Bayley Olivia, Chapota Hilda, Kainja Esther, Phiri Tambosi, Gondwe Chelmsford, King Carina, Nambiar Bejoy, Mwansambo Charles, Kazembe Peter, Costello Anthony, Rosato Mikey, Colbourn Tim
University College London Institute for Global Health, London, UK.
MaiMwana Project, Mchinji, Malawi.
BMJ Open. 2015 Apr 20;5(4):e007753. doi: 10.1136/bmjopen-2015-007753.
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.
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.
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.
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.
在马拉维，孕产妇死亡率仍然很高。现有的孕产妇死亡审查未能充分审查大多数死亡病例，也未能涵盖那些发生在卫生系统之外的死亡病例。我们评估了社区参与对改善社区孕产妇死亡病例的记录和应对的价值。
我们在马拉维的姆钦吉区设计并试点了一个社区关联孕产妇死亡审查（CLMDR）流程，该流程让社区和卫生机构利益相关者合作，以识别和审查孕产妇死亡病例，并制定预防未来死亡的行动。CLMDR流程包括五个阶段：社区口头尸检、社区和机构审查会议、公开会议以及由社区和机构代表参与的双月审查。
发现CLMDR流程在识别姆钦吉区（2008年人口为456,500）的死亡病例方面与之前基于研究的监测系统相当。在2011年7月至2012年6月期间识别出52例孕产妇死亡病例，其中27例（52%）在没有社区参与的情况下不会被识别出来。根据该地区的人口估计数（500,000）和粗出生率（每1000人口中有35例出生），孕产妇死亡率约为每10万活产中有300例孕产妇死亡。在启动CLMDR流程的41例病例中，28例（68%）完成了所有五个阶段。我们发现CLMDR流程增加了可获得的信息量，并让更广泛的利益相关者参与到孕产妇死亡审查（MDR）中。该流程导致社区计划行动的完成率很高（82%），以及地区医院（67%）和卫生中心（65%）预防孕产妇死亡行动的完成率很高。
CLMDR是现有MDR形式的重要补充。它显示出作为孕产妇死亡监测系统的潜力，并且可能适用于孕产妇死亡率高的类似情况。
