Evaluation of the Perinatal Death Surveillance and Response System in Eastern Province, Rwanda

Abstract Background Perinatal mortality remains a significant public health concern, particularly in low- and middle-income countries where the majority of deaths occur. The Maternal, Perinatal, and Child Death Surveillance and Response (MPCDSR) system was established to improve identification, reporting, review, and response to perinatal deaths. However, the performance of this system remains suboptimal in many settings. This study aimed to evaluate the performance of the perinatal death surveillance system using surveillance attributes and core functions in selected health facilities of Eastern province, Rwanda. Methods A descriptive cross-sectional surveillance system evaluation was conducted in selected health facilities in Eastern Province, Rwanda. Routinely collected surveillance data from 2021 to 2025, document reviews, and structured questionnaires administered to members of MPCDSR committees were used to assess surveillance system attributes and core functions based on the updated CDC guidelines. Performance was summarized using descriptive statistics and categorized as poor (≤ 50%), fair (51–79%), or good (≥ 80%). Results A total of 4,414 perinatal deaths were identified during the evaluation period. Of these, 3,050 (69%) were detected in HMIS and 1,440 (47%) were formally notified through the surveillance system. Data collection and management achieved excellent performance (100%), whereas notification (47%), analysis and interpretation (0%), and response and action based on the audited cases (58%) demonstrated weaknesses. Among surveillance attributes, usefulness (84.2%), data quality (90.5%), timeliness (92.0%), simplicity (80.1%), and flexibility (80.3%) were rated as good, while stability (59.8%), acceptability (77.5%), and representativeness (74.2%) showed fair performance. Conclusion The surveillance system demonstrated strong performance in data collection and documentation but important weaknesses in notification, analysis, and implementation of response actions. Strengthening timely notification, regular death reviews, feedback mechanisms, and the use of surveillance data for decision-making is essential to improve the effectiveness of the MPCDSR system and support the reduction of preventable perinatal deaths.