Preventable maternal mortality in Morocco: the role of hospitals

Abstract

Abstractobjective In 2009, the Ministry of Health of Morocco launched a national confidential enquiry around maternal deaths based on the newly implemented routine maternal death surveillance system (MDSS). The objective of this paper is to show the importance of substandard care among the factors associated with maternal deaths.methods The Moroccan National Expert Committee (NEC) organised an audit of maternal deaths identified by the MDSS to determine the medical cause, the preventability of the deaths and the type of substandard care involved.results Three hundred and three cases of maternal deaths were analysed for the year 2009. Direct causes accounted for 80.8%. 75.9% were considered avoidable by the NEC. The three main factors were insufficient follow-up of care in 45.6% of cases, inadequate treatment in 43.9% and delay in seeking care in 41.3%. The auditors found that 54.3% of all maternal deaths could have been avoided if appropriate action had been taken at the health facilities.conclusion The audit of maternal deaths in Morocco enabled a better understanding of the circumstances contributing to maternal deaths and pinpointed that more than half of maternal deaths were associated with substandard care in hospitals.

Quality of routine essential care during childbirth: clinical observations of uncomplicated births in Uttar Pradesh, India

“…Even in health facilities, however, failures in the processes of care can result in bad obstetric and neonatal outcomes 5 , 6 and care of poor quality often leads to low demand for maternal health services 7 , 8 . Some routine interventions can be ineffective or even harmful 9 …”

Quality of routine essential care during childbirth: Clinical observations of uncomplicated births in Uttar Pradesh, India

“…2,3 An estimated 72% of all deliveries -including 69% of those in South Asia -now occur in health facilities. 4 Even in health facilities, however, failures in the processes of care can result in bad obstetric and neonatal outcomes 5,6 and care of poor quality often leads to low demand for maternal health services. 7,8 Some routine interventions can be ineffective or even harmful.…”

Health equity and access to health facility delivery andCaesarean sections inMorocco

“…in the light of results and conclusions provided from the report published by the FEM health team in 2014 and the two papers written by Abouchadi et al . and published in TMIH in 2013 .…”

“…Third, following up on comment 2, the paper published by Abouchadi et al . in TMIH in 2013 on ‘Preventable maternal mortality in Morocco: the role of hospitals’ raises a crucial point: ‘simply reaching the hospital may not be sufficient to manage obstetric complications and save mothers’ lives’ . The authors report that ‘almost 80% of the maternal deaths in Morocco in 2009 were avoidable and that in more than half of the hospital deaths substandard care in hospital was involved’.…”

“…The authors report that ‘almost 80% of the maternal deaths in Morocco in 2009 were avoidable and that in more than half of the hospital deaths substandard care in hospital was involved’. It was stressed that such a high proportion of avoidable deaths was shocking for National Expert Committee members, policymakers and practitioners .…”