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MDSR : Evidence of Effectiveness from the International Literature

MDSR : Evidence of Effectiveness from the International Literature. From: http://hamlin.org.au/what-we-do/. Cycle of Data Collection, Reflection & Action. IDENTIFY THE PROBLEM. MONITOR ACTIONS & ADAPT IF REQUIRED. COLLECT DATA. IMPLEMENT RECOMMENDATIONS. PRESENT DATA IN USEFUL FORMATS.

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MDSR : Evidence of Effectiveness from the International Literature

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  1. MDSR: Evidence of Effectiveness from the International Literature From: http://hamlin.org.au/what-we-do/

  2. Cycle of Data Collection, Reflection & Action IDENTIFY THE PROBLEM MONITOR ACTIONS &ADAPT IF REQUIRED COLLECT DATA IMPLEMENT RECOMMENDATIONS PRESENT DATA IN USEFUL FORMATS PROPOSE SOLUTIONS DISCUSS DATA WITH RELEVANT PEOPLE ANALYSE DATA

  3. Cycle of Data Collection, Reflection & Action EVIDENCE IDENTIFY THE PROBLEM MONITOR ACTION &ADAPT IF REQUIRED COLLECT DATA IMPLEMENT RECOMMENDATIONS PRESENT DATA IN USEFUL FORMATS ACTION DISCUSS DATA WITH RELEVANT PEOPLE PROPOSE SOLUTIONS ANALYSE DATA REVIEW

  4. Example 1: Piloting a new MDSR in ZAMBIA(Evidence of improved quality of care)

  5. Piloting MDSR in Zambia • In 2007, Zambia’s MMR estimated at 591 • Data often not recorded outside labour ward EVIDENCE: • IMDA: Investigate Maternal Deaths and Act Piloted over 12 months 2006-7 • Facility & Community based data collection (TBA trained to notify maternal deaths) • Narrative approach to record immediate causes and wider social determinants M. Hadley and M. Tuba (2011) Local problems; local solutions: an innovative approach to investigating and addressing causes of maternal deaths in Zambia’s Copperbelt. Reproductive Health8:17  

  6. Piloting and MDSR in Zambia REVIEW: • 4-5 anonymised cases discussed per meeting • 11 Data review meetings held, chaired by Provincial Health Director • Participants: provincial & district officers, health staff, blood transfusion reps, TBA, external obstetricians • Total of 56 deaths reported (53 in tertiary hospital; 1 HC; 1 home) • Meetings also reviewed progress on previously identified action points

  7. Health Seeking Issues: • Families often sought traditional remedies first • Some husband didn’t give approval to seek care • Communities lack resources for transport Health systems weaknesses: • Shortfall in supplies • Absence of Obstetricians • Inadequate blood supply Case Management at facilities: • 67% cases had inaccurate diagnosis • Post mortems not routinely conducted • Malaria used as “default” cause of death in unclear cases but not confirmed

  8. ACTIONS (based on 68 recommendations): • Obstetrician allocated to hospital • Post mortems conducted • Antibiotics stocked for post-abortion and post-partum sepsis • Birth planning introduced in antenatal care • Measures to increase blood supply introduced

  9. RE-STARTING THE CYCLE : Looking for Evidence of Progress one year later • 61% recommendations implemented • 12 % partially implemented • 27% not implemented

  10. Example 2: Facility Based MDSR in SENEGAL(Evidence of improved clinical outcomes)

  11. MDSR Effects on Clinical Outcomes in Senegal Evidence: • Facility based MDR + interviews with family • Midwives responsible for identifying maternal deaths • Senior Obstetrician reviewed cases and collected data from others • Data analysed for baseline (1997) and 3 years after MDSR introduced (1998-2000)

  12. MDSR Effects on Clinical Outcomes in Senegal REVIEW: • 153 maternal deaths reviewed in total • District Health Manager chairs annual meetings and evaluates progress ACTION: • 13 recommendations implemented, mainly: • 24-hour availability of life saving services, drugs and blood products • Improved availability of basic emergency obstetric care • Recommendations NOT implemented included • Expansion of delivery unit • Staff recruitment

  13. CHANGES IN QUALITY OF CARE: • Increased uptake of Antenatal care (in Year 1, 11% women had no ANC visit and by Year 2, just 4.2% did not attend) • Rates of transfusion up from 1% in Year 2 to 2.1% in Year 3 CHANGES IN MATERNAL MORTALITY: Baseline: 50 deaths Year 1: 43 deaths Year 2: 33 deaths Year 3: 27 deaths Number of maternal deaths fell by almost 50% over the study period

  14. From Dumont et al (2006) Facility Based Maternal Death Reviews: Effects on Maternal Mortality in a District Hospital in Senegal. Bulletin of the World Health Organization 84: 218-224.

  15. Summary Points • MDSRs involve an ongoing cycle of collecting and synthesising data, reviewing the determinants of maternal deaths, implementing actions, and monitoring them to ensure change • Many countries have introduced MDSR and demonstrate positive effects on quality of care and health outcomes • Responses should link with and strengthen existing quality improvement measures, rather than introduce parallel processes

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