Obstetric audit in resource-poor settings: lessons from a multi-country project auditing 'near miss' obstetrical emergencies

Abstract

This paper outlines the practical steps involved in setting up and running multi-professional, in-depth case reviews of 'near miss' obstetrical complications. It draws on lessons learned in 12 referral hospitals in Benin, Côte d'Ivoire, Ghana and Morocco. A range of feasibility indicators are presented which measured the implementation and frequency of audit activities, the quality of participation, adherence to the planned protocol for the near-miss audits, the quality of audit discussions and the sustainability of the project. Although the principles of the audit approach were well accepted and implemented everywhere, near-miss audits appeared most successful in first referral level hospitals. Contextual factors that determine the successful implementation of near-miss audit include staff finding adequate time for audit activities, financial incentives to groups rather than individuals, involvement of senior staff and hospital managers, the ease of communication in smaller units, the employment of social workers for the incorporation of women's views at audits, and the strength of external support provided by the research team. The poor quality of information recorded in case notes was recognized everywhere as a deficiency, but did not present a major obstacle to effective case reviews. Ownership and leadership within the hospital, more easily achieved in the first-level referral hospitals, were probably the most important determinants of successful implementation. Sustainability requires a commitment to audit from policy makers and managers at higher levels of the health system and some devolution of resources for implementing recommendations.

Maternal mortality in Senegal

“…10,11 In these two reports, there was a 50% drop in maternal mortality within a 3pyear intervention period, which is similar to the pattern noted in our study. There are also several studies of facilitypbased audits of perinatal deaths, 20 uterine rupp p ture, 21 nearpmisses [22][23][24] or criterionpbased audit. 25,26 However, controlled evaluation studies of audit interventions are rare and the absolute or relative effects of these approaches on professional practices and outcomes are generally only small to moderate.…”

Near miss maternal mortality, who is responsible? Administration, healthcare system or the people themselves

“…[1][2][3] According to WHO, National near miss refers to a woman who nearly died but survived a complication that occurred during pregnancy, child birth or within 42 days of termination of pregnancy. 4 To implement the maternal near miss approach, WHO has done extensive research and provided essential operational definitions.…”

Research on Severe Maternal Morbidities and Near-Misses in Brazil: What We Have Learned

“…Moreover, studying what happened to them is made easier by their greater numbers and the possibility of being able to listen to them directly. [3][4][5] Although the concept of near-miss is already well-established, a consensual definition has yet to be adopted, including how the women comprising this group may be recognised. [6][7][8] Considering the potential of near-misses to contribute to the development of strategies for reducing maternal mortality, we decided to study different aspects of them using different approaches.…”