# Maternal death surveillance and response system evaluation in Makonde District, Zimbabwe, 2021

## TL;DR

This study evaluated how well a system to track and respond to maternal deaths worked in a district in Zimbabwe in 2021.

## Contribution

The study provides an evaluation of the maternal death surveillance and response system in Makonde District, identifying strengths and weaknesses.

## Key findings

- Health workers had good knowledge of MDSR, but only 62% of maternal deaths were audited.
- Only 31.6% of facilities used electronic health records, and feedback was limited.
- Maternal death notification forms were often not completed or submitted on time.

## Abstract

Maternal mortality is of global concern, almost 800 women die every day due to maternal complications. The maternal death surveillance and response (MDSR) system is one strategy designed to reduce maternal mortality. In 2021 Makonde District reported a maternal mortality ratio of 275 per 100 000 and only sixty-two percent of deaths recorded were audited. We evaluated the MDSR system in Makonde to assess its performance.

A descriptive cross-sectional study was conducted using the CDC guidelines for evaluating public health surveillance systems. An Interviewer-administered questionnaire was used to collect data from 79 health workers involved in MDSR and healthcare facilities. All maternal death notification forms, weekly disease surveillance forms, and facility monthly summary forms were reviewed. We assessed health workers’ knowledge, usefulness and system attributes.

We interviewed 79 health workers out of 211 workers involved in MDSR and 71 (89.9%) were nurses. The median years in service was 8 (IQR: 4–12). Overall health worker knowledge (77.2%) was good. Ninety-three percent of the deaths audited were of avoidable causes. Twelve out of the thirty-eight (31.6%) facilities were using electronic health records system. Feedback and documented shared information were evident at four facilities (21%) including the referral hospital. Nineteen (67.9%) out of 28 maternal death notification forms were completed within seven days and none were submitted to the PMD on time.

The MDSR system was acceptable and simple but not timely, stable and complete. Underutilization of the electronic health system, work load, poor documentation and data management impeded performance of the system. We recommended appointment of an MDSR focal person, sharing audit minutes and improved data management.