Improving Mortality Surveillance through Notification of Death at Mbale Regional Referral Hospital, Uganda, October 2023-April 2024

BackgroundAccurate mortality reporting is crucial for monitoring population health, detecting disease outbreaks, and informing health policies. However, the implementation of medical certification of cause of death remains low in Uganda, with only 3.2% of health facility deaths being notified to the Ministry of Health. Using a quality improvement approach, we aimed to improve mortality reporting through medical certification of cause of death at Mbale Regional Referral Hospital (MRRH) in Uganda from 1% to 80% within 6 months. MethodsWe purposively selected MRRH as one of five regional referral hospitals with the lowest death notifications (0%-20%) during 2022 and 2023. We adopted the existing quality improvement team, which includes medical and non-medical personnel. Focus group discussions identified challenges that informed the root cause analysis. Using the Plan-Do-Study-Act (PDSA) cycle, we generated change ideas (interventions) to address these bottlenecks. We monitored the progress of the interventions with process indicators (number of mentorship sessions conducted, number of review meetings held) and an outcome indicator (proportion of deaths occurring in the hospital notified through the District Health Information System version 2 (DHIS2)) for 6 months. We tracked notifications monthly and analyzed the trend at six months using the Mann-Kendall test. ResultsWe conducted 4/6 (67%) mentorship sessions and 7/19 (38%) review meetings and trained 32/50 (64%) nurses. The qualitative findings highlighted key challenges, including lack of knowledge and training, competing priorities and workload, resource constraints, undervaluing the importance of mortality reporting, failure to follow guidelines, and heavy workloads. The interventions included training and mentorship sessions for the staff on properly completing the death notification form, adopting a standardized process for form completion, and conducting bi-monthly review meetings. The proportion of deaths notified through DHIS2 from November 2023 to April 2024 increased from 17% to 65% (p=0.01). ConclusionTraining of staff, adoption of a standard protocol on notification, and routine review meetings could facilitate death notification and improve mortality surveillance in Uganda enabling more accurate resource allocation for mortality prevention. The target was not met probably because all the staff were not trained, and the review meetings were sub-optimal.