Local problems; local solutions: an innovative approach to investigating and addressing causes of maternal deaths in Zambia's Copperbelt

Abstract

BackgroundMaternal mortality in developing countries is high and international targets for reduction are unlikely to be met. Zambia's maternal mortality ratio was 591 per 100,000 live births according to survey data (2007) while routinely collected data captured only about 10% of these deaths. In one district in Zambia medical staff reviewed deaths occurring in the labour ward but no related recommendations were documented nor was there evidence of actions taken to avert further deaths. The Investigate Maternal Deaths and Act (IMDA) approach was designed to address these deficiencies and is comprised of four components; identification of maternal deaths; investigation of factors contributing to the deaths; recommendations for action drawn up by multiple stakeholders and monitoring of progress through existing systems.MethodsA pilot was conducted in one district of Zambia. Maternal deaths occurring over a period of twelve months were identified and investigated. Data was collected through in-depth interviews with family, focus group discussions and hospital records. The information was summarized and presented at eleven data sharing meetings to key decision makers, during which recommendations for action were drawn up. An output indicator to monitor progress was included in the routine performance assessment tool. High impact interventions were identified using frequency analysis.ResultsA total of 56 maternal deaths were investigated. Poor communication, existing risk factors, a lack of resources and case management issues were the broad categories under which contributing factors were assigned. Sixty three recommendations were drawn up by key decision-makers of which two thirds were implemented by the end of the pilot period. Potential high impact actions were related to management of AIDS and pregnancy, human resources, referral mechanisms, birth planning at household level and availability of safe blood.ConclusionIn resource constrained settings the IMDA approach promotes the use of existing systems to reduce maternal mortality. In turn the capacity of local health officers to use data to determine, plan and implement relevant interventions that address the local factors contributing to maternal deaths is strengthened. Monitoring actions taken against the defined recommendations within the routine performance assessment ensures sustainability. Suggestions for further research are provided.

‘Born before arrival’: user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia

“…This belief of infidelity and obstructed labour has been noted in other Zambian studies [32, 33] and elsewhere in Africa [29, 34]. Furthermore, culture expected women to show strength and endurance during labour.…”

A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa

“…1 (Hadley and Mary Tuba, 2011) 1 1 (Koyanagi A. et al, 2009) 3 1 (Crowe et al, 2012) 1 (Binkin et al, 2011) 5 2 (Warren et al, 2006WHO, 2010) 2 1 (Kumar et al, 2010) 3 (Clements et al, 2008;Hiller et al, 2007;Raven et al, 2011) 3 (Kidney et al, 2009;Schiffman. et al, 2004(Sibley L. andSipe T., 2004)) 4 (Blencowe et al, 2011;Darmstadt et al, 2005;Haws et al, 2007;Lawn et al, 2010) 14…”

Access to transport for women with hypovolemic shock differs according to weeks of pregnancy

“…A systematic review of qualitative studies on maternal emergency transport [15] noted that many women reported difficulty finding transport, a lack of transport options, and long waits and travel times for all maternal complications. In Zambia, a lack of functioning, staffed ambulances was noted as a factor contributing to maternal deaths [16]. Additionally, a systematic review of studies examining why women die when they reach the hospital [17] found that 12 of the 16 studies recorded inadequate emergency transport as a factor contributing to maternal mortality.…”