Facility‐based audit of maternal mortality in Lebanon: A feasibility study

Matar

Intl J Gynecology & Obste

2010

contrasting

confidence: 87%

A 20‐year (1989–2008) audit of maternal mortality in Damascus, Syria

Matar

Intl J Gynecology & Obste

2010

“…Maternal and perinatal death reviews have been conducted in Tanzanian facilities since 2006 and have identified avoidable factors and opportunities for improvement via confidential multidisciplinary team discussions led by healthcare providers and by reviewing patient records [ 28 ]. A Lebanese study mentioned that the FDR approach helped professionals to understand the causes and determinants of maternal mortality [ 29 ]. In Asia, the WHO initiated maternal and perinatal death review at facilities in Bangladesh, Sri Lanka, India, Nepal, Myanmar, Bhutan, the Maldives, Indonesia, Thailand, and Korea [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Facility Death Review of Maternal and Neonatal Deaths in Bangladesh

Biswas

Rahman²,

Eriksson

et al. 2015

PLoS ONE

ObjectivesTo explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.MethodsThis was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.ResultsFDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.DiscussionFDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

“…Information might have been missed, particularly if the information of interest was presented as a single word, or only reported once in the entire text [29]. In summary, the information documented within medical charts has been characterized in the literature and through our observations as being poorly maintained and marred with errors, omissions, and idiosyncrasies [26,30,31]. However, the data extractors were still able collect some valuable data and triangulate it with the other information to glean a better picture of what did and did not occur.…”

Section: Discussionmentioning

confidence: 99%

Easier said than done!: methodological challenges with conducting maternal death review research in Malawi

Thorsen

Sundby

Meguid

et al. 2014

BMC Med Res Methodol

BackgroundMaternal death auditing is widely used to ascertain in-depth information on the clinical, social, cultural, and other contributing factors that result in a maternal death. As the 2015 deadline for Millennium Development Goal 5 of reducing maternal mortality by three quarters between 1990 and 2015 draws near, this information becomes even more critical for informing intensified maternal mortality reduction strategies. Studies using maternal death audit methodologies are widely available, but few discuss the challenges in their implementation. The purpose of this paper is to discuss the methodological issues that arose while conducting maternal death review research in Lilongwe, Malawi.MethodsCritical reflections were based on a recently conducted maternal mortality study in Lilongwe, Malawi in which a facility-based maternal death review approach was used. The five-step maternal mortality surveillance cycle provided the framework for discussion. The steps included: 1) identification of cases, 2) data collection, 3) data analysis, 4) recommendations, and 5) evaluation.ResultsChallenges experienced were related to the first three steps of the surveillance cycle. They included: 1) identification of cases: conflicting maternal death numbers, and missing medical charts, 2) data collection: poor record keeping, poor quality of documentation, difficulties in identifying and locating appropriate healthcare workers for interviews, the potential introduction of bias through the use of an interpreter, and difficulties with locating family and community members and recall bias; and 3) data analysis: determining the causes of death and clinical diagnoses.ConclusionConducting facility-based maternal death reviews for the purpose of research has several challenges. This paper illustrated that performing such an activity, particularly the data collection phase, was not as easy as conveyed in international guidelines and in published studies. However, these challenges are not insurmountable. If they are anticipated and proper steps are taken in advance, they can be avoided or their effects minimized.