{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:53:31Z","timestamp":1781769211235,"version":"3.54.5"},"reference-count":61,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Research Council of Norway","doi-asserted-by":"publisher","award":["315590"],"award-info":[{"award-number":["315590"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Identifying the causes of maternal deaths and contributing factors is essential for improving care. In 2015, Tanzania began implementing the maternal and perinatal death surveillance and response (MPDSR) system, including facility-based maternal death reviews. While most MPDSR studies highlight implementation and technical barriers, less is known about how systemic and institutional dynamics influence these reviews. This study examined stakeholders\u2019 experiences and perceptions of MPDSR in Tanzania, focusing on how clinical causes of death and contributing factors were identified. The study is based on 5 months of ethnographic fieldwork conducted in a Tanzanian region in 2023\u20132024. It included 33 days of participatory observation of obstetric care, attending nine facility-based maternal death review meetings and conducting 20 in-depth interviews with health workers and administrative staff. Viewing MPDSR as a travelling model and drawing upon the concept of situated knowledge, we examined how institutional and professional factors influenced these reviews. Reviews were routinized and integrated into the regional health system, offering opportunities for teaching and defining standards of practice. However, participants disagreed on whether the reviews promoted quality improvement or focused on individual fault-finding, on how responsibility should be attributed, and whether reviews could accurately establish the causes of deaths. The facility-based death reviews were influenced by institutional and epistemic hierarchies, with responsibility often placed on individuals at the lowest health system level. While MPDSR aims to promote blame-free learning and quality improvement, the process narrowed attention to individual error, obscured systemic constraints, and hindered understanding of the \u2018real cause\u2019 of maternal deaths. To capture contextual complexity without adding reporting burden, we recommend expanding the free-text narrative fields in the official MPDSR maternal death report forms and increasing frontline representation in district- and regional reviews to strengthen links between facility and higher-level reviews.<\/jats:p>","DOI":"10.1093\/heapol\/czag053","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T12:51:53Z","timestamp":1776430313000},"page":"967-978","source":"Crossref","is-referenced-by-count":0,"title":["Identifying the \u2018real cause of death\u2019: the complexities of maternal death reviews in Tanzania"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2771-0320","authenticated-orcid":false,"given":"Kerstin","family":"Almdal","sequence":"first","affiliation":[{"name":"Centre for International Health, University of Bergen , \u00c5rstadveien 21, Bergen 5009 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences , 9 United Nations Road, Upanga West, P.O. Box 65001, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Marie","family":"Moland","sequence":"additional","affiliation":[{"name":"Centre for International Health, University of Bergen , \u00c5rstadveien 21, Bergen 5009 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Melberg","sequence":"additional","affiliation":[{"name":"Centre for International Health, University of Bergen , \u00c5rstadveien 21, Bergen 5009 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"2026061803223933700_czag053-B1","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1111\/tmi.12353","article-title":"Strengths and weaknesses in the implementation of maternal and perinatal death reviews in Tanzania: perceptions, processes and practice","volume":"19","author":"Armstrong","year":"2014","journal-title":"Trop Med Int Health"},{"key":"2026061803223933700_czag053-B2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1002\/ijgo.14041","article-title":"So hard not to feel blamed!\u201d: assessment of implementation of Benin\u2019s maternal and perinatal death surveillance and response strategy from 2016\u20132018","volume":"158","author":"Boyi Hounsou","year":"2022","journal-title":"Int J Gynecol Obstet"},{"key":"2026061803223933700_czag053-B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmhs.2024.100032","article-title":"\u201cWe do these audits, but in the end, it\u2019s useless.\u201d how can facility-based maternal death reviews improve the quality of care in Benin?","volume":"3","author":"Boyi Hounsou","year":"2024","journal-title":"SSM\u2014Health Syst"},{"key":"2026061803223933700_czag053-B4","first-page":"183","volume-title":"The Counselling & Psychotherapy Research Handbook","author":"Braun","year":"2014"},{"key":"2026061803223933700_czag053-B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2020.113066","article-title":"What explains sub-national variation in maternal mortality rates within developing countries? 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