RT Journal Article SR Electronic T1 Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2200281 DO 10.9745/GHSP-D-22-00281 VO 11 IS 2 A1 Abera Kenay Tura A1 Sagni Girma A1 Yadeta Dessie A1 Delayehu Bekele A1 Jelle Stekelenburg A1 Thomas van den Akker A1 Marian Knight A1 on behalf of the Ethiopian Obstetric Surveillance System Steering Committee YR 2023 UL http://www.ghspjournal.org/content/11/2/e2200281.abstract AB Key FindingsImplementation of obstetric surveillance through a network of reporting clinicians and implementers is feasible in a setting like Ethiopia.The introduction of regional obstetric surveillance combining mortality and morbidity data may help to improve care by providing more robust, rapid, and context-sensitive data collection.Key ImplicationsEstablishing obstetric surveillance in low-resource settings requires addressing challenges related to poor medical recordkeeping and reporting, as well as capacity-building among clinicians and policymakers to generate and use research evidence locally.Involving practicing clinicians, decision-makers, and implementers from the onset is essential for successful implementation and sustainability, and including morbidity data rather than focusing on deaths alone could enhance their participation.Ministries of health, professional societies, and academic institutions should actively participate in implementing nationwide obstetric mortality and morbidity surveillance, which could strengthen the current approaches to maternal and perinatal death surveillance and response followed by these stakeholders.Background:Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia.Methods:We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS.Results:Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts.Conclusions:In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.