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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….!