Implementing Community-Maternal and Perinatal Death Surveillance and Response to identify and prevent maternal and perinatal mortality in Kaduna State, Nigeria: Results and lessons from a pilot study

Abstract

Abstract Background: There is low utilisation of antenatal care, health facility delivery, and post-natal care in Kaduna State, Nigeria, contributing to high maternal and perinatal mortality. Our research aimed to determine if community-Maternal and Perinatal Death Surveillance and Response, inclusive of verbal and social autopsies, increased antenatal care coverage (ANC), facility deliveries, and postnatal care coverage (PNC). Methods: Mixed methods were used to monitor and evaluate the project. Data sources included health facility summary data from January 2021 to December 2022, Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with health care workers from local facilities and men and women from the two communities. Indicators analysed included ANC coverage, skilled birth attendance rate, PNC coverage and qualitative indicators linked to trust of healthcare workers, blame for adverse events, and adoption of remedies to modifiable causes of maternal and or perinatal deaths. Quantitative and qualitative analyses were done on Microsoft Excel. Results: Social autopsies were found to be acceptable and valued by community members. Actions developed may have had a lifesaving impact: maternity clinic run by an unskilled attendant was closed down, 24-hour free transportation for pregnant women provided by taxi drivers, and pre-emptive blood donations by community members to support emergency preparedness for childbirth. Qualitative data suggested that c-MPDSR led to increases in health facility attendance for antenatal care, improved quality of care, and increased trust between community members and health facility staff. Conclusions: c-MPDSR with verbal and social autopsies supports communities in Kaduna State to identify and discuss the causes of maternal and perinatal deaths and design actions that save lives and improve the health of women and newborns.