Evaluation of the Maternal Death Surveillance and Response System, Sierra Leone, 2019
Introduction: Sierra Leone has one of the world's highest maternal mortality ratios (1,120 per 100,000 live births in 2017). It implemented the Maternal Death Surveillance and Response (MDSR) system in 2016 to track maternal deaths in real time. We evaluated the system's effectiveness by a...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
African Field Epidemiology Network
2025-01-01
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| Series: | Journal of Interventional Epidemiology and Public Health |
| Subjects: | |
| Online Access: | https://www.afenet-journal.net/content/series/8/2/1/full/ |
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| Summary: | Introduction: Sierra Leone has one of the world's highest maternal mortality ratios (1,120 per 100,000 live births in 2017). It implemented the Maternal Death Surveillance and Response (MDSR) system in 2016 to track maternal deaths in real time. We evaluated the system's effectiveness by assessing key surveillance attributes.
Methods: A descriptive cross-sectional evaluation assessed Sierra Leone's MDSR system from October to November 2019, reviewing 2018 data. Thirty-six health workers were interviewed across various levels of the MDSR system (national, district, and health facility). We reviewed maternity registers and the MDSR forms and analyzed the National MDSR database using Excel. The evaluation followed the CDC Updated Guidelines for Surveillance Systems Evaluation and National MDSR Technical Guidelines.
Results: The MDSR system requires multi-level reporting; form completion takes 10-20 minutes per case. Facilities visited had adequate reporting forms but limited MDSR guidelines and standard operating procedures. Challenges included limited internet and computer access (75%; 27/36) and difficulty analyzing data 58% (21/36). Only 42% (15/36) reported using MDSR data for decision-making. All respondents viewed maternal death notification as their duty, with 33% holding regular MDSR meetings. In 2018, the MDSR system reported 588 MDs, with 84% (494/588) reviewed, and 86% (504/588) recorded in the DHIS2. Completeness of report was 89.9%, and timeliness 76%, with 63% (281/447) of facility-based deaths notified within 24 hours and 78% (51/65) of community-based deaths within 48 hours.
Conclusion: Overall, the MDSR system partially meets its objective of obtaining and using information to guide public health actions. The system was useful and acceptable but not simple. Delays in MDs notification and poor data quality may negatively affect the system in reporting accurate and timely information. A review of all MDs is recommended, enhanced data quality and regular system evaluations to identify gaps and implement interventions for improvement. |
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| ISSN: | 2664-2824 |