We are pleased to share the findings of our maternal mortality surveillance project in Somalia, conducted using verbal autopsy to enhance death registries, forecast disease burden, and optimize resource allocation. This initiative, led by MakeDeathsCount (MDC) in collaboration with SIHR, marks a significant step in addressing critical gaps in mortality data within the region.
Acknowledgments
We extend our heartfelt gratitude to Margaret Thorn, whose generous donation made this project a reality, and Dr. Khoshnood, whose support has been vital for MDC’s success. Additionally, we commend our dedicated interviewers, supervisors, and partners for their invaluable contributions throughout this process.
Project Overview
The project focused on maternal mortality surveillance in Galkayo, Puntland, Somalia, utilizing the 2022 WHO Verbal Autopsy survey. We collected 50 mortality cases to assess the feasibility of verbal autopsy implementation in Somalia. Given the region's data collection challenges, we used a convenience sampling technique, engaging community leaders and hospital records to identify cases.
Challenges Encountered
Several obstacles emerged during the study, including:
Translation and Language Barriers: Despite translating surveys into Somali, supervisors had to assist interviewers in translating open narrative responses into English.
Difficulty Identifying Death Cases: Health facility records were often incomplete or missing due to manual documentation processes.
Environmental and Safety Concerns: Flooding delayed interviews and created safety concerns for interviewers during transportation.
Cultural Sensitivities: Certain verbal autopsy questions, especially those related to HIV/AIDS, were considered highly sensitive, and male respondents were sometimes hesitant to engage with female interviewers.
Community Skepticism: Some respondents were wary of the study’s purpose, providing limited information due to suspicion or shyness.
Findings and Data Insights
1. Causes of Maternal Mortality
Hemorrhage (48%) was the leading cause of maternal death.
Sepsis and infection accounted for the second-highest number of deaths.
Eclampsia and gestational hypertension were also significant contributors.
Obstructed labor and anemia were noted in some cases.
2. Comorbidities and Risk Factors
26% of deceased individuals had a history of hypertension.
Diabetes, asthma, epilepsy, depression, stroke, and kidney disease were also reported but at lower frequencies.
No reported cases of cancer, COPD, or other major infectious diseases.
3. Demographics and Healthcare Access
50% of maternal deaths occurred in hospitals.
26% of deaths occurred at home.
Lack of transportation and delays in reaching healthcare facilities were major barriers to timely medical intervention.
Many respondents indicated limited antenatal and postnatal care access.
Key Lessons Learned
Timing of Interviews: Conducting verbal autopsies too soon (within one month) may be intrusive to grieving families while waiting over a year increases recall bias.
Community Awareness Campaigns: Public education about the importance of mortality surveillance can reduce skepticism and improve participation.
Diverse Interviewer Selection: Employing both male and female interviewers can ease cultural sensitivities and encourage more open responses.
Integration of Social Autopsy: Understanding social determinants of health (such as education level and access to healthcare) is crucial for a holistic analysis.
Engagement with the Ministry of Health: Partnering with local health authorities ensures sustainability and institutional support for continued mortality surveillance.
Next Steps
Moving forward, MDC and SIHR aim to:
Expand the project to include broader mortality surveillance beyond maternal deaths.
Engage with policymakers and international organizations to advocate for improved death certification and health data collection.
Secure funding to scale up the initiative, including training more interviewers and enhancing data collection methodologies.
Explore the implementation of a social autopsy to analyze the social and economic factors contributing to maternal mortality.
We invite partners, funders, and stakeholders to join us in scaling this vital work. Please reach out if you know of grants or funding opportunities for maternal health and mortality surveillance. Together, we can drive meaningful change in global health data collection and maternal care interventions.
We sincerely appreciate SIHR, our dedicated interviewers and supervisors, and everyone who contributed to this pioneering project. We look forward to further collaborating to expand our efforts to reduce maternal mortality in Somalia and beyond.
📩 For further collaboration or inquiries, contact us.
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