities was observed. Program staff could identify broad areas of intervention but lacked capacity to monitor, analyse, interpret and utilize the generated information to develop feasible actionable plans. Information gathered was incomplete and inaccurate in many cases. Challenges observed showed that it will require more time and continuous committed efforts of health staff for implementation of high quality MDR. Successful implementation will improve the response of the health system and contribute to improved maternal health.
authors: Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1-Amar Coop Society, Kavuri Hills, Madhapur, Hyderabad, 500033, Andhra Pradesh, India, samiksha.singh@iiphh.org.
authors: Samiksha
authors: S
authors: Singh
authors: Gudlavalleti V S
authors: GV
authors: Murthy
authors: Anitha
authors: A
authors: Thippaiah
authors: Sanjeev
authors: S
authors: Upadhyaya
authors: Murali
authors: M
authors: Krishna
authors: Rajan
authors: R
authors: Shukla
authors: S R
authors: SR
authors: Srikrishna
mesh_terms: D000328:Adult; D002423:Cause of Death; D055812:Community-Based Participatory Research; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D008423:Maternal Age; D063130:Maternal Death / Q000208:ethnology / Q000706:statistics & numerical data*; D008427:Maternal Health Services / Q000458:organization & administration; D008428:Maternal Mortality; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011181:Postnatal Care; D006473:Postpartum Hemorrhage / Q000208:ethnology; D011247:Pregnancy; D012111:Residence Characteristics
references: Bull World Health Organ. 2011 Nov 1;89(11):779-779A
references: 22084519
references: Health Res Policy Syst. 2011 Nov 30;9:41
references: 22128848
references: Glob Health Sci Pract. 2013 Mar 21;1(1):84-96
references: 25276519
references: J Health Popul Nutr. 2009 Apr;27(2):220-34
references: 19489417
references: Indian J Public Health. 2010 Apr-Jun;54(2):57-64
references: 21119236
references: Womens Health Issues. 2009 Jan-Feb;19(1):14-20
references: 19111783
references: Glob Health Action. 2013 Apr 03;6:19145
references: 23561028
references: Lancet. 2006 Apr 1;367(9516):1066-1074
references: 16581405
references: BMC Pregnancy Childbirth. 2008 Sep 11;8:42
references: 18786267
references: Semin Perinatol. 2012 Feb;36(1):7-13
references: 22280859
references: Reprod Health Matters. 2007 Nov;15(30):91-102
references: 17938074
references: Indian J Public Health. 2006 Jul-Sep;50(3):173-8
references: 17191404
references: Int J Gynaecol Obstet. 2009 Jul;106(1):89-94
references: 19428010
references: Asia Pac J Public Health. 2015 Mar;27(2):NP1161-9
references: 22308538
references: BMC Pregnancy Childbirth. 2008 Feb 28;8:6
references: 18307796
references: Bull World Health Organ. 2002;80(3):228-34
references: 11984609