By Jael Namiganda
Uganda is strengthening its maternal and perinatal death surveillance system to improve the documentation of deaths, identify gaps in healthcare delivery and strengthen the country’s ability to detect emerging health threats.
The initiative is being implemented through the Maternal and Perinatal Death Surveillance and Response (MPDSR) system, with the Ministry of Health working alongside health partners to improve the quality and use of data collected from health facilities and communities.
According to Ministry of Health statistics, Uganda recorded approximately 2,917 maternal deaths in 2023, representing a reduction in the absolute number of maternal deaths. The infant mortality rate also fell to 35.9 deaths per 1,000 live births in 2024, indicating some improvement in neonatal care and health facility readiness.
Despite these improvements, health authorities say more needs to be done to understand why mothers and newborns continue to die and identify gaps that could be addressed to prevent avoidable deaths.
Dr Richard Mugahi, Commissioner for Reproductive and Child Health at the Ministry of Health, says an Implementation Science Programme is currently being piloted in Kasese, Mukono and Kyegegwa districts.
The programme follows an assessment which found that 48 percent of maternal and infant deaths had no documented cause, limiting the ability of health authorities to establish why the deaths occurred and how they could be prevented.
Dr Mugahi says health workers are being trained to document detailed symptoms, examination findings and other information that can help determine the circumstances surrounding maternal and newborn deaths. “Without proper documentation of the symptoms and examination findings, it becomes difficult to work backwards and establish what caused the death,” Dr Mugahi says.
Data to identify gaps in care
The programme is using a digital tool known as the Babies Matrix to capture information such as a newborn’s birth weight and age.
The information will be integrated into the national District Health Information System 2 (DHIS2) to allow health authorities to analyse mortality trends and identify areas requiring investigation.
Dr Mugahi says the objective is not simply to collect data but to use it to identify possible weaknesses in healthcare delivery.
“For example, if the data shows that babies weighing more than 2.5 kilogrammes are dying in large numbers, health authorities can investigate whether the deaths are linked to delays during labour, referrals, emergency interventions or gaps in newborn care,” Dr Mugahi says.
MPDSR can strengthen disease surveillance
Kenneth Mwehonge, Executive Director of HEPS Uganda, says the existing maternal and perinatal death surveillance system can also be used to strengthen broader public health surveillance.
He says mothers and children frequently interact with the health system, making information generated through their care useful in identifying early signs of emerging epidemics and other health threats. “MPDSR gives us an opportunity to leverage the systems that are already in place to strengthen global health security,” Mwehonge says.
HEPS Uganda conducted a baseline assessment in the three pilot districts to identify challenges affecting data quality, data capture and reporting. Mwehonge says the findings are being used by the Ministry of Health to develop corrective action plans and roadmaps aimed at strengthening surveillance.
Delays in referrals remain a concern
Mwehonge says delays in responding to mothers who are referred to higher-level health facilities remain an area requiring urgent attention.
He says referring a patient is not enough if the receiving facility does not provide timely medical attention. The initiative is also examining perinatal deaths involving newborns with normal birth weights.
Mwehonge says these deaths need to be investigated to determine whether there are gaps in monitoring, labour management, referral systems or newborn care.
Focus on stillbirths
The programme is also strengthening the documentation of stillbirths. Dr Mugahi says health workers need to distinguish between fresh and older stillbirths because the condition of the baby can provide clues about when the death occurred.
“A fresh stillbirth, where the baby’s skin remains pink and intact, may point to problems during labour or delivery, including delays in referral or emergency intervention. An older stillbirth, characterized by peeling or darkened skin, may indicate that the baby died before labour and could point to challenges during pregnancy or antenatal care,” Dr Mugahi says.
However, Dr Mugahi says cultural sensitivities surrounding stillbirths can make it difficult for health workers to obtain detailed information from grieving families.
He says information about the mother’s pregnancy history, treatment and antenatal care remains important in understanding the circumstances surrounding a death and preventing similar deaths in the future.
Three districts selected for the pilot
Dr Mugahi says the three districts were selected because they represent different public health settings. Kyegegwa was selected because it hosts refugees, while Kasese was chosen because of its proximity to the Democratic Republic of Congo and its exposure to recurring disease outbreaks.
Mukono was selected because it combines urban and peri-urban communities.
The different settings are expected to provide lessons on how mortality surveillance can be strengthened across different populations and health system environments.
Partners join efforts
The initiative is being supported by the Ministry of Health, HEPS Uganda, CDC Atlanta, CDC Foundation and UNICEF, among other partners. The Ministry of Health is leading the government response, while HEPS Uganda is supporting data capture, data systems and monitoring.
“The partners are working to ensure that information collected at district and health facility level is analysed and translated into action,” Dr Mugahi says.
He stresses that the ultimate goal is to move beyond simply counting maternal and newborn deaths to understanding why they occur and what can be done to prevent avoidable deaths.
By strengthening documentation, improving data quality and ensuring that findings are acted upon, health authorities hope to identify gaps in care earlier and improve outcomes for mothers and newborns across Uganda.
