“To achieve accelerated reduction in maternal and perinatal mortality, the quality of care provided to pregnant women and newborns in health facilities must meet quality criteria which include health care that must be safe, effective, timely, efficient, equitable and people-centred” stated Professor Jamilu Tukur, Aminu Kano Teaching Hospital.
“Also, to improve quality of care, availability of health information plays a vital role, and this is the core aim of the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme”, added Professor Tukur the National coordinator, WHO Maternal and Paternal Database for Quality, Equity and Dignity Project (MPD-4-QED).
To make data readily available for quality of care improvement and accelerate progress towards the 2030 SDGs targets of reducing maternal and neonatal mortality, the World Health Organization (WHO) Nigeria in collaboration with the Federal Ministry of Health (FMoH) launched a two –year project, MPD-4-QED supported by MSD for Mothers* in 2019.
The MPD-4-QED programme uses a nationwide electronic system established in 54-referral level facilities to collect data on maternal and perinatal events during labour, childbirth and the early neonatal period. The data is routinely extracted from the hospital records of every pregnant woman at the end of her pregnancy and uploaded into a web based DHIS2 dashboard by designated trained medical records officers. In the case of a maternal or perinatal death, the designated hospital coordinators (an obstetrician and neonatologist) conduct an audit to find out the primary causes of deaths and their contributing factors.
WHO focal points in the Country Office and headquarters supported the Central Coordination Team (CCT) in Aminu Kano Teaching Hospital, Kano, Northwest Nigeria to train and equip medical records officers and hospital coordinators (obstetrician and neonatologist) in each of the participating hospitals to capture data from clients’ case files after discharge and conduct audits of maternal and perinatal deaths that occur. This information is analysed and disseminated to stakeholders including the FMoH periodically as scorecards and publication of quarterly newsletters.
After a year of continuous data collection (September 2019 to August 2020), the database had 76 563 women enrolled comprising of 71 758 obstetric and 4 805 gynaecologic admissions with 97% of deaths audited. There is timely information on facility specific maternal mortality ratio (adjusted maternal mortality ratio) for the collaborating hospitals which averaged nationally at 575 per 100 000 live births as at 31 August, 2020 with regional variations ranging from 393 per 100 000 livebirths in the Southeast to 790 per 100 000 livebirths in the Northeast.
The figures have generated discourse by the network of hospitals, FMoH and WHO on why these deaths occur and hospitals themselves have identified innovative and feasible micro and macro strategies that can be implemented with minimal resources to improve quality of care at the facility level.
“Thus, the MPD-4-QED programme has successfully provided a system that generates timely and quality information on maternal and perinatal care in the health facilities. Findings from death audits are used by the hospital management to make decisions that will improve the quality of care provided to pregnant women and their babies, improve the experiences of pregnant women and their families and can be used by the MPDRS committees in tertiary health facilities” stated Dr Adebimpe Adebiyi (Director Hospital Services, FMoH).
“She added that this database will go a long way in reducing neonatal mortality as the causes are now evident and necessary measures are taken to ensure no case is repeated”.
In the light of this, the Federal Ministry of Health has adopted the MPD-4-QED programme as its core strategy to strengthen implementation of MPDSR in tertiary level facilities to improve the quality of care provided to mothers and newborns.
“The global direction is to end preventable maternal and perinatal death. Every pregnancy and birth is unique, and collecting and analyzing data on each one is important as it provides vital information to help mitigate the causes and factors associated with maternal and perinatal morbidity and mortality” says Dr Bosede Ezekewe, Technical Officer, Reproductive Health WHO Nigeria.
WHO provided technical assistance to the FMoH and National Primary Health Care Development Agency (NPHCDA) to finalize the National MPDSR Bill through facilitating input and recommendation from colleagues and partners from the Regional Office and Headquarters. WHO is also adding her voice to advocate for the passage of the Bill into law.
The MPD-4-QED programme is supported by funding from MSD, through MSD for Mothers, the company’s $500 million global initiative to help create a world where no woman has to die while giving life. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.