Mortality impact of implementing maternal perinatal deaths surveillance and response quality-of-care improvement strategy for maternal and newborn care, northeast Namibia: a quasi-experimental study

Background: Northeast Namibia's neonatal mortality rate is higher than the national level. From June 2019, Northeast Namibia regional hospital implemented maternal perinatal death surveillance and response system as a part of quality improvement strategy to address increasing newborn deaths. Yet, no documentation exists pre-and-post implementation of the system. This study therefore aims to assess and describes the before-and-after mortality impact of its implementation. Methods: A pre-post intervention study design was conducted. Quantitative routine facility data was collected for women who gave birth and their babies from January 2019-December 2021. Data was gathered from maternity, neonatal and paediatric wards by the hospital health information system officer. The excel for Mac version 28.0.1.1 was used to calculate the proportions, rates/ratios, and descriptive statistics applied. Analysis was done for maternal, perinatal and newborn deaths, number and mode of deliveries, and caesarean section rates. Results: Institutional mortality statistically reduced except for stillbirths. Neonatal mortality rate fell from 11.4 to 7.7 per 1000 live births (P = 0.035), perinatal mortality rate fell from 30.0 to 24.3 per 1000 total births (P = 0.049), while maternal mortality rate statistically reduced from 339.6 to 111.6 per 100 000 live births (P = 0.015). The still birth rate reduced marginally from 18.4 to 17.3 per 1000 total births, but was not statistically significant (P = 0.361). Average percentage intrapartum stillbirths reduced from 46.6 to 33.3%. The proportion of neonatal deaths in the first week of life increased from 75.4 to 83.6%. Conclusions: High perinatal (stillbirths and early neonatal deaths) accounted for most deaths within the neonatal period. Thus, improving the quality-of-care around childbirth and immediate postnatal care when most neonates are highly vulnerable requires urgent health system programmatic and policy attention. Overall, implementation of maternal perinatal death surveillance and response strategy proved feasible in improving care and reducing maternal and newborn mortality.