Thoughts from the Last Mile Welcome to the VillageReach Blog
12.04 2014

Making Sense of Maternal and Child Mortality

The Role of Data Collection and One Community’s Path Toward Change

While working on the Kwitanda Community Health Project (KCHP), based in the Kwitanda catchment area, Balaka District, in southern Malawi, I have seen firsthand how critical the role of data collection is to improving health outcomes. In this rural and remote setting, the news of a maternal death spreads quickly, but quietly, almost like a rumor or story. “Did you hear? Another mother died in childbirth in that village. Another neonatal death occurred last week.” It is difficult to understand the causes of the death, or how often they occur because little information is collected and reported on these events.

Although the District Health Office (DHO) tracks indicators for maternal and neonatal mortality for Kwitanda, the reporting system isn’t reliable and leads to underreporting of deaths in the area.  Since KCHP is working to reduce maternal and neonatal mortality in the area, it is important for us to know both the depth and breadth of the problem. There are many questions we need to answer including: How many women have died? How many newborns? When did the deaths occur? Why? What could be done to prevent these deaths?

To strengthen and supplement the inconsistent and incomplete reporting mechanisms within Kwitanda, VillageReach has undertaken several new initiatives to better understand the questions above.

DHO Partnership: We are strengthening and expanding our partnership with the DHO and with the community health workers, known as Health Surveillance Assistants (HSAs). As community-based staff, the HSAs are usually the first to know of a death and are responsible for reporting these deaths to the DHO. Together with the DHO, VillageReach reviewed the reporting structures and processes for reporting maternal and neonatal deaths. VillageReach also helped to clear up confusion on the definitions of maternal and neonatal deaths for the HSAs.

Investigative Audits: As the reporting from Kwitanda improved, the DHO and VillageReach began meeting together to conduct maternal and neonatal death audits. For each death that is identified, a thorough investigation into the medical, social, geographical, and economic factors that contributed to the death is reviewed. The data coming back from these investigations is helping to identify key areas where VillageReach can intervene, including improving referral processes, increasing access to transport, and encouraging women to deliver in a facility.

Mother’s Registry: The third initiative that we introduced was the identification and registration of all pregnant women in Kwitanda. To fully understand the scope of poor maternal and neonatal outcomes, it’s important to have a full understanding of the whole population at risk. The HSAs use a comprehensive maternal and neonatal health register to document the services and education a woman receives during her pregnancy and the postpartum period, where she delivers, and the outcome of the pregnancy.
In the first 4 months the register was used, more than 700 pregnant women were identified and registered.

Over the next several months, VillageReach will review the information that is collected from this register and share it with the DHO, other NGOs working in the area, and with the community so that programs and resources are allocated to where they are most needed.

The more we know about specific factors influencing maternal morbidity in a particular community, the better informed and equipped we are to design appropriate interventions that can have a positive impact-saving lives of mothers and children living in remote, rural communities.

Additional Background: VillageReach Kwitanda Community Health Project (KCHP), seeks to reduce maternal, neonatal, and child morbidity and mortality by utilizing a comprehensive approach to address the major drivers of poor health through malaria and diarrhea prevention and treatment activities, water and sanitation initiatives, and improving access to and incentivizing use of maternal health services including antenatal care, facility-based deliveries, and postnatal care attendance.

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