Beyond No Blame: Practical Challenges of Conducting Maternal and Perinatal Death Reviews in Eastern Ethiopia

Tura, Abera Kenay; Fage, Sagni Girma; Ibrahim, Alexander Mohamed; Mohamed, Ahmed; Ahmed, Redwan; Gure, Tadesse; Zwart, Joost J.; Akker, Thomas van den

doi:10.9745/ghsp-d-19-00366

Cited by 16 publications

(27 citation statements)

References 23 publications

(31 reference statements)

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“…In Afghanistan, the poor quality of medical records, lack of knowledge and skills, staff turnover, lack of coordination, the culture of blame and inadequate resources are barriers to conducting effective death reviews ( 14 , 31 , 32 ). Effective maternal death reviews require supportive political and legal supports, individual commitment, and an environment conducive to learning as integral part of improving service coverage and quality of care.…”

Section: Discussionmentioning

confidence: 99%

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Maruf

Tappis²,

Stekelenburg

et al. 2021

Front. Glob. Womens Health

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Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan.Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium.Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths.Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting.

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Section: Discussionmentioning

confidence: 99%

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Maruf

Tappis²,

Stekelenburg

et al. 2021

Front. Glob. Womens Health

Self Cite

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“…Continuous emphasis was put on the idea of “ no shame, no blame ” through allowing all attendees to exchange ideas on how to move forward together without blaming. Meetings with staff of the department of obstetrics and gynecology gradually grew from hesitancy, self-defense, and blamings to self-reflections and active involvement in finding solutions [ 12 , 31 , 32 , 33 ]. The initial meetings were characterized by defensive feedback by the staff: repeatedly complaining about lack of resources by the staff and lack of efficient use of resources by the head of the hospital and other officials [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypertensive disorders of pregnancy, obstetric hemorrhage, and sepsis were identified as the major underlying conditions among 622 women with life-threatening complications [ 10 , 11 ]. Following these findings, the Averting Maternal And Neonatal Morbidity And Mortality through obstetric Audit (AMAN-MAMA) project was introduced in HFSUH to improve care practices and work towards improving outcome [ 12 ]. The AMAN-MAMA project involves performing maternal and perinatal death reviews and a criterion-based audit of obstetric complications to upgrade the quality of hospital care.…”

Section: Introductionmentioning

confidence: 99%

Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations

Tura

Aboul-Ela

Fage

et al. 2020

IJERPH

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With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.

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“…The Federal Ministry of Health of Ethiopia launched the national MDSR system in May 2013 to enhance the service quality of maternal health care, particularly during pregnancy, childbirth, and postpartum periods [ 13 , 14 ]. Currently, the system is actively running throughout all regions of Ethiopia with varying levels of performance.…”

Section: Introductionmentioning

confidence: 99%

Target areas to reduce the burden of maternal death due to obstetric hemorrhage in Ethiopia

Tesfay

Tariku²,

Zenebe³

et al. 2022

PLoS ONE

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Background Obstetric hemorrhage is defined as active bleeding of more than 500 ml in vaginal delivery or 1000ml following cesarean delivery. It is the leading cause of maternal death, which contributes to up to 50% of maternal deaths in Ethiopia. This study aims to assess the relationships between adverse maternal health exposure (personal and medical factors) and delay in health care (hesitancy in opting to seek care, lag in reaching a health facility, and wait in receiving health care at the facility) and adverse outcomes of obstetric hemorrhage among reviewed maternal deaths in Ethiopia. Methods This study utilizes 4530 reported maternal death surveillance data obtained from Ethiopian maternal death surveillance and response (MDSR) system between 2013 to 2020. Latent class analysis was applied to identify underlying patterns of adverse maternal health exposures. Furthermore, the associations between latent classes and adverse outcomes of obstetric hemorrhage were analyzed using multilevel logistics regression model adjusted for clustering within reporting provinces. Results Nearly 56% of the reviewed maternal deaths were due to the adverse outcome of obstetric hemorrhage, among which nearly 75% died during the postpartum period. The study identified six separate sub-groups of women based on their vulnerability to adverse maternal health conditions. The six subgroups identified by this study are 1) women who travelled for a long duration to reach a health care provider, 2) those who had no access to a health facility (HF) within a 5Km radius, 3) those who failed to decide to go to a health facility: 4) those with multiparity,5) those who were injured during delivery with history of coagulopathy, and 6) those who got injured during delivery and failed to decide to go to a health facility. Women in the class of grand multipara have demonstrated the highest risk of death due to the adverse outcomes of obstetric hemorrhage (β = 1.54, SE = 0.09, p<0.0001). Conclusions The study has attempted to identify women that are at a higher risk for the adverse outcomes of obstetric hemorrhage. Henceforth, targeted intervention should be taken on women of reproductive age group, and those identified as at a higher risk, to reduce the high rate of maternal death due to obstetric hemorrhage.

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Beyond No Blame: Practical Challenges of Conducting Maternal and Perinatal Death Reviews in Eastern Ethiopia

Cited by 16 publications

References 23 publications

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations

Target areas to reduce the burden of maternal death due to obstetric hemorrhage in Ethiopia

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