Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

Bradshaw, Debbie; Chopra, Mickey; Kerber, Kate; Lawn, Joy E; Bamford, Lesley; Moodley, J.; Pattinson, Robert Clive; Patrick, Mark; Stephen, Cindy; Velaphi, Sithembiso

doi:10.1016/s0140-6736(08)60564-4

Cited by 100 publications

(50 citation statements)

References 21 publications

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“…A community-based maternal death review can be a useful tool for program planners, managers, and health advocates, provided that the data are used appropriately and strengths and weaknesses of the tool are kept in mind 27 . Strengths of the MDR lie in the depth of information that can be gathered on the process that the pregnant woman and her family went through and the barriers that they faced.…”

Section: Discussionmentioning

confidence: 99%

“…The maternal death review (MDR) is a tool used in many countries to understand the underlying factors leading to maternal deaths, providing programs with information to improve services and reduce MMR 10 , 11 . In an effort to analyze the reasons for maternal deaths for appropriate local intervention, the Government of India introduced Maternal Death Review guidelines in 2010, 7 based on the experience of implementing such reviews in Kerala, Tamil Nadu, and West Bengal 12 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Raj

Maine

Sahoo

et al. 2013

Glob Health Sci Pract

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Raj

Maine

Sahoo

et al. 2013

Glob Health Sci Pract

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“…Although substantial progress has been made in reducing maternal and child mortality in the last few years, this will not be sufficient to reach the millennium development goals (MDGs) 4 and 5 [4]. There is now, more than ever, an urgent need to scale up high impact interventions to save the lives of mothers, newborns and children [5–7]. With just a few months left to the millennium development goals (MDG) deadline in 2015, the focus of the international community is shifting to the post-2015 development agenda, with calls for family planning to be at the core of the post-2015 goals because of its potential to contribute to sustainable development [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

et al. 2015

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IntroductionFamily planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa.MethodsThe Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030.ResultsIf CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers.ConclusionMaternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception.

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“…Most maternal and perinatal death audits have been restricted to a single facility or region with no widely utilized centralized mechanism for aggregating data from across countries [12–14]. Up to now, the avoidable factors in deaths cataloged in these reports have not been comprehensively pooled and analyzed.…”

Section: Introductionmentioning

confidence: 99%

Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review

Merali

Lipsitz

Hevelone

et al. 2014

BMC Pregnancy Childbirth

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BackgroundAudits provide a rational framework for quality improvement by systematically assessing clinical practices against accepted standards with the aim to develop recommendations and interventions that target modifiable deficiencies in care. Most childbirth-associated mortality audits in developing countries are focused on a single facility and, up to now, the avoidable factors in maternal and perinatal deaths cataloged in these reports have not been pooled and analyzed. We sought to identity the most frequent avoidable factors in childbirth-related deaths globally through a systematic review of all published mortality audits in low and lower-middle income countries.MethodsWe performed a systematic review of published literature from 1965 to November 2011 in Pubmed, Embase, CINAHL, POPLINE, LILACS and African Index Medicus. Inclusion criteria were audits from low and lower-middle income countries that identified at least one avoidable factor in maternal or perinatal mortality. Each study included in the analysis was assigned a quality score using a previously published instrument. A meta-analysis was performed for each avoidable factor taking into account the sample sizes and quality score from each individual audit. The study was conducted and reported according to PRISMA guidelines for systematic reviews.ResultsThirty-nine studies comprising 44 datasets and a total of 6,205 audited deaths met inclusion criteria. The analysis yielded 42 different avoidable factors, which fell into four categories: health worker-oriented factors, patient-oriented factors, transport/referral factors, and administrative/supply factors. The top three factors by attributable deaths were substandard care by a health worker, patient delay, and deficiencies in blood transfusion capacity (accounting for 688, 665, and 634 deaths attributable, respectively). Health worker-oriented factors accounted for two-thirds of the avoidable factors identified.ConclusionsAudits provide insight into where systematic deficiencies in clinical care occur and can therefore provide crucial direction for the targeting of interventions to mitigate or eliminate health system failures. Given that the main causes of maternal and perinatal deaths are generally consistent across low resource settings, the specific avoidable factors identified in this review can help to inform the rational design of health systems with the aim of achieving continued progress towards Millennium Development Goals Four and Five.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-280) contains supplementary material, which is available to authorized users.

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Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

Cited by 100 publications

References 21 publications

Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review

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