{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:52:29Z","timestamp":1791967949282,"version":"4.3.4"},"reference-count":19,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR303806"],"award-info":[{"award-number":["NIHR303806"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T037962\/1"],"award-info":[{"award-number":["MR\/T037962\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background Despite having high maternal mortality, no recent confidential enquiry into maternal deaths (CEMD) has been implemented in Ethiopia. This paper outlines the introduction of the CEMD, major findings, and key methodological considerations. Methods We embedded this CEMD in the ongoing Ethiopian Obstetric Surveillance System (EthOSS), a regional system that monitors a range of major obstetric conditions in eastern Ethiopia. Multiple methods (both qualitative and quantitative) were used to collect, analyse and report the data. A multidisciplinary committee was established and trained on principles and methodology of CEMD by international experts. The CEMD committee conducted two plenary CEMD sessions to review maternal deaths reported from April 1, 2021, to March 31, 2022, from 13 hospitals in the EthOSS consortium. Each case was assessed for causes, contributing factors, delays in care using the three-delays model, preventability, and recommendations for improving care. Results Out of 70 maternal deaths, in 59 there was enough information to enable a review by the committee; 27\/59 (46%) and 15\/59 (25%) were caused by obstetric haemorrhage and hypertensive disorders of pregnancy respectively. In 55\/59 (93%), at least one of the three delays was identified: delay one (seeking care) in 48 (81%), delay two (reaching an appropriate facility) in 52 (88%), and delay three (receiving adequate care) in 54 (92%). The review indicated that almost all reported deaths could have been prevented with better care. Conclusions Almost all the maternal deaths in the region were considered preventable. Training for improving providers\u2019 clinical skills, improving availability of blood and basic supplies, strengthening postpartum monitoring, and referrals were recommended for saving lives through reducing preventable maternal deaths.<\/ns3:p>","DOI":"10.3310\/nihropenres.14170.1","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:29:11Z","timestamp":1791966551000},"page":"1","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Introduction of confidential enquiry into maternal deaths in Ethiopia: Implementation and methodological considerations"],"prefix":"10.3310","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3858-190X","authenticated-orcid":false,"given":"Sagni","family":"Girma","sequence":"first","affiliation":[{"name":"College of Health and Medical Sciences Harar Haramaya University"},{"name":"Department of Obstetrics and Gynaecology Leiden Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden Leiden University Medical Center"},{"name":"Amsterdam Vrije Universiteit Amsterdam Athena Instituut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redwan","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Harar Hiwot Fana Specialized Comprehensive University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4143-3297","authenticated-orcid":false,"given":"Mohammed","family":"Yuya","sequence":"additional","affiliation":[{"name":"College of Health and Medical Sciences Harar Haramaya University"},{"name":"Department of Obstetrics and Gynaecology Leiden Leiden University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle","family":"Stekelenburg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Leeuwarden Medical Centre Leeuwarden"},{"name":"Department of Global Health Groningen University Medical Centre Groningen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahir Ahmed","family":"Hassen","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health Newcastel New South Wales The University of Newcastle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delayehu","family":"Bekele","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Addis Ababa St Paul's Hospital Millennium Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1984-4575","authenticated-orcid":false,"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit, Nuffield Department of Population Health Oxford University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abera Kenay","family":"Tura","sequence":"additional","affiliation":[{"name":"College of Health and Medical Sciences Harar Haramaya University"},{"name":"Department of International Public Health Liverpool Liverpool School of Tropical Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref-1","article-title":"Trends in maternal mortality estimates 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division.","year":"2025"},{"key":"ref-2","article-title":"National Maternal and Perinatal Death Surveillance and Response (MPDSR) system annual report 2013 EFY.","year":"2022"},{"key":"ref-3","article-title":"Maternal Death Surveillance and Response: technical guidance information for action to prevent maternal death.","year":"2013"},{"key":"ref-4","article-title":"Maternal Death Surveillance and Response (MDSR) technical Guideline","year":"2012"},{"key":"ref-5","article-title":"National technical guidance for Maternal and Perinatal Death Surveillance and Response","year":"2017"},{"key":"ref-6","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1405-6","article-title":"Implementing Maternal Death Surveillance and Response: a review of lessons from country case studies.","volume":"17","author":"H Smith","year":"2017","journal-title":"BMC Pregnancy Childbirth."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"492-498","DOI":"10.1093\/heapol\/czz075","article-title":"'Maternal deaths should simply be o': politicization of maternal death reporting and review processes in Ethiopia.","volume":"34","author":"A Melberg","year":"2019","journal-title":"Health Policy Plan."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"150-154","DOI":"10.9745\/GHSP-D-19-00366","article-title":"Beyond No blame: practical challenges of conducting maternal and perinatal death reviews in Eastern Ethiopia.","volume":"8","author":"A Tura","year":"2020","journal-title":"Glob Health Sci Pract."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"345-354","DOI":"10.9745\/GHSP-D-17-00130","article-title":"Implementing Maternal Death Surveillance and Response in Kenya: incremental progress and lessons learned.","volume":"5","author":"H Smith","year":"2017","journal-title":"Glob Health Sci Pract."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"62-75G","DOI":"10.2471\/BLT.22.288703","article-title":"Maternal and Perinatal Death Surveillance and Response: a systematic review of qualitative 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system annual report 2010 Ethiopian Fiscal Year (EFY).","year":"2018"},{"key":"ref-19","article-title":"Saving mothers lives: confidential enquiry into Maternal Deaths in Kenya.","year":"2017"}],"container-title":["NIHR Open 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.15421.r39183, Farid Midhet, Bahria University, Karachi, 04 Feb 2026, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/6-1\/v1#referee-response-39183","order":0,"name":"referee-response-39183","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.15421.r39327, Abera Mersha Mamo, Mizan-Tepi University, Mizan-Teferi, 06 Feb 2026, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/6-1\/v1#referee-response-39327","order":1,"name":"referee-response-39327","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Marian Knight is an NIHR senior investigator; grant reference NIHR303806. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}