Russell Neal, Tappis Hannah, Mwanga Jean Paul, Black Benjamin, Thapa Kusum, Handzel Endang, Scudder Elaine, Amsalu Ribka, Reddi Jyoti, Palestra Francesca, Moran Allisyn C
, London, UK.
Jhpiego, Baltimore, MD, USA.
Confl Health. 2022 May 7;16(1):23. doi: 10.1186/s13031-022-00440-6.
Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analysing and learning lessons from such deaths in order to respond and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA and UNHCR on 17th-18th October 2019, informed by semi-structured interviews with a range of professionals, including expert attendees.
Interviewees revealed significant obstacles to full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicisation of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalisation and implementation capacity for MPDSR within humanitarian organisations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings.
Despite the challenges, examples exist where the lessons learnt from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.
孕产妇和围产期死亡监测与应对（MPDSR）是一个识别、分析此类死亡事件并从中吸取教训以做出应对和预防未来死亡的系统，世界卫生组织（WHO）已推荐该系统，近年来在许多低收入和中等收入地区得以实施。然而，关于MPDSR在人道主义环境中的经验记录有限。2019年10月17日至18日，WHO、联合国儿童基金会（UNICEF）、美国疾病控制与预防中心（CDC）、救助儿童会、联合国人口基金（UNFPA）和联合国难民事务高级专员公署（UNHCR）召开了一次关于人道主义环境中MPDSR的会议，会议参考了对包括专家与会者在内的一系列专业人员进行的半结构化访谈。
受访者揭示了在人道主义环境中全面实施MPDSR流程存在的重大障碍。许多障碍在资源匮乏的环境中普遍存在，但在人道主义危机背景下被放大，例如服务负担过重、报告的抑制因素、问责差距、指责态度以及死亡率的政治化。人道主义背景下更独特的因素包括对卫生工作者安全的担忧和道德困扰。人道主义组织内部MPDSR的制度化和实施能力水平各不相同。有人认为，如果实施不当，特别是采用惩罚性或指责性方法，MPDSR可能会适得其反。尽管如此，也有人描述了MPDSR取得的成功，即该流程促成了预防死亡的具体行动，并且死亡审查增进了对导致人道主义环境中死亡的复杂且可纠正的背景因素的理解。
尽管存在挑战，但仍有一些例子表明，从MPDSR流程中学到的经验教训已在人道主义环境中带来了更好的医疗服务可及性和质量，包括成功的宣传倡导。需要一种经过调整的方法来确保可行性，在危机的不同阶段可以有不同的实施方式。在人道主义背景下需要关于MPDSR的指导，以及更多的经验记录和借鉴。
