See related article by Smith et al.
While extensive efforts to reduce maternal mortality through a maternal death surveillance and response (MDSR) investigation approach in Kenya were laudable, they fell far short in a number of ways toward having any tangible impact. In low- and middle-income countries (LMICs) with high maternal mortality, resources are better spent addressing obvious causes through interventions with proven effectiveness.
The MDSR strategy aims to improve quality of care and reduce maternal deaths by investigating individual maternal deaths and taking action to avoid remediable causes. As reported in this issue of GHSP, the MDSR (or an early variant thereof) was first introduced in Kenya in 2004.1 At that time, the Kenyan maternal mortality ratio (MMR) was estimated at over 700 deaths per 100,000 live births. As of 2015, a decade later, the MMR was not significantly different, at an estimated 510 per 100,000 live births.2 Yet there were further efforts to strengthen and implement the MDSR nationally. We explore the aims and implementation steps of the MDSR as launched by the World Health Organization (WHO) in 2013; the recent process of MDSR implementation in Kenya and its results; the long history of maternal death audits including response efforts; and the effectiveness of MDSR in other LMICs.
WHAT IS THE MDSR?
As WHO stated …