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MATERNAL AND PERINATAL DEATH SURVEILLANCE AND RESPONSE (MPDSR)

This is one of the interventions proposed to reduce maternal and perinatal mortality where maternal and perinatal deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths. .Maternal and perinatal death reviews have been in practice for a long time worldwide and the World Health Organization (WHO) introduced the Maternal and Perinatal Death Surveillance and Response with a guideline in 2013. Studies have shown that acting on recommendations from MPDSR can reduce maternal and perinatal mortality by improving quality of care in the community and health facilities.

Steps in implementing MPDSR

The process of MPDSR involves a number of specific steps that have to be followed to make it effective.
 * 1) Identification and notification: The first step is identification and notification where all maternal and perinatal deaths that occur in health facility are identified and notified within 24 hours and those from the community within 48hours. Identification is done by using the WHO definition of maternal and perinatal deaths. Each country has its own system of deaths identification and notification. The WHO recommends also zero reporting to take place
 * 2) Death review. There are two types of reviews; i.e; facility based maternal/perinatal death review and or community based maternal/perinatal death reviews which are done by designated MPDSR committees. A facility based review is meant to explore what happened to the patient in the health care system before his/her death. It usually reveals the gaps in quality of care in terms of time, equipments, expertise, supplies, communication, human resource and governance. The information from facility review is complimented by community based review which seeks to identify the personal, family or community factors that may have contributed to the death in women/newborn who died outside of a medical facility or before the deceased reaches the facility . The information from both facility and community reviews usually reveals the causes of maternal deaths and contributing factors both from the community and health facility .This information is used to prevent similar deaths through analysis, interpretation and action.
 * 3) After the facility and community reviews, the next step is analysis and interpretation of the data generated to provide recommendations for action. The action plans for response should be immediate and or long-term plans, should be evidence based and specific for the health facility and community and involve all stakeholders . The action plans are tailored to address the specific underlying cause of death and contributing cause/factors of death. For this reason it is very important to the MPDSR committee to have correct and consistent categorization of maternal deaths according to International  Classification of Diseases Version 10 Maternal Mortality (ICD-10 MM) .This is based on classification and codes of diseases from ICD-10 . A proper and correct categorization of cause of death using ICD-10 MM will ensure that the actions plans for response are specific and will prevent death from similar cause and circumstance.
 * 4) Maternal and Perinatal Death Surveillance and Response also involve monitoring and evaluation. It entails follow up of implementation of recommendations from the reviews
 * 5) It also involves dissemination of information from lower level to higher level of care with feedback. Reports of death reviews from health facility and community are sent to higher level of care (district or regional). The district/region is responsible for compiling the reports, provide feedback to the facilities/communities and send aggregated information to the national level (Ministry of Health). The ministry compiles national reports, disseminates the reports and uses the information to affect policy change. Therefore MPDSR involves the whole health system from the community to national level. This flow of information and feedback is important in strengthening the health system by addressing deficiencies that can lead to maternal mortality and morbidity.