Table 2. Summary of studies where a community death review was conducted.

Source	Person(s) responsible for review or response	Method(s) for review & response	Number of deaths reviewed	Response/ recommendations implemented
Biswas et al. [7] Bangladesh	• Health inspectors, Assistant Health Inspector & Family Planning Inspector were responsible for facilitating reviews • A community representative chaired each meeting	• Community discussion attended by 20–50 community members • Field notes taken during the discussions following a guideline	SA was performed for 28 out of 59 maternal deaths notified between January & December 2010	• Regular antenatal care visits • Mothers to prepare birth planning & ensure they deliver their baby at the health facility by trained provider • Community awareness of maternal complications
Bayley et al [31] Malawi	• HSAs discussed factors contributing to maternal deaths in a meeting held in the community • HSAs reported the information from the VA and the community team discussions • HSAs summarised the case & facilitated an open discussion	• Community team meeting • Meeting at the local health facility/district hospital • Public meeting in the local community	• 37 deaths were discussed at a community death review meeting • 44 deaths were discussed at a health facility death review meeting • 32 deaths were discussed at the community feedback meeting	• Improving drug supplies–adequate stock of antihypertensive medication • Training sessions for clinicians • Health education events for communities on maternal health topics • Improved provision of emergency transport • Changing protocols to improve access to rural hospitals
Willcox et al. [39] Mali & Uganda	Online and face-to-face meetings chaired by local paediatrician with 8–15 attendees (local doctors, nurses, health-care assistants & one community representative [VHT members in Uganda & local traditional health practitioners in Mali])	• Confidential enquiry (District panel meeting) • Community meeting (Whole-village meetings in Mali & meetings of VHTs in Uganda)	762 deaths in Mali and 442 in Uganda were reviewed	• Community education & improving treatment seekingEstablishment of loan fund in Mali to facilitate emergency access to healthcare • Transfer of staff to understaffed health centres • Mobile phone calling circle to solve a staff communication problem • Refresher training for local staff • Introduction of clinical guidelines
Moshabela et al. [40] Senegal	Regional Millennium Village Project (MVP) staff	Monthly community meetings with regional MVP staff & local community members to discuss deidentified VASA findings alongside other routine health indicators	5 maternal deaths	• Provision of surgical packs, equipment & drugs by MVP • Reshuffling, training & supervision of the surgical team by the hospital • Combined effort to track, avail and prepare blood donors for obstetric emergency care • Quarterly mortality reviews • Overhaul of the hospital infrastructure
O’Conner et al. [54] Sierra Leone	• The Health Management Committee Chair for the community chaired the meeting • Sessions were facilitated by operations research study staff. Over time, participants took the lead in reviewing the data and reporting the findings	Community health data review meetings attended by 30 to 50 people	CHWs submitted 2409 reports over 34 months which were reviewed in 29 meetings from July 2015 to April 2017	• Participants sought clarity from primary health unit staff on clinic hours of operation & actions to take if no staff are found at the PHU • Improving data quality & completeness of CHWs’ reporting