About MDAC

“Maternal Death Audits in Communities” (MDAC) means to thoroughly examine and respond to the social, biological and medical events that led to a maternal or perinatal death. Inquiries are conducted of the deaths that occur in a community over several months time, in order to identify common factors that can be acted upon to prevent further deaths. Ongoing inquiries over several years allow a community to assess the impact of its preventive actions and the need for additional interventions. Death inquiries are conducted in the community using a “verbal autopsy” interview with the families of deceased persons. This is particularly helpful in areas where many deaths occur outside of health facilities and for highlighting relevant social factors and health care seeking problems. Health facilities where many deaths occur also should review the care provided to the women and children in order to identify medical practices that need to be improved to prevent additional deaths.

MDAC Project

UNICEF is supporting the implementation of MDAC in the context of RCH2, which calls for increasing community participation in bottom-up health planning and the demand for quality health care. The goals and objectives of the MDAC project are to:

1. Sensitize communities to maternal and perinatal health issues, including the need for birth preparedness, complication readiness and inquiries into maternal and perinatal deaths;
2. Identify recent maternal deaths and conduct community-based inquiries with close acquaintances of the women;
3. Share the findings of the death inquiries with communities and help them interpret the data to develop appropriate local interventions and advocate for improvements in health care; and
4. UNICEF also will use the findings of the inquiries to advocate with policy makers for needed improvements in health care.

While the MDAC project focuses on community-based death inquiries, UNICEF is partnering with WHO to support facility-based reviews of maternal deaths. The project is initially focusing on inquiries of maternal deaths. Perinatal death inquiries will be added in the future.

MDAC Tool

In the three delay model of emergency obstetric care, the first is delay in deciding to seek care. The second delay is delay in referral/transportation to the health facility. The third delay is the delay in receiving adequate care at the referral facility after arrival. MDAC tool identifies information and underlying factors related to care seeking delays 1 and 2 and to some extent, delay 3.

This tool has two versions. Earlier Version-I has 10 sections on which data has to be collected from family members of the women who dies from maternal death through inquiring about the fatal illness focusing on social factors and health care seeking problems. The analysis identified the common factors and data shared with the community to plan for actions to avoid deaths in future.

1. The 4 types of MDAC verbal autopsy formats are:
2. 1. Maternal death notification format
   2. Front section: For all Women who died
   3. For Women who died while Pregnant
   4. For Women who died during or after Labour and Delivery
   5. For Women who died during or after Abortion
3. The updated (combined) Version-II has 10 sections
4. 1. Notification format of a death of a reproductive age women
   2. Maternal verbal autopsy questionnaire for suspected maternal deaths.

Web-based Data Entry and Analysis Tool

This is web based data entry and analysis application corresponding to the MDAC Tool and analysis framework consisting of core indicators and supplementary indicator. Access to this tool is restricted members in the project organization. The web based application consists of following modules. Only one module can be accessed at a time by the user.  

1. Data Entry
2. Data Analysis
3. Auditing
4. User Admin

Refer User Manual for more details.

Project Organization can avail help through e-mail service. Email your queries to jcaravotta@unicef.org. Please mention your username first in the subject for facilitating tracking of queries and providing support.