Jody R Lori1, Amy E Starke. 1. University of Michigan, School of Nursing, 400N. Ingalls Bldg., Room 4320B, Ann Arbor, MI 48109-5482, USA. jrlori@umich.edu
Abstract
OBJECTIVE: To conduct a secondary analysis of maternal death and near-miss audits conducted at the community and facility level to explore the causes and circumstances surrounding maternal mortality and severe morbidity in one rural county in Liberia, West Africa. DESIGN: A non-experimental, descriptive design utilising maternal death and near-miss audit surveys was utilised for data collection. Thaddeus and Maine's Three Delays Model was used as a framework for analysis. SETTING: One rural county in north-central Liberia. PARTICIPANTS: Interviews were conducted with (1) women who suffered a severe morbidity or nearmiss event, (2) family members of women who died or presented with a severe morbidity, and (3) community members or health workers involved in the care of the woman. MEASUREMENTS: (1) Maternal mortality, (2) near-miss events, and (3) delays related to problem identification, transportation challenges and delays after reaching the referral site. FINDINGS: 120 near-miss events and 28 maternal mortalities were analysed. 16% of all deliveries at the referral hospital were classified as near-miss events. Near-miss events were six times more common than deaths. The majority of women experiencing a near-miss event (85%) were in critical condition upon arrival at the hospital suggesting important delays were encountered in reaching the facility. KEY CONCLUSIONS: Maternal mortality and near-miss audits allow exploration of medical and non-medical factors leading up to a severe complication or maternal death. Delays in reaching a referral hospital can have a significant impact on maternal survival rates. IMPLICATIONS FOR PRACTICE: Audits can stimulate a change in clinical practice and help identify areas for county health departments to focus their scant resources. Audits can be used as a quality improvement tool in facilities. Results can be used to identify communities with high rates of delay to target educational programmes.
OBJECTIVE: To conduct a secondary analysis of maternal death and near-miss audits conducted at the community and facility level to explore the causes and circumstances surrounding maternal mortality and severe morbidity in one rural county in Liberia, West Africa. DESIGN: A non-experimental, descriptive design utilising maternal death and near-miss audit surveys was utilised for data collection. Thaddeus and Maine's Three Delays Model was used as a framework for analysis. SETTING: One rural county in north-central Liberia. PARTICIPANTS: Interviews were conducted with (1) women who suffered a severe morbidity or nearmiss event, (2) family members of women who died or presented with a severe morbidity, and (3) community members or health workers involved in the care of the woman. MEASUREMENTS: (1) Maternal mortality, (2) near-miss events, and (3) delays related to problem identification, transportation challenges and delays after reaching the referral site. FINDINGS: 120 near-miss events and 28 maternal mortalities were analysed. 16% of all deliveries at the referral hospital were classified as near-miss events. Near-miss events were six times more common than deaths. The majority of women experiencing a near-miss event (85%) were in critical condition upon arrival at the hospital suggesting important delays were encountered in reaching the facility. KEY CONCLUSIONS: Maternal mortality and near-miss audits allow exploration of medical and non-medical factors leading up to a severe complication or maternal death. Delays in reaching a referral hospital can have a significant impact on maternal survival rates. IMPLICATIONS FOR PRACTICE: Audits can stimulate a change in clinical practice and help identify areas for county health departments to focus their scant resources. Audits can be used as a quality improvement tool in facilities. Results can be used to identify communities with high rates of delay to target educational programmes.
Authors: Joseph E Perosky; Michelle L Munro; Jillian L Kay; Aloysius Nyanplu; Garfee Williams; Pamela B Andreatta; Jody R Lori Journal: J Health Commun Date: 2015-07-06
Authors: Lauren A V Orenstein; Evan W Orenstein; Ibrahima Teguete; Mamoudou Kodio; Milagritos Tapia; Samba O Sow; Myron M Levine Journal: PLoS One Date: 2012-10-04 Impact factor: 3.240
Authors: Joyce L Browne; Sabine W van Nievelt; Emmanuel K Srofenyoh; Diederick E Grobbee; Kerstin Klipstein-Grobusch Journal: PLoS One Date: 2015-04-29 Impact factor: 3.240
Authors: Rodolfo C Pacagnella; José G Cecatti; Mary A Parpinelli; Maria H Sousa; Samira M Haddad; Maria L Costa; João P Souza; Robert C Pattinson Journal: BMC Pregnancy Childbirth Date: 2014-05-05 Impact factor: 3.007
Authors: Felix Sayinzoga; Leon Bijlmakers; Jeroen van Dillen; Victor Mivumbi; Fidèle Ngabo; Koos van der Velden Journal: BMJ Open Date: 2016-01-22 Impact factor: 2.692