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. 2008 Sep 11:8:42.
doi: 10.1186/1471-2393-8-42.

The difficulties of conducting maternal death reviews in Malawi

Eugene J Kongnyuy  1 , Nynke van den Broek
Affiliations

The difficulties of conducting maternal death reviews in Malawi

Eugene J Kongnyuy et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges.

Methods: SWOT (strengths, weaknesses, opportunities and threats) analysis of the process of maternal death review during a workshop in Malawi.

Results: Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement.

Conclusion: Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.

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Figures

Figure 1
Figure 1
Cycle of maternal death audit. Maternal death audit (reviews) process consists of five steps. (a) Identification of maternal deaths: this can be difficult where many deaths take place outside health facilities. Even in health facilities, maternal deaths in other wards other than the maternity ward can be missed. (b) Data collection: data can be collected from many sources such as hospital registers, case notes, referral letters and interviews of family members and relatives. (c) Analysis of findings: data is analysed to identify the causes of maternal deaths and avoidable factors. (d) Recommendations and actions: recommendations are made to implement changes that will prevent the occurrence of similar deaths in the future. (e) Evaluation and refinement: the implementation of recommendations is followed up and evaluated and professional practice refined if necessary.
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