Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care

Abstract

BackgroundMaternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria’s high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care.MethodsWe searched for maternal death reviews and obstetric care audits reported in the published literature from 2000–2014. A ‘best-fit’ framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score.ResultsOf the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services.ConclusionsObstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions.

Systematic review of obstetric care from a women‐centered perspective in Nigeria since 2000

“…Factors that were reported to contribute to maternal deaths or complications were assessed against these attributes and a narrative summary was constructed. A quality assessment was performed according to a previously described method . In brief, a score of 0 or 1 was given for each of nine study characteristics: description of study population, explanation of sampling strategy, consideration of missing cases, pretesting or piloting of study instruments, use of a standard data collection form, description of data collectors, training, quality checks for data entry, and assessment of inter‐observer/inter‐site variability.…”

“…A quality assessment was performed according to a previously described method. 9 In brief, a score of 0 or 1 was given for each of nine study characteristics: description of study population, explanation of sampling strategy, consideration of missing cases, pretesting or piloting of study instruments, use of a standard data collection form, description of data collectors, training, quality checks for data entry, and assessment of inter-observer/inter-site variability. Quality assessment was not performed for case reports because these normally include a detailed description of a single patient, usually a rare clinical situation; therefore, most of the criteria used in the quality assessment (e.g.…”

“…In the light of the accumulating literature on maternal death audits but the limited understanding and application of patient‐centered care in Nigeria, the aim of the present study was to review evidence from maternal‐death reviews to provide an overview of issues affecting the provision of obstetric care from a patient‐centered care perspective. The patient‐centered perspective differentiates this review from earlier work performed from a biomedical model of care perspective …”

“…The patient-centered perspective differentiates this review from earlier work performed from a biomedical model of care perspective. 9…”

Experiencias de mujeres sobrevivientes a morbilidad materna extrema en México, un estudio cualitativo desde el modelo de las tres demoras

“…La Organización Mundial de la Salud (OMS) recomienda que sean llevados a cabo más estudios con mujeres sobrevivientes de morbilidad materna extrema, puesto que trabajar con ellas posibilita acceder a un mayor número de casos para analizar, entendiendo de que por cada muerte materna se tiene un registro de cerca de 20 sobrevivientes de morbilidad materna extrema 2 . En este sentido, mientras en África y Asia han comenzado a impulsarse trabajos de investigación con sobrevivientes de morbilidad materna extrema 3,4,5,6,7 , en América Latina la investigación ha continuado centrándose principalmente en las muertes maternas.…”