Assessment of maternal and perinatal death surveillance and response (MPDSR) implementation in health facilities in Kigoma, Tanzania: a descriptive cross-sectional study

BACKGROUND: Maternal mortality remains a critical public health concern in many countries. To reduce maternal mortality, the Tanzanian Ministry of Health is committed to implementing Maternal and Perinatal Death Surveillance and Response (MPDSR). We assessed the level of MPDSR system readiness in hospitals and health centers in a remote region in Tanzania and examined facility characteristics that may influence MPDSR sustainability. METHODS: A cross-sectional study design was used to assess MPDSR implementation readiness in 11 hospitals and 29 health centers in the Kigoma region using a Health Facility Assessment in 2023. Data were abstracted from each facility to inform the MPDSR implementation readiness phase (i.e., early adoption, evidence of practice, integrated practice, or sustainable practice). Fisher’s exact test was used to test the associations between facility characteristics and facilities with sustainable practice. RESULTS: The MPDSR implementation readiness in hospitals and health centers varied: 25% were in the early adoption phase, 20% in the evidence of practice phase, 32.5% in the integrated practice phase, and 22.5% in the sustainable practice phase. Sustainable MPDSR practice (n = 9) was associated with urban facility location (p = 0.0014), not having a staffing gap for midwife/nurse officer/enrolled nurse (p = 0.0072), higher facility delivery volume (p = 0.0472), higher proportion of deliveries with direct obstetric complications (p = 0.0036), and having personnel trained in MPDSR (p = 0.0051). CONCLUSION: Implementation of the MPDSR in Kigoma region has been challenging, with less than one in four of the assessed facilities demonstrating sustainable practice. Large, urban health facilities with an adequate number of skilled staff who were trained in MPDSR and provided care to a high volume of obstetric complications were most likely to have reached sustainable practice. CLINICAL TRIAL NUMBER: Not applicable.