Abstract:
Background: Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and
middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation
of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and
the Tanzanian Maternal Death and Surveillance (MDSR) system propose the use of narrative summaries during
maternal death reviews for discussing the case to categorize causes of death, identify gaps in care and recommend
action plans to prevent deaths. Suggested action plans are recommended to be Specific, Measurable, Attainable,
Relevant and Time bound (SMART). To identify gaps in documenting information and developing
recommendations, comprehensiveness of written narrative summaries and action plans were assessed.
Methods: A total of 76 facility maternal deaths that occurred in two regions in Southern Tanzania in 2018 were
included for analysis. Using a prepared checklist from Tanzania 2015 MDSR guideline, we assessed
comprehensiveness by presence or absence of items in four domains, each with several attributes. These were
socio-demographic characteristics, antenatal care, referral information and events that occurred after admission. Less
than 75% completeness of attributes in all domains was considered poor while 95% and above were good/
comprehensive. Action plans were assessed by application of SMART criteria and according to the place of planned
implementation (community, facility or higher level of health system).
Results: Almost half of narrative summaries (49%) scored poor, and only1% scored good/comprehensive.
Summaries missed key information such as demographic characteristics, time between diagnosis of complication
and commencing treatment (65%), investigation results (47%), summary of case evolution (51%) and referral
information (47%). A total of 285 action points were analysed. Most action points, 242(85%), recommended
strategies to be implemented at health facilities and were mostly about service delivery, 120(42%). Only 42% (32/76)
of the action points were deemed to be SMART.
Conclusions: Abstraction of information to prepare narrative summaries used in the MDSR system is inadequately
done. Most recommendations were unspecific with a focus on improving quality of care in health facilities
