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

Abstract

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.

Quality of routine data related to facility-based maternal mortality measurement in Kampala City, Uganda

“…These ndings suggest that additional measures to verify data on maternal deaths reported through the routine outpatient monthly reports should be applied, since the non-zero values reported might not be representative of all maternal deaths occurring in facilities. This is in accordance with existing evidence which demonstrates reporting challenges for maternal deaths, particularly underreporting (47,48). Also, maternal deaths appeared to be concentrated in a relatively small number of facilities which can facilitate targeted initiatives to improve completeness of the data reported.…”

“…Nonetheless, it is unclear from this study to what extent the measure of completeness (non-zero values) re ects if every maternal death that occurred in the different facilities were reported. Based on the results of this study showing potential under-reporting in private facilities of maternal deaths, together with challenges of facility documentation such underreporting and incompleteness that have been reported (47,48), the completeness and accuracy of data on maternal deaths needs additional veri cation.…”

Mortality and disability-adjusted life years in North Africa and Middle East attributed to kidney dysfunction: a systematic analysis for the Global Burden of Disease Study 2019

“…The NAME region consists of low- to high-income countries. Even now in some countries of the region, specialized medical services are not generally available while some others have better situations that can address the current medical standards [ 33 – 37 ]. As conflicts and wars change the focus of policy makers from chronic disease to acute ones and also bring destruction to facilities, countries experiencing conflicts face worsening of the situation in the burden of chronic disease that continues in the upcoming years after conflicts and wars [ 38 ].…”

Maternal mortality in Afghanistan: Challenges, efforts, and recommendations

“…20 Studies indicate substandard record keeping and poor documentation, as cause of death was not recorded in nearly half of maternal death cases reviewed. 21 Also, the latest survey on the subject matter was conducted in 2017, 7 this creates an uncertainty regarding maternal mortality figures which might be considerably higher now than they were 5 years ago. Lastly, the poor research capacity makes it difficult to acquire data from rural areas, where around 74% of the country's population resides, 22 and prevents a much-needed geographical comparison of maternal mortality.…”