Evaluation of Maternal Deaths Surveillance System in Erongo Region - Namibia, 2016-2020

Background

In Namibia, maternal death (MD) is an immediate mandatory notifiable event incorporated in the Integrated Disease Surveillance and Response (IDSR) reports and captured in the District Health Information Software2 (DHIS2). The goal of maternal death surveillance (MDS) is to detect MD and reduce maternal mortality rate. MD reports and MDS data captured at health facilities in Erongo Region (ER) have reportedly been plagued with incompleteness despite timely reporting. We assessed the attributes of MDS in ER from January 2016 to December 2020 to see if its meeting its objectives.

Methods

We conducted a descriptive cross-sectional study and evaluated MDS using updated CDC guidelines. We used semi-structured questionnaires to collect information from 21 conveniently chosen key informants. Scorecards were developed to assess usefulness, simplicity, data quality and timeliness. To create a case line list, we extracted data from medical records, maternal death review forms (MDRF), IDSR reports and DHIS2. Microsoft Excel was used to perform descriptive analysis.

Results

Usefulness: MDS detected 11 MD and 4 deaths (36%) were preventable. Simplicity: 19 respondents (90.4%) correctly defined maternal mortality and 18 (81%) reported was easy to apply. However, 13 (62%) indicated data entry into DHIS2 was complex and tedious; 10 respondents (47.6%) received DHIS2 and IDSR training due to high turnover staff. Timeliness: All MD were reported within 24 hours, maternal death review meetings were held for all cases at district and regional levels; and feedback was given back to facilities promptly. Data quality: MDRF of 4 (36%) MD were incompletely filled and had discrepancies in classification of underlying causes of deaths captured in DHIS2 and IDSR reports.

Conclusion

MDS in ER is meeting its objectives. It is useful, timely, simple but complex for data entry. We recommended focal surveillance and health information officers to conduct regular DHIS2 and IDSR trainings; provide adequate supervision and mentorship to health-workers.