Strengthening MPDSR Practices to Improve Quality of Care in RMNCAH Services in Tanzania: Innovation of Coordinating National Meetings through Virtual

Abstract

Aziza Machenje, Saturini Manangwa, Jafari Lutavi, Ziada Sella and Sunday Dominico

Introduction: Maternal and Perinatal Death Surveillance and Response (MPDSR) is among the proven and evidenced-based interventions strongly recommended by the WHO in reducing maternal and perinatal mortality (1). The MPDSR process applies the principles of the clinical audit by ensuring each maternal and perinatal death occurring at any point of care and in the community are identified, notified reviewed by MPDSR teams at facility, council and regional levels to establish the causes, contributing factors and develop actions to -prevent similar deaths. Maternal death reviews have been done in many countries, including Tanzania, to reveal the causes and contributing factors to maternal deaths, with some success and challenges.

In December,2020 Ministry of health established online MPDSR Zoom meeting which comprises with different members includes;- obstetricians, Gynecologists, paediatrician, other experts doctors, nurses and Midwives. The aim was strengthening skills of the maternal and perinatal health to leaders and healthcare providers in MPDSR processes that contribute to reductions in preventable maternal /perinatal deaths and improve the quality of maternal and perinatal health care by identifying gaps and find possible solutions.

Methods: A retrospective review of maternal and perinatal deaths was conducted daily through virtual meetings involving selected cases from specific region where the team included technical experts from Ministry of Health, PO RALG, academic institutions, respective professional associations and health care providers from respective region. National coordination team was responsible in providing schedules for the regions to present cases for discussion where in each meeting there was a chairperson to moderate discussion. The analysis of the cases discussed was done on monthly basis. Data cleaning and descriptive analysis were performed using Excel, with visualizations created to present findings in figures and tables. Descriptive statistics including frequencies and proportions were utilized to summarize the outcomes of the review.

Results: A total of 139 maternal deaths and 38 perinatal deaths were reviewed from 26 regions from 1st January to 31st December, 2024. Majority of Women 68 (49%) died due to postpartum hemorrhage while few of them died due to other causes such as Malaria, sickle cell Anemia and others 1 (7%). Majority of maternal deaths occurred in the health facilities mainly in Regional referral hospital 43(31%) and District hospital 50(36%). Perinatal death discussed were 38 and majority of deaths were due to birth asphyxia 22(58%) and Respiratory distress syndrome 11(30%) while 1(3%) were due to other causes such as Meconium aspiration syndrome, Brain hypoxia and perinatal sepsis. Majority of deaths occurred at Region referral hospital 30(79%). limitation of the competencies among health care workers was revealed to be the main driver to death ( 80% ) followed with inadequate supervision and support from leadership system which affected health care workers negatively in relation to accountability.

Conclusion: Despite the decline MMR and PMR in Tanzania as reported in TDHS (2022), these rates remain distant from the SDG 2030 target. Therefore, there is a critical need to revitalized MPDSR activities throughout Tanzania and improving EMONC services across all levels of care.

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