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Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study

BMJ open, 2016-01, Vol.6 (1), p.e009734-e009734 [Peer Reviewed Journal]

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016 ;ISSN: 2044-6055 ;EISSN: 2044-6055 ;DOI: 10.1136/bmjopen-2015-009734 ;PMID: 26801466

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  • Title:
    Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study
  • Author: Sayinzoga, Felix ; Bijlmakers, Leon ; van Dillen, Jeroen ; Mivumbi, Victor ; Ngabo, Fidèle ; van der Velden, Koos
  • Subjects: Adolescent ; Adult ; Audit committees ; Births ; Case management ; Cause of Death ; Classification ; Departments ; Female ; Health facilities ; Hospitals ; Humans ; Information management ; Maternal & child health ; Maternal Health Services - standards ; Maternal Mortality ; Medical Audit ; Obstetrics ; Obstetrics and Gynaecology ; Pregnancy ; Pregnancy Complications - mortality ; Pregnancy Complications - prevention & control ; Prenatal care ; Quality Assurance, Health Care ; Quality Improvement ; Retrospective Studies ; Rwanda - epidemiology ; Womens health ; Young Adult
  • Is Part Of: BMJ open, 2016-01, Vol.6 (1), p.e009734-e009734
  • Description: ObjectivePresenting the results of 5 years of implementing health facility-based maternal death audits in Rwanda, showing maternal death classification, identification of substandard (care) factors that have contributed to death, and conclusive recommendations for quality improvements in maternal and obstetric care.DesignNationwide facility-based retrospective cohort study.SettingsAll cases of maternal death audited by district hospital-based audit teams between January 2009 and December 2013 were reviewed. Maternal deaths that were not subjected to a local audit are not part of the cohort.Population987 audited cases of maternal death.Main outcome measuresCharacteristics of deceased women, timing of onset of complications, place of death, parity, gravida, antenatal clinic attendance, reported cause of death, service factors and individual factors identified by committees as having contributed to death, and recommendations made by audit teams.Results987 cases were audited, representing 93.1% of all maternal deaths reported through the national health management information system over the 5-year period. Almost 3 quarters of the deaths (71.6%) occurred at district hospitals. In 44.9% of these cases, death occurred in the post-partum period. Seventy per cent were due to direct causes, with post-partum haemorrhage as the leading cause (22.7%), followed by obstructed labour (12.3%). Indirect causes accounted for 25.7% of maternal deaths, with malaria as the leading cause (7.5%). Health system failures were identified as the main responsible factor for the majority of cases (61.0%); in 30.3% of the cases, the main factor was patient or community related.ConclusionsThe facility-based maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. Rwanda can complement maternal death audits with other strategies, in particular confidential enquiries and near-miss audits, so as to inform corrective measures.
  • Publisher: England: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 2044-6055
    EISSN: 2044-6055
    DOI: 10.1136/bmjopen-2015-009734
    PMID: 26801466
  • Source: ProQuest One Psychology
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