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6 materanal and perinatal death investigation 2.pptx

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Maternal and Perinatal Death Investigation and Verification
Presentation Outline Objectives of the Module Introduction The Deaths Investigation Process- Community The Verbal Autopsy Forms The Death Investigation Process- Health Facilities The Health Facility Data Abstraction Forms Summary Exercises
Objectives of the Module After Completing this module Trainees are expected to acquire the following knowledge and skills Introduce to major principles and prerequisites for maternal and perinatal death investigation Understand the process for maternal and perinatal death investigation in the community and health facilities Acquire the skills to properly use and code the maternal and perinatal death investigation tools
Introduction The objectives of maternal and perinatal death investigation are; Verify the suspected death Collect information on possible causes and contributing factors Effective investigation of maternal and perinatal death requires; Mapping and using all appropriate information sources Approach information sources ethically and sympathetically Using and recording the death investigation tools accurately
Introduction CONT . . . All deaths fulfilling the suspected or standard case definition should be investigated Community- Perinatal The birth of a dead foetus or death of a new born after 7 month of pregnancy + New born dead at the time of birth OR within 28 days of delivery Health Facility- Perinatal A death of a fetus born after 28 completed weeks of gestation or neonatal deaths through the first 28 completed days after birth Community- Maternal Death of a woman of reproductive age group (between 15-49 years of age) + Died while pregnant or within 42 days of termination of pregnancy or missed her menses before she died Health Facility- Maternal The death of a woman while pregnant or within 42 days of the end of pregnancy (irrespective of duration and site of pregnancy), from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
Deaths Investigation Process-Community All suspected maternal and perinatal deaths should be investigated by the health extension worker The community death investigation should be conducted within two weeks in order to; Give adequate mourning period for families Reduce the recall biases
Community Deaths Investigation CONT . . The health extension worker uses the standard verbal autopsy tool to verify and investigate maternal and perinatal deaths in the community Information sources to complete verbal autopsy includes, Families of the deceased mother /neonate who were around the during the death circumstance Traditional birth attendants- if applicable Any community member who were around the deceased during the death circumstance
Community Deaths Investigation CONT . . Before start of interview proper oral consent should be taken and the consent information needs to contain Introduce your self The objectives of the investigation The confidentiality of the information provide Before and during the interview process respectful, sympathetic and culturally right approaches should be followed
Verbal Autopsy The objective of verbal autopsy is to verify the suspected deaths in the community and collect basic information to identify possible causes and contributing factors Verbal autopsy is used by health extension workers only for maternal and perinatal death which fulfill the community suspected cased definition There is a separate verbal autopsy forms for maternal deaths and perinatal deaths
Verbal Autopsy CONT . . . The verbal autopsy form for maternal death contains five sections to be completed for all suspected maternal deaths in the community The verbal autopsy form for perinatal death contains nine parts and to be completed for all suspected perinatal deaths in the community When both the mother and the neonate are deceased maternal and perinatal verbal autopsy forms should be completed
Community Level Data Capture (verbal Autopsy)
Collect data from family members, friends, neighbors, and potentially HEW on circumstances around death Help construct the pathway to death including background factors Investigates the womans or the babies health issues, decisions about care, services received, and community factors (e.g. Transportation) Verbal Autopsies
Any community member can alert HEW about deaths of women 15-49 HEW identify deaths, report them as part of PHEM, screen for maternal causes, and notify HC Data from VA presented at the HC review committee Community Data Collection - process
Timing is important VA should be conducted after the mourning period, but before key details are forgotten (roughly 2 weeks after the death) Important to find respondents familiar with the case and events leading up to it Families may have separated or moved Logistical Issues
Maternal and Perinatal deaths are emotional events Grief of the family must be respected Information provided must be voluntary There should be no repercussions for family members actions The VA process can raise sensitive issues requiring support (disagreements, abortion, lack of available care) Ethical Issues
Informed Consent Formally establishes voluntary participation Reassures family members Can offer legal protection to communities Builds rapport and trust before starting data collection
When obtaining Informed Consent, remember to mention ... Purpose of the VA interview What will happen during the interview Risks involved (feeling uncomfortable, sad) Benefits (avoiding future deaths) Confidentiality Voluntary participation Informed Consent:
Planning a community visit Approaching the household Selecting the best respondent(s) Obtaining Informed Consent Conducting the VA interview Recording the information accurately Submitting the filled format to the Health Centre Steps in Conducting VA:
Friendly approach Explain the purpose of your visit in positive terms Ensure privacy Interviews will go more smoothly if you are undisturbed Speak slowly & clearly explain anything that the respondent doesnt understand Probe for detailed information Best Practices for Verbal Autopsy (1)
There are NO right answers - let respondents tell their story in their own words Take notes write down additional relevant information in the blank spaces of the VA form Pay attention show that you are listening & aware of respondents emotions Best Practices for Verbal Autopsy (2)
Deaths Investigation Process- Health Facilities All maternal and perinatal deaths which fulfil the standard case definitions should be investigated The health facility death investigation should be conducted within 24 hours in order to; Get all the necessary medical registers timely Reduce the recall biases Avail timely information for service quality improvement The surveillance officer uses the standard facility data abstraction form to investigate and verify maternal and perinatal deaths in the health facility
Deaths Investigation Process CONT . . . Information sources to complete data abstraction includes, Medical records- client chart, registers, death logs, operation notes Health care providers in the facility who involved in the provision of health care Before start of interview with health care providers proper consent should be taken and the consent information needs to contain Introduce your self (if useful) The objectives of the investigation The no bale principles of the MPDSR The confidentiality of the information provide
Health Facility Data Abstraction Form The objective of the facility data abstraction form is to verify deaths in the health facilities and collect basic information to identify of possible causes and contributing factors Facility based data abstraction form is used by surveillance officer only for maternal and perinatal death which fulfill the standard cased definition There is a separate facility data abstraction form for maternal deaths and perinatal deaths
Data Abstraction CONT . . . The data abstraction form for maternal death contains four sections to be completed for all maternal deaths The data abstraction form for perinatal death contains eight parts and to be completed for all perinatal deaths within When both the mother and the neonate are deceased maternal and perinatal data abstraction form should be completed
Exercise 1 Coding of Maternal And Perinatal Deaths
Exercise 2: Verbal Autopsy Exercise on how to fill the maternal and perinatal death verbal autopsy forms Verbal Autopsy- Maternal Death Verbal Autopsy- Perinatal Death
Exercise 3: Facility Based Abstraction : Exercise on how to fill the maternal and perinatal death facility based abstraction from by using anonymous clinical cases Facility Based Abstraction Form-maternal Death Facility Based Abstraction Form- Perinatal Death
Summary of the Module Community Maternal and Perinatal Deaths Investigation Process o The Prerequisite for investigation- Suspected case definitions o The Investigation process o The verbal autopsy forms Maternal and Perinatal Deaths Investigation Process In Health Facilities o The Prerequisite for investigation- standard case definitions o The Investigation process o The data abstraction forms
6 materanal and perinatal death investigation 2.pptx

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6 materanal and perinatal death investigation 2.pptx

  • 1. Maternal and Perinatal Death Investigation and Verification
  • 2. Presentation Outline Objectives of the Module Introduction The Deaths Investigation Process- Community The Verbal Autopsy Forms The Death Investigation Process- Health Facilities The Health Facility Data Abstraction Forms Summary Exercises
  • 3. Objectives of the Module After Completing this module Trainees are expected to acquire the following knowledge and skills Introduce to major principles and prerequisites for maternal and perinatal death investigation Understand the process for maternal and perinatal death investigation in the community and health facilities Acquire the skills to properly use and code the maternal and perinatal death investigation tools
  • 4. Introduction The objectives of maternal and perinatal death investigation are; Verify the suspected death Collect information on possible causes and contributing factors Effective investigation of maternal and perinatal death requires; Mapping and using all appropriate information sources Approach information sources ethically and sympathetically Using and recording the death investigation tools accurately
  • 5. Introduction CONT . . . All deaths fulfilling the suspected or standard case definition should be investigated Community- Perinatal The birth of a dead foetus or death of a new born after 7 month of pregnancy + New born dead at the time of birth OR within 28 days of delivery Health Facility- Perinatal A death of a fetus born after 28 completed weeks of gestation or neonatal deaths through the first 28 completed days after birth Community- Maternal Death of a woman of reproductive age group (between 15-49 years of age) + Died while pregnant or within 42 days of termination of pregnancy or missed her menses before she died Health Facility- Maternal The death of a woman while pregnant or within 42 days of the end of pregnancy (irrespective of duration and site of pregnancy), from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
  • 6. Deaths Investigation Process-Community All suspected maternal and perinatal deaths should be investigated by the health extension worker The community death investigation should be conducted within two weeks in order to; Give adequate mourning period for families Reduce the recall biases
  • 7. Community Deaths Investigation CONT . . The health extension worker uses the standard verbal autopsy tool to verify and investigate maternal and perinatal deaths in the community Information sources to complete verbal autopsy includes, Families of the deceased mother /neonate who were around the during the death circumstance Traditional birth attendants- if applicable Any community member who were around the deceased during the death circumstance
  • 8. Community Deaths Investigation CONT . . Before start of interview proper oral consent should be taken and the consent information needs to contain Introduce your self The objectives of the investigation The confidentiality of the information provide Before and during the interview process respectful, sympathetic and culturally right approaches should be followed
  • 9. Verbal Autopsy The objective of verbal autopsy is to verify the suspected deaths in the community and collect basic information to identify possible causes and contributing factors Verbal autopsy is used by health extension workers only for maternal and perinatal death which fulfill the community suspected cased definition There is a separate verbal autopsy forms for maternal deaths and perinatal deaths
  • 10. Verbal Autopsy CONT . . . The verbal autopsy form for maternal death contains five sections to be completed for all suspected maternal deaths in the community The verbal autopsy form for perinatal death contains nine parts and to be completed for all suspected perinatal deaths in the community When both the mother and the neonate are deceased maternal and perinatal verbal autopsy forms should be completed
  • 11. Community Level Data Capture (verbal Autopsy)
  • 12. Collect data from family members, friends, neighbors, and potentially HEW on circumstances around death Help construct the pathway to death including background factors Investigates the womans or the babies health issues, decisions about care, services received, and community factors (e.g. Transportation) Verbal Autopsies
  • 13. Any community member can alert HEW about deaths of women 15-49 HEW identify deaths, report them as part of PHEM, screen for maternal causes, and notify HC Data from VA presented at the HC review committee Community Data Collection - process
  • 14. Timing is important VA should be conducted after the mourning period, but before key details are forgotten (roughly 2 weeks after the death) Important to find respondents familiar with the case and events leading up to it Families may have separated or moved Logistical Issues
  • 15. Maternal and Perinatal deaths are emotional events Grief of the family must be respected Information provided must be voluntary There should be no repercussions for family members actions The VA process can raise sensitive issues requiring support (disagreements, abortion, lack of available care) Ethical Issues
  • 16. Informed Consent Formally establishes voluntary participation Reassures family members Can offer legal protection to communities Builds rapport and trust before starting data collection
  • 17. When obtaining Informed Consent, remember to mention ... Purpose of the VA interview What will happen during the interview Risks involved (feeling uncomfortable, sad) Benefits (avoiding future deaths) Confidentiality Voluntary participation Informed Consent:
  • 18. Planning a community visit Approaching the household Selecting the best respondent(s) Obtaining Informed Consent Conducting the VA interview Recording the information accurately Submitting the filled format to the Health Centre Steps in Conducting VA:
  • 19. Friendly approach Explain the purpose of your visit in positive terms Ensure privacy Interviews will go more smoothly if you are undisturbed Speak slowly & clearly explain anything that the respondent doesnt understand Probe for detailed information Best Practices for Verbal Autopsy (1)
  • 20. There are NO right answers - let respondents tell their story in their own words Take notes write down additional relevant information in the blank spaces of the VA form Pay attention show that you are listening & aware of respondents emotions Best Practices for Verbal Autopsy (2)
  • 21. Deaths Investigation Process- Health Facilities All maternal and perinatal deaths which fulfil the standard case definitions should be investigated The health facility death investigation should be conducted within 24 hours in order to; Get all the necessary medical registers timely Reduce the recall biases Avail timely information for service quality improvement The surveillance officer uses the standard facility data abstraction form to investigate and verify maternal and perinatal deaths in the health facility
  • 22. Deaths Investigation Process CONT . . . Information sources to complete data abstraction includes, Medical records- client chart, registers, death logs, operation notes Health care providers in the facility who involved in the provision of health care Before start of interview with health care providers proper consent should be taken and the consent information needs to contain Introduce your self (if useful) The objectives of the investigation The no bale principles of the MPDSR The confidentiality of the information provide
  • 23. Health Facility Data Abstraction Form The objective of the facility data abstraction form is to verify deaths in the health facilities and collect basic information to identify of possible causes and contributing factors Facility based data abstraction form is used by surveillance officer only for maternal and perinatal death which fulfill the standard cased definition There is a separate facility data abstraction form for maternal deaths and perinatal deaths
  • 24. Data Abstraction CONT . . . The data abstraction form for maternal death contains four sections to be completed for all maternal deaths The data abstraction form for perinatal death contains eight parts and to be completed for all perinatal deaths within When both the mother and the neonate are deceased maternal and perinatal data abstraction form should be completed
  • 25. Exercise 1 Coding of Maternal And Perinatal Deaths
  • 26. Exercise 2: Verbal Autopsy Exercise on how to fill the maternal and perinatal death verbal autopsy forms Verbal Autopsy- Maternal Death Verbal Autopsy- Perinatal Death
  • 27. Exercise 3: Facility Based Abstraction : Exercise on how to fill the maternal and perinatal death facility based abstraction from by using anonymous clinical cases Facility Based Abstraction Form-maternal Death Facility Based Abstraction Form- Perinatal Death
  • 28. Summary of the Module Community Maternal and Perinatal Deaths Investigation Process o The Prerequisite for investigation- Suspected case definitions o The Investigation process o The verbal autopsy forms Maternal and Perinatal Deaths Investigation Process In Health Facilities o The Prerequisite for investigation- standard case definitions o The Investigation process o The data abstraction forms

Editor's Notes

  • #2: Note for Instructor Total time given for this module is 120 minutes and here is the possible allocated time for each sections. Introduction- 10 minutes Death investigation process-community- 10 minutes VA forms- 20 minutes Death investigation process-Health facility- 10 minutes Data Abstraction Forms- 20 minutes Summary Exercises-40 minutes Summary, questions and suggestions- 10 minutes
  • #4: Note for Instructor The objective of maternal and perinatal death investigation is to verify the reported suspected death and provide information for identification of possible causes and underling factors. Maternal and perinatal death that occurs in health facilities is considered as a confirmed death as far as it fulfils the standard case definition and the main objective of death investigation is more of to collect information that helps to identify the possible cause and contributing factors of the death. Effective death investigation needs Using all appropriate information sources- Before conducting death investigation the expert needs to map or identifay the possible information sources. The common sources of information includes; families and peoples around the deceased, health professionals who provided the service and all medical registers of the deceased. Using appropriate information sources such as peoples around the deceased, health professionals demands ethical and sympathetic approach so as to get a better information from them.
  • #5: Note for Instructor Animation- Each boxes of case definitions follows after you make a click Since death investigation is conducted for death which only fulfill the suspected (for community) or standard (for health facilities) case definitions, before you go to the death investigation process please revise the suspected and the standard case definition.
  • #6: Note for Instructor All suspected maternal and perinatal deaths that are documented at the health post & notified to the respective health centre should be investigated and verified within two weeks by the health extension worker using verbal autopsy tool and submit the completed formats to the respective health centre surveillance focal person.
  • #7: Note for Instructor The listed information sources are only the common one and for varieties of conditions the health extension can include any other appropriate sources to collect more useful information.
  • #8: Note for Instructor While getting oral consent the health extension worker needs to emphasize the objective of the death investigation in a way understandable by the community . In simple terms the objective can be stated as, to know the problems related with the death of the mother or neonate so as to learn and prevent similar death in the locality. When the health extension worker asks each investigation questions, it should be asked with respect and sympathetically in order to note provoke unwanted emotions.
  • #21: Note for Instructor All suspected maternal and perinatal deaths that occurred at health facilities (irrespective of the department where it happened), should be investigated and verified within 24 hours by the surveillance officer using the data abstraction form
  • #22: Note for Instructor While collecting information from the health care providers the objective of the investigation should be explained. It can explained as the objective is note to judge the professional ability of the provider and it has noting to do with legal investigation but, it is to identify the wholstic problems related with the death of the mother or neonate so as to learn and improve to identify similar deaths in the facility.
  • #26: Note for Instructor Open the hyperlink and explain how to fill each five sections of the maternal verbal autopsy Please remind them that as far as possible all question should be asked as stated on the VA tool but when the interviewee doesnt understand or forgets the issue appropriate probing can be done. Probing includes explaining the question in way understandable by the interviewee (without missing the main concept). For instance if the family member forgets if the mother took a iron supplementation they can remind them by telling the color and shape of the pills or the can give common remindable calendar days like religious holidays . . To make them remind the incidence.
  • #27: Note for Instructor Open the hyperlink and explain how to fill each five sections of the maternal verbal autopsy Please remind them that as far as possible all question should be asked as stated on the VA tool but when the interviewee doesnt understand or forgets the issue appropriate probing can be done. Probing includes explaining the question in way understandable by the interviewee (without missing the main concept). For instance if the family member forgets if the mother took a iron supplementation they can remind them by telling the color and shape of the pills or the can give common remindable calendar days like religious holidays . . To make them remind the incidence.
  • #28: Note for Instructor Summarize the listed major components of the MPDSR investigation process before ending the module.