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Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to  deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2015. , 100 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 63
Keyword [en]
Bangladesh, Facility Death Review, Maternal and Neonatal Health, Social Autopsy, Verbal Autopsy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:oru:diva-46379ISBN: 978-91-7529-103-1 (print)OAI: oai:DiVA.org:oru-46379DiVA: diva2:866359
Public defence
2015-12-09, Hörsalen, Musikhögskolan, Örebro universitet, Fakultetsgatan 1, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2016-08-10Bibliographically approved
List of papers
1. Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh
Open this publication in new window or tab >>Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh
2014 (English)In: Health, ISSN 1949-5005, Vol. 6, no 16, 2218-2226 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system.

Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010.

Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities.

Place, publisher, year, edition, pages
China: Scientific Research Publishing, 2014
Keyword
Community death notification, maternal and neonatal death, bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-41207 (URN)10.4236/health.2014.616257 (DOI)
Note

Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2016-08-10Bibliographically approved
2. Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh
Open this publication in new window or tab >>Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh
Show others...
2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh.

Methods: Both quan- titative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangla- desh. Death notifications from households, subsequent data collections from a focus-group discus- sion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines.

Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness pro- grammes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community health- care providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13).

Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

Keyword
Maternal and neonatal health, death review, primary healthcare, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-41213 (URN)
Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2017-02-28Bibliographically approved
3. Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh
Open this publication in new window or tab >>Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh
Show others...
2015 (English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:oru:diva-46529 (URN)
Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-02-23Bibliographically approved
4. Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal Deaths
Open this publication in new window or tab >>Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal Deaths
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:oru:diva-46531 (URN)
Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2015-11-18Bibliographically approved
5. Facility Death Review of Maternal and Neonatal Deaths in Bangladesh
Open this publication in new window or tab >>Facility Death Review of Maternal and Neonatal Deaths in Bangladesh
Show others...
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, e0141902Article in journal (Refereed) Published
Abstract [en]

Objectives: To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.

Methods This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.

Results: FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.

Discussion: FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

Place, publisher, year, edition, pages
San Francisco, USA: Public Library of Science, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:oru:diva-46535 (URN)10.1371/journal.pone.0141902 (DOI)000364303800035 ()26540233 (PubMedID)2-s2.0-84951309788 (Scopus ID)
Note

Funding Agencies:

UNICEF, Bangladesh through Canadian CIDA (Department of Foreign Affairs, Trade and Development)

Department for International Development (DFID) & European Commission (EC)

Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-03-07Bibliographically approved
6. The economic cost of implementing maternal and neonatal death review in a district of Bangladesh
Open this publication in new window or tab >>The economic cost of implementing maternal and neonatal death review in a district of Bangladesh
(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:oru:diva-46533 (URN)
Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2015-11-18Bibliographically approved

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