Objective: To evaluate the risk of maternal death following the intensification of Maternal and Perinatal Death Surveillance (MPDSR) activities and the substitution of dinoprostone for misoprostol for labour induction. Design: Case-cohort Setting: Kiambu County Referral Hospital(KCRH), Kiambu County, Kenya Population or Sample: Mothers delivering at KCRH during January 2018 - December 2021 Methods: We recruited all 58 mothers who died between January 2018 and December 2021 as cases. A random subcohort of 232 mothers who did not die was selected from a retrospective cohort study of 411 mothers as controls. Multiple logistic regression was used to model the determinants of maternal mortality adjusted for intensified MPDSR activities and labour induction agents. Main Outcome Measures: Adjusted odds ratio of maternal mortality for mothers induced with misoprostol versus dinoprostone and for delivery prior to and after the intensification of MPDSR activities. Results: Factors associated with increased risk maternal mortality included: unemployment (AOR 1.83; 95% C.I.: 0.52 – 7.50), singlehood (AOR 3.47; 95% C.I.: 0.59 – 17.9), labour induction with misoprostol (AOR 7.17; 95% C.I.: 0.72 - 182), multiparity (AOR 3.11; 95% C.I.: 1.37 – 6.98, p = 0.006), or being pre-term (AOR 4.79; 95% C.I.: 1.56 – 15.7, p = 0.007). Conclusions: The risk of maternal mortality did not decrease with the intensification of MPDSR activities but increased with the use of misoprostol to induce labour. Funding: Ministry of Health (Kenya), Transforming Health for Universal Health Coverage

Health information is a powerful vehicle for enhancing community health and it highlights both the problems and opportunities that exist for development. In Uganda, there are cases where decisions have been made without using health information in primary health care units. The existing capacity inadequacy to efficiently utilize information to track service use patterns over time to determine the impacts of policy and service delivery improvements in Uganda is one of the key weaknesses. With the support of the Ministry of Health, the government of Uganda is implementing projects to build and enhance the nation’s web-based national health information system (DHIS2), which collects data from all health systems and allows for making decisions based on evidence on the delivery of health services. The broad study objective was to establish the factors influencing the utilization of routine health information for decisions making among the health workers. The research design was based on an analytical cross-sectional design. The target population for this study was 260 health workers specifically targeting those involved in the use of routine utilization of health information. Purposive sampling was used to select the key informants and other respondents were selected using simple and stratified random sampling. The self-administered structured questionnaire and key informants’ interviews were used to collect data from respondents. The analysis of the quantitative data was done using descriptive statistics consisting of tables, bar graphs, pie charts, frequency, percentages, mean and standard deviations. Logistic regression analysis was conducted for establishing the association amongst the variables. The study established that technical factors (χ2=801.069; p=0.001), organizational factors (χ2=895.224; p=0.000), and behavioural factors (χ2=994.559; p=0.000) had a significant influence on utilization of routine health information for decision making. Talk of significant predictors of utilization of routine health information for decision making, technical factors (p = 0.013) had the greatest influence on utilization of routine health information for decision making among health workers at health facilities followed by organizational factors (p = 0.049). The study recommends that management of health facilities in Moyo district to create organizational culture through increased demand for and use of routine health information for evidence-based decision making in all aspects. The study further established areas of the routine health information system that requires to be reinforced and backed up to ensure the use of routine data in health facility to make decisions.