title: Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi.
abstract: BACKGROUND
  In Malawi, maternal mortality remains high. Existing maternal death reviews fail to adequately review most deaths, or capture those that occur outside the health system. We assessed the value of community involvement to improve capture and response to community maternal deaths.
  
  
  METHODS
  We designed and piloted a community-linked maternal death review (CLMDR) process in Mchinji District, Malawi, which partnered community and health facility stakeholders to identify and review maternal deaths and generate actions to prevent future deaths. The CLMDR process involved five stages: community verbal autopsy, community and facility review meetings, a public meeting and bimonthly reviews involving both community and facility representatives.
  
  
  RESULTS
  The CLMDR process was found to be comparable to a previous research-driven surveillance system at identifying deaths in Mchinji District (population 456,500 in 2008). 52 maternal deaths were identified between July 2011 and June 2012, 27 (52%) of which would not have been identified without community involvement. Based on district estimates of population (500,000) and crude birth rate (35 births per 1000 population), the maternal mortality ratio was around 300 maternal deaths per 100,000 live births. Of the 41 cases that started the CLMDR process, 28 (68%) completed all five stages. We found the CLMDR process to increase the quantity of information available and to involve a wider range of stakeholders in maternal death review (MDR). The process resulted in high rates of completion of community-planned actions (82%), and district hospital (67%) and health centre (65%) actions to prevent maternal deaths.
  
  
  CONCLUSIONS
  CLMDR is an important addition to the established forms of MDR. It shows potential as a maternal death surveillance system, and may be applicable to similar contexts with high maternal mortality.
authors.affiliation: University College London Institute for Global Health, London, UK.
authors.forename: Olivia
authors.initials: O
authors.lastname: Bayley
authors.affiliation: MaiMwana Project, Mchinji, Malawi.
authors.forename: Hilda
authors.initials: H
authors.lastname: Chapota
authors.affiliation: MaiMwana Project, Mchinji, Malawi.
authors.forename: Esther
authors.initials: E
authors.lastname: Kainja
authors.affiliation: MaiMwana Project, Mchinji, Malawi.
authors.forename: Tambosi
authors.initials: T
authors.lastname: Phiri
authors.affiliation: Department of Safe Motherhood, Mchinji District Health Management Team, Mchinji, Malawi.
authors.forename: Chelmsford
authors.initials: C
authors.lastname: Gondwe
authors.affiliation: University College London Institute for Global Health, London, UK.
authors.forename: Carina
authors.initials: C
authors.lastname: King
authors.affiliation: University College London Institute for Global Health, London, UK.
authors.forename: Bejoy
authors.initials: B
authors.lastname: Nambiar
authors.affiliation: Government of Malawi Ministry of Health, Lilongwe, Malawi Parent and Child Health Initiative (PACHI), Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Mwansambo
authors.affiliation: Parent and Child Health Initiative (PACHI), Lilongwe, Malawi Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.
authors.forename: Peter
authors.initials: P
authors.lastname: Kazembe
authors.affiliation: University College London Institute for Global Health, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: Women and Children First, London, UK.
authors.forename: Mikey
authors.initials: M
authors.lastname: Rosato
authors.affiliation: University College London Institute for Global Health, London, UK.
authors.forename: Tim
authors.identifier: http://orcid.org/0000-0002-6917-6552
authors.initials: T
authors.lastname: Colbourn
mesh_terms: D002423:Cause of Death; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008427:Maternal Health Services; D008428:Maternal Mortality; D010865:Pilot Projects; D011314:Preventive Health Services; D015397:Program Evaluation; D062486:Public Health Surveillance / Q000379:methods*; D012423:Rural Health / Q000706:statistics & numerical data*
keywords: AUDIT; HEALTH SERVICES ADMINISTRATION & MANAGEMENT