Indicators and Analysis

Dr Kaninika MitraUNICEF, West Bengal

Maternal Death Review

The need for indicators

•“A quantitative or qualitative factor or variable that provides a simple and reliable means to measure achievement, to reflect changes connected to an intervention, or to help assess the performance of a development actor” (DAC Glossary of Key Terms in Evaluation, May 2002)

Types of MDR Indicators

•Process indicators•Program indicators•HMIS

CB-MDR Process Indicators

Proportion of maternal deaths investigated in the district

•Reported versus expected/estimated•Investigated versus reported

•How do we calculate?

FBMDR Process Indicators•Proportion of eligible institutions that conducted

FBMDR•Number of maternal deaths reported•Proportion of maternal deaths investigated•Proportion of eligible institutions that conducted

FBMDR meetings•Proportion of minor gaps resolved•Proportion of major gaps on which action is initiated

(proposals submitted)•Proportion of major gaps on which action taken

(proposals approved and process begun)

•How do we calculate?

District Level process indicators:•Proportion of maternal deaths notified vs.

estimated.•Proportion of maternal deaths investigated vs

notified.•Proportion of maternal deaths reviewed

versus investigated•Proportion of MDR meetings conducted by the

DM•Proportion of maternal deaths (among all

deaths of RH age group)•How do we calculate?

Program indicators-district & state level

• Proportion of deaths among adolescents (15-49 yrs)

• Distribution of maternal deaths, by district, block

• Distribution of maternal deaths, by education status, age at marriage, age of death

• Distribution of maternal deaths, by caste, religion

• How do we calculate?

Program indicators …contd•Distribution of deaths, in antenatal, intra-natal

and post-partum period•Proportion of deaths during or after abortion-

spontaneous & induced•Distribution of deaths, by place of death-home,

institution, transit•Distribution of deaths, by ANC & PNC received•Distribution of deaths, by delays (first, second

and third)•Distribution of deaths by causes•How do we calculate?

HMIS Indicators: HMIS formats\bleeding TN reports. xls, HMIS formats\district hospital.xls•Number of deaths, by district•Number of deaths, by month•Proportion of deaths, by cause

▫Bleeding▫Severe hypertension/fits▫Obstructed labor▫Fever related▫Others

Some examples of indicators calculated & graphically

represented

Based on data from commjunity based maternal death

investigation (MAPEDIR) in Purulia

Maternal deaths investigated against reported

68

9099

83

69

26

137

96

120

92

71

28

0

20

40

60

80

100

120

140

160

2005 2006 2007 2008 2009 2010 (till July)

Reported

Investigated

Spatial distribution of maternal deaths

2005 2006 2007

2008 2009

2010 (Jan-Jul)

DECREASING NUMBER OF REPORTED MATERNAL DEATHSBLOCK-WISE PROGRESS

LITERACY STATUS OF THE DECEASED WOMEN

47.2 48.3340.2

34.9 31.6737.4

7.5 12.1

13.2 12.5 10.3

4.7

0%20

%40

%60

%80

%10

0%

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

Illiterate Upto 8th Standard 9th Standard & above DNK

Strongest association with Female Literacy

52.8

44.3

2.8

34.17

50.0

11.67

0.83 3.33

22.4

67.3

4.7 5.6

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

AGE AT MARRIAGE

11-17 years 18-20 years 21-24 >24 Not Known Data not available

12%

77%

10%

25%

59%

16%

9%

64%

26%

0%

20

%4

0%

60

%8

0%

10

0%

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

AGE AT DEATH < 20 20-30 > 30

21%

71%

8%

TIMING OF DEATHS

ante-natal post-natal

abortion related

65%14%

19%

2%

PLACES OF DEATHS

Instituion

Home

Transit

Others

0%20

%40

%60

%80

%10

0%

May 2005 –July 2006

July 2006-

Sept 2007

May 2008 -

March 2010

PROBABLE CAUSES OF DEATH

Others

Injury/accident

Tuberculosis

Malaria

anaemia

Sepsis

Obstructed Labour / Ruptured uterus

Eclampsia/ pre-eclamsia

Haemorrhage

There is a woman behind every number….!