The difficulties of conducting maternal death reviews in Malawi

Kongnyuy, Eugene J; Broek, Nynke van den

doi:10.1186/1471-2393-8-42

Cited by 56 publications

(93 citation statements)

References 9 publications

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“…In places where establishment of maternal mortality audits has led to improved quality of obstetric care, the success has been particularly attributed to strong leadership and accountability of both health providers and key decision makers [7,11,25,26]. Our findings recommend a more responsive health system from the level of the ministry of health down to the grass root levels.…”

Section: Discussionmentioning

confidence: 82%

Using audit to enhance quality of maternity care in resource limited countries: lessons learnt from rural Tanzania

Nyamtema

Jong

Urassa

et al. 2011

BMC Pregnancy Childbirth

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BackgroundAlthough clinical audit is an important instrument for quality care improvement, the concept has not yet been adequately taken on board in rural settings in most resource limited countries where the problem of maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions.MethodsMethods are informed by the principles of operations research. An audit system was established, all patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and strategic action plans for improvement were developed and implemented.ResultsThere were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care. Patients, health workers and administration related substandard care factors were identified in 50% - 61% of women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the workforce for health care, referral system improvement and upgrading of health centres located in hard to reach areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result of audit.ConclusionsOur findings indicate that audit can be implemented in rural resource limited settings and suggest that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are limited if strategic interventions are implemented.

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Section: Discussionmentioning

confidence: 82%

Using audit to enhance quality of maternity care in resource limited countries: lessons learnt from rural Tanzania

Nyamtema

Jong

Urassa

et al. 2011

BMC Pregnancy Childbirth

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“…There are challenges to conducting an MDA [25,26]. These include fear of repercussions, lack of anonymity during audit sessions, resistance of healthcare providers to have their care evaluated by peers or to evaluate care given by peers, lack of staff commitment, and lack of knowledge and skills among some healthcare providers.…”

Section: Auditmentioning

confidence: 99%

“…Standards should be set with a clear objective, and structure, process, and outcome criteria need to be clearly defined. The standards and criteria for audit can be developed by expert teams or by the QI teams themselves [26]. The latter enhances ownership of the QI process by those implementing the changes at service-delivery level.…”

Section: Auditmentioning

confidence: 99%

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Methodology and tools for quality improvement in maternal and newborn health care

Raven

Hofman

Adegoke

et al. 2011

Intl J Gynecology & Obste

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The documented experience with the identified approaches, methodologies, and tools indicates that none is sufficient by itself to achieve a desirable improvement in quality of care. The choice of methodologies and tools depends on the healthcare system and its available resources. There is a lack of studies that describe the process of quality improvement and a need for research to provide evidence of the effectiveness of the identified methods and tools.

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“…Therefore, it is worrying that the rate of implementation of recommendations made by audit committees was 30% in the present study. However, it has been suggested that healthcare managers and staff-owing to health system weaknesses-face difficulties in using the audit process and its recommendations to improve quality of care [8]. This calls for institutionalization of the implementation of audit committee recommendations and the setting up of systems to monitor progress toward reducing maternal deaths.…”

Section: Discussionmentioning

confidence: 96%