Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study
Abstract Background Maternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed...
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doaj-a95be81f897a4410bca22e055067bcad2020-11-25T03:48:26ZengBMCInternational Journal for Equity in Health1475-92762020-07-0119111110.1186/s12939-020-01185-5Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods studyJean-Bertin Bukasa Kabuya0Arthur Mataka1Gerald Chongo2Luc Kambale Kamavu3Priscilla N’gandu Chola4Christine Manyando5Vincent De Brouwere6Matthew M. Ippolito7Department of Clinical Sciences, Tropical Diseases Research CentreSaint Paul’s General HospitalNchelenge District Health OfficeSaint Paul’s General HospitalSaint Paul’s General HospitalDepartment of Public Health, Tropical Diseases Research CentreUnit of Health Services Organization, Department of Public Health, Institute of Tropical MedicineJohns Hopkins University School of MedicineAbstract Background Maternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed the impact of an [MDR program] at a district-level hospital in rural Zambia. Methods We conducted a mixed methods convergent study using hospital data on maternal mortality and audit reports of 106 maternal deaths from 2007 to 2011. To evaluate the overall impact of MDR on maternal mortality, we compared baseline (2007) to late (2010–11) post-intervention inpatient maternal mortality indicators. MDR committee reports were coded and dominant themes were extracted in a qualitative analysis. We assessed potential risk factors for maternal mortality in a before-and-after design comparing the periods 2008–09 and 2010–11. Results In-hospital maternal mortality declined from 23 per thousand live births in 2007 to 8 per thousand in 2010–11 (P < 0.01). Maternal case fatality for puerperal sepsis and uterine rupture decreased significantly from 63 and 32% in 2007 to 10 and 9% in 2010–11 (P < 0.01). No significant reduction was seen in case fatality due to postpartum hemorrhage. Qualitative analysis of risk factors for maternal mortality revealed four core themes: standards of practice, health systems, accessibility, and patient factors. Specific risk factors included delayed referral, missed diagnoses, intra-hospital delays in care, low medication inventory, and medical error. We found no statistically significant differences in the prevalence of risk factors between the before-and-after periods. Conclusions Implementation of MDR was accompanied by a significant decrease in maternal mortality with reductions in maternal death from puerperal sepsis and uterine rupture, but not postpartum hemorrhage. Qualitative analysis of audit reports identified several modifiable risk factors within four core areas. Comparisons of potential explanatory factors did not show any differences over time. These results imply that MDR offers a means for hospitals to curtail maternal deaths, except deaths due to postpartum hemorrhage, suggesting additional interventions are needed. Documentation of MDR meetings provides an instrument to guide further quality improvements.http://link.springer.com/article/10.1186/s12939-020-01185-5Maternal healthHospital epidemiologyQuality improvementRural healthZambia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jean-Bertin Bukasa Kabuya Arthur Mataka Gerald Chongo Luc Kambale Kamavu Priscilla N’gandu Chola Christine Manyando Vincent De Brouwere Matthew M. Ippolito |
spellingShingle |
Jean-Bertin Bukasa Kabuya Arthur Mataka Gerald Chongo Luc Kambale Kamavu Priscilla N’gandu Chola Christine Manyando Vincent De Brouwere Matthew M. Ippolito Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study International Journal for Equity in Health Maternal health Hospital epidemiology Quality improvement Rural health Zambia |
author_facet |
Jean-Bertin Bukasa Kabuya Arthur Mataka Gerald Chongo Luc Kambale Kamavu Priscilla N’gandu Chola Christine Manyando Vincent De Brouwere Matthew M. Ippolito |
author_sort |
Jean-Bertin Bukasa Kabuya |
title |
Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study |
title_short |
Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study |
title_full |
Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study |
title_fullStr |
Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study |
title_full_unstemmed |
Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study |
title_sort |
impact of maternal death reviews at a rural hospital in zambia: a mixed methods study |
publisher |
BMC |
series |
International Journal for Equity in Health |
issn |
1475-9276 |
publishDate |
2020-07-01 |
description |
Abstract Background Maternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed the impact of an [MDR program] at a district-level hospital in rural Zambia. Methods We conducted a mixed methods convergent study using hospital data on maternal mortality and audit reports of 106 maternal deaths from 2007 to 2011. To evaluate the overall impact of MDR on maternal mortality, we compared baseline (2007) to late (2010–11) post-intervention inpatient maternal mortality indicators. MDR committee reports were coded and dominant themes were extracted in a qualitative analysis. We assessed potential risk factors for maternal mortality in a before-and-after design comparing the periods 2008–09 and 2010–11. Results In-hospital maternal mortality declined from 23 per thousand live births in 2007 to 8 per thousand in 2010–11 (P < 0.01). Maternal case fatality for puerperal sepsis and uterine rupture decreased significantly from 63 and 32% in 2007 to 10 and 9% in 2010–11 (P < 0.01). No significant reduction was seen in case fatality due to postpartum hemorrhage. Qualitative analysis of risk factors for maternal mortality revealed four core themes: standards of practice, health systems, accessibility, and patient factors. Specific risk factors included delayed referral, missed diagnoses, intra-hospital delays in care, low medication inventory, and medical error. We found no statistically significant differences in the prevalence of risk factors between the before-and-after periods. Conclusions Implementation of MDR was accompanied by a significant decrease in maternal mortality with reductions in maternal death from puerperal sepsis and uterine rupture, but not postpartum hemorrhage. Qualitative analysis of audit reports identified several modifiable risk factors within four core areas. Comparisons of potential explanatory factors did not show any differences over time. These results imply that MDR offers a means for hospitals to curtail maternal deaths, except deaths due to postpartum hemorrhage, suggesting additional interventions are needed. Documentation of MDR meetings provides an instrument to guide further quality improvements. |
topic |
Maternal health Hospital epidemiology Quality improvement Rural health Zambia |
url |
http://link.springer.com/article/10.1186/s12939-020-01185-5 |
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