Evidence map›Paper›PMID 31365076›Full record

ArticleHealth policy and planning2019

'Maternal deaths should simply be 0': politicization of maternal death reporting and review processes in Ethiopia.

Andrea Melberg, Alemnesh Hailemariam Mirkuzie, Tesfamichael Awoke Sisay, Mitike Molla Sisay, Karen Marie Moland

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Health policy and planning, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 3 pooled it
8.7field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 3 syntheses or guidelines pooled it, 59 citations in OpenAlex.

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  13. Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Andrea MelbergCentre for International Health, University of Bergen, Årstadveien 21, N-5007 Bergen, Norway.
Alemnesh Hailemariam MirkuzieNational Data Management Center for Health, Ethiopian Public Health Institute, Gulelle Arbegnoch Street, Gulele Sub City, Addis Ababa, Ethiopia.
Tesfamichael Awoke SisaySchool of Public Health, College of Health Sciences, Addis Ababa University, Algeria Street, Arada Sub City, Addis Ababa, Ethiopia.
Mitike Molla SisaySchool of Public Health, College of Health Sciences, Addis Ababa University, Algeria Street, Arada Sub City, Addis Ababa, Ethiopia.
Karen Marie MolandCentre for International Health, University of Bergen, Årstadveien 21, N-5007 Bergen, Norway.
Addis Ababa University · ETUniversity of Bergen · NOEthiopian Public Health Institute · ET

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The Maternal Death Surveillance and Response system (MDSR) was implemented in Ethiopia in 2013 to record and review maternal deaths. The overall aim of the system is to identify and address gaps in order to prevent future death but, to date, around 10% of the expected number of deaths are reported. This article examines practices and reasoning involved in maternal death reporting and review practices in Ethiopia, building on the concept of 'practical norms'. The study is based on multi-sited fieldwork at different levels of the Ethiopian health system including interviews, document analysis and observations, and has documented the politicized nature of MDSR implementation. Death reporting and review are challenged by the fact that maternal mortality is a main indicator of health system performance. Health workers and bureaucrats strive to balance conflicting demands when implementing the MDSR system: to report all deaths; to deliver perceived success in maternal mortality reduction by reporting as few deaths as possible; and to avoid personalized accountability for deaths. Fear of personal and political accountability for maternal deaths strongly influences not only reporting practices but also the care given in the study sites. Health workers report maternal deaths in ways that minimize their number and deflect responsibility for adverse outcomes. They attribute deaths to community and infrastructural factors, which are often beyond their control. The practical norms of how health workers report deaths perpetuate a skewed way of seeing problems and solutions in maternal health. On the basis of our findings, we argue that closer attention to the broader political context is needed to understand the implementation of MDSR and other surveillance systems.

Indexed as

Epidemiological MonitoringAnthropology, CulturalEthiopiaFemaleHumansMaternal DeathPoliticsPopulation SurveillancePregnancyQuality of Health CareEthiopiaindicatorsmaternal healthMDSRmulti-sited ethnography

Identifiers

PMID31365076
PMCPMC6788214
OpenAlexW2965758321

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.