Rotary International/RFPD is supporting and accelerating the implementation of the Nigerian MPDSR (Maternal and Perinatal Death Surveillance and Response) guidelines with Obstetric Quality Assurance
The objective of this project is to improve maternal and child health in Nigeria by introducing an e-platform database, which helps to systematically collect maternal and infant abnormalities, using the Nigerian MPDSR guidelines. The generated hospital reports support gynecologists and midwives in finding possible interventions. Additional Data is collected to ensure a systematic improvement of quality of structure, quality of process and quality of outcome. The project is complemented by Rotary’s hitherto largest project on family planning. Through the close collaboration with the Federal Ministry of Health the project aims to cover the entire country.
In March 2017):The RFPD Consultant from Germany Nicholas Lack together with Mr. Peter Kroll the Project Technical Official were joined by the project team I Nigeria led by PDG Prof E. Adedolapo Lufadeju to conduct the training of State Ministry of Health (SMoH) statisticians in data management, training of SMoH Maternal and Child health (MCH) executives, in analysis of MCH reports, and training in Online data entry of monthly maternity statistics and facility based maternal death reviews (MDR) in Kano, Kaduna, FCT Abuja, Ondo, Enugu, Ebonyi, Anambra and Osun for a total of 65 hospitals
The role of the Federal Government of Nigeria in this project are listed below
- Allocation of user role to state MOH Statistician
- Generation of National MCH report
- Monitoring state wise data completeness
- Close liaison with the national MPDSR committee
- Conduction of specific statistical analyses at the request of the FMOH MCH executive.
TRAINING GUIDE FOR COMMUNITY LEVEL USERS
The community based MPDSR is used to track Maternal Death and Perinatal death occurrence within the community which will or may not be captured by the Health facility. (This information is confidential and must be treated as such)
Role:
- The Community MPDSR focal person is expected to collect information on occurrence of Death of a Pregnant Woman and still birth or death of new born Baby that occur within the community.
- The information gathered is to be filled on the MCH platform which will be forwarded via email to the State Statisticians for action.
- The Community MPDSR focal person is also expected to liaise with the Hospital Medical Records Officer for any community level Brought in Dead (BID) cases which was not captured at the community level. (Not to miss any data)
- The Community focal person is expected to work with the village Health committee to discuss issues around causes of death
Stage 2 of the process involves:: –Extension to perinatal death reviews (PDR), LNG-IUS (contraceptive device insertions), hygiene and equipment rating –Extension of Maternal Death Responses (MDRs) and Perinatal Death Responses (PDRs) to full documentation of all items according to national guidelines (FORM1 –FORM4 and FORM6 and FORM7) –Automatic electronic export of Maternal and Perinatal Death Response (MPDR) datasets to the MoH statisticians –Additional performance indicators •Structure: facility based equipment rating •Process: facility based hygiene rating, PDR rate, LNG-IUS insertion rate •Outcome: facility based maternal morbidity rates
Stage 3 of the project involves : –Extension to cover community based death reviews (CMPDSR) as well as information on community dialogues and family planning –Additional performance indicators: •Structure: number of communities served by individual facilities •Process: CMPDRSR rates, community dialogues (number, total attendees, topics), number of door-to-door FP visits in two pilot regions •Outcome: overall maternal morbidity rates
Remote data base entry and report generation on „mch-nigeria.net“ began in 2017
•Multiuser interface provides users specific access at hospital, state and national level
•Multifactoral approach to Quality Assurance in Obstetrics (OQA) includes MPDSR according to national guidelines
•Indicators show quality of structure(e.g. equipment), process (e.g. MDR) and outcome (mortality-and morbidity)
Quality of Process
•Online data entry of hygiene conditions for hospital
•Operating theater shows good hygiene conditions
Quality of Process
•Online data entry of facility based maternal death according to MPDSR guidelines
Quality of Outcome
- Online data entry of monthly maternity statistics for hospital
- Maternal deaths
- Fetal deaths – fresh still born or macerated
- Eclampsia -no fits or eclampsia with fits
- Retained placenta
It is important to note that this is the first time in Nigeria that a Rotary /RFPD initiated project is being adopted by the Nigerian Government for Nationwide inclusion into the primary health system of the country’
By
E. ASdedolapo Lufadeju
Robert Zinser
Nicholas Lack
Peter Kroll and
Kola owoka