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BACKGROUND: Response should be a key part of maternal death surveillance and response (MDSR) programmes, which include confidential enquiries into maternal deaths. The programmes investigate avoidable factors in maternal deaths and make recommendations for improving maternity care. There is a gap in information on how these recommendations are transformed into practice. OBJECTIVE: To explore the methods used to assess the implementation status of recommendations made in confidential enquiries into maternal deaths and other health outcomes. DATA SOURCES: We searched PubMed, Web of Science, CINAHL, and Google Scholar databases and general web for grey literature using the "Arksey and O'Malley framework" in all major scientific databases and search engines. STUDY SELECTION AND DATA EXTRACTION: An initial screening was followed by extraction of information using a data chart. Variables in the chart were based on the response component of maternal death and surveillance systems. SYNTHESIS: Information collected was summarised using content analysis method. RESULTS: We reviewed 13 confidential enquiry systems into maternal deaths. Many confidential enquiries into maternal deaths published reports with their recommendations and dissemination often involved national-level scientific presentations. Only five reports provided strategies for implementing the recommendations. Follow-up of previous recommendations was routinely published in only two reports. However, impact assessment of recommendations on other health outcomes was found only in the UK. CONCLUSION: There is a gap in monitoring the response generated by confidential enquiries into maternal deaths. Actions to develop this are therefore needed.

Original publication




Journal article


Paediatr Perinat Epidemiol

Publication Date



confidential enquiry, health care, peer review, quality of health care, surveillance