Maternal Death Surveillance and Response: Developing Implementation Guidelines for Haiti Public

Abstract

Global maternal mortality has fallen worldwide by fifty percent since the 1990s. Haiti, however has made slow progress in this field and, as a result, claims the highest maternal mortality rate in the Western hemisphere. The World Health Organization's Technical Working Group developed general implementation guidelines for their newest tool, the Maternal Death Surveillance and Response system. Literature shows that this is an effective tool for reducing national maternal mortality. However, its effectiveness greatly depends on a country's capacity for local adaption and ownership of this system. The goal of this project is, therefore, to adapt Maternal Death Surveillance and Response implementation guidelines to the Haitian context by examining full- and partial-implementation approaches from Ethiopia, Zambia, Senegal, Morocco and India. These case studies demonstrated the importance of integrating maternal death into notifiable disease systems as well as creating community death reporting systems that feed into facility reporting systems. These lessons combined with available information on barriers to health care access in Haiti inform the most effective way to adapt World Health Organization's Maternal Death Surveillance and Response Technical Guidance for Haiti. The development of these content-specific guidelines will support Haiti in establishing a sustainable maternal mortality surveillance system as well as improving provider adherence to this system which will, in turn, reduce the national maternal mortality rate.

Table of Contents

ACKNOWLEDGEMENTS....................................................1

ACRONYMS.....................................................................2

INTRODUCTION..............................................................3

Problem Statement..........................................................3

Purpose Statement..........................................................4

Target Audience..............................................................4

Conclusion.....................................................................5

LITERATURE REVIEW.....................................................6

Introduction...................................................................6

Methods.........................................................................6

Overview of Maternal Mortality in Haiti............................7

Proposed Maternal Death Surveillance and Response...........13

Socio-cultural Challenges of Implementing MDSR...............14

Case Studies of Full- and Partial- MDSR Implementation.....17

Maternal Death Reporting in Haiti...................................25

MDSR Technical Guidance..............................................27

Conclusion....................................................................31

METHODS....................................................................32

Introduction.................................................................32

Survey Development.....................................................32

Guideline Development.................................................35

IRB Exemption..............................................................35

Quality and Limitations.................................................36

Conclusion....................................................................37

SYNTHESIS...................................................................39

Introduction..................................................................39

Adaptation Process........................................................40

Next Steps and Recommendations..................................46

Conclusion...................................................................49

REFERENCES...............................................................50

APPENDICES...............................................................54

Appendix 1: Survey......................................................54

Appendix 2: MDSR: Implementation Guidelines for Haiti DRAFT.....58

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	maternal mortality MDSR guidelines surveillance Haiti
Committee Chair / Thesis Advisor	Evans, Dabney, Emory University
Committee Members	Handzel, Endang, Centers for Disease Control and Prevention Lathrop, Eva, Emory University
Partnering Agencies	CDC

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