Maternal and perinatal death review at the facility: An innovative approach to collect and analyze data on maternal and neonatal deaths in Bangladesh

Inequalities in terms of socio-economic status and geographic location are major challenges in achieving equitable development in maternal and child health. Notwithstanding the significant progress made in improving maternal, neonatal and under-five child mortality, the key challenges include lack of access, and inadequate and poor quality of MNH services in Bangladesh. Maternal and perinatal death review (MPDR) is one of the key activities of P4P project of Population Council where MPDR committees were formed and collected data, utilizing structured tools, on the causes of admission, diagnosed causes of death, referral system, condition during admission and management of the reviewed facilities. Statistical analysis was done with the findings. A descriptive analysis of the MPDR meeting minutes was conducted where doctors, nurses and managers of the respective facilities reviewed all findings and discussed the underlying cause of the death event. The delay to recognize a life-threatening condition or an emergency when births occur at home was found as the primary reason for deaths. Ninety-one percent of the referred newborn cases were received in an unstable condition or dead. Ninety five percent cases were referred by either unqualified or community-level providers. The key reason for the 5 maternal deaths was the inadequate care women received at the community level and upon arrival at the facility. Attributing supply-side factors responsible for these deaths included lack of inputs, e.g., technology necessary to provide critical care, unavailability of qualified providers at receiving facilities, and lack of skills among community-level providers to identify high-risk mothers.