Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study
Objective Presenting 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 a...
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| Format: | Article |
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BMJ Publishing Group
2016-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/6/1/e009734.full |
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| author | Jeroen van Dillen Felix Sayinzoga Leon Bijlmakers Fidele Ngabo Victor Mivumbi Koos van der Velden |
| author_facet | Jeroen van Dillen Felix Sayinzoga Leon Bijlmakers Fidele Ngabo Victor Mivumbi Koos van der Velden |
| author_sort | Jeroen van Dillen |
| collection | DOAJ |
| description | Objective Presenting 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.Design Nationwide facility-based retrospective cohort study.Settings All 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.Population 987 audited cases of maternal death.Main outcome measures Characteristics 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.Results 987 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.Conclusions The 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. |
| format | Article |
| id | doaj-art-8f657d7e4d404812aed5c6c3211be4f8 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-8f657d7e4d404812aed5c6c3211be4f82025-02-01T21:05:09ZengBMJ Publishing GroupBMJ Open2044-60552016-01-016110.1136/bmjopen-2015-009734Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort studyJeroen van Dillen0Felix Sayinzoga1Leon Bijlmakers2Fidele Ngabo3Victor Mivumbi4Koos van der Velden53Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands1Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, RwandaDepartment for Health Evidence, Radboud University Medical Center (Radboudumc), Nijmegen, Netherlands1Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda1Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, RwandaDepartment of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, Radboud University Medical Center, Nijmegen, The NetherlandsObjective Presenting 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.Design Nationwide facility-based retrospective cohort study.Settings All 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.Population 987 audited cases of maternal death.Main outcome measures Characteristics 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.Results 987 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.Conclusions The 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.https://bmjopen.bmj.com/content/6/1/e009734.full |
| spellingShingle | Jeroen van Dillen Felix Sayinzoga Leon Bijlmakers Fidele Ngabo Victor Mivumbi Koos van der Velden Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study BMJ Open |
| title | Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study |
| title_full | Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study |
| title_fullStr | Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study |
| title_full_unstemmed | Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study |
| title_short | Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study |
| title_sort | maternal death audit in rwanda 2009 2013 a nationwide facility based retrospective cohort study |
| url | https://bmjopen.bmj.com/content/6/1/e009734.full |
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