Background
Methods
Study area
Study design
Development and validation of audit record form
Definition of terms and inclusion Criteria
Data Collection
Audit team
Evaluation of the auditing process
Data analysis
Results
Background information
Domain | SFDDH Total Deliveries n = 6572 | Maternal Morbidities n = 363 |
---|---|---|
Age distribution | ||
< 20 years | 1577 (24%) | 102 (28%) |
20 - 35 years | 4403 (67%) | 231 (64%) |
36 years and above | 526 (8%) | 30 (8%) |
Missing or did not know their age | 66 (1%) | 0 (0%) |
Distance of village of residence from SFDDH | ||
Within 50 km | 4075 (62%) | 243 (67%) |
51 - 100 km | 1643 (25%) | 72 (20%) |
101 - 150 km | 592 (9%) | 14 (4%) |
151+ km | 131 (2%) | 34 (9%) |
Residential village/street not recognized* | 131 (2%) | 0 (0%) |
Parity 5 and above | 523 (9%) | 32 (9%) |
HIV status | ||
HIV positive | 270 (5%) | 8 (2%) |
Not known (not checked) | 1383 (25%) | 53 (15%) |
Characteristics of maternal mortalities and morbidities
Severe morbidity/mortality | Total morbidities (judged as primary causes) | Number of maternal deaths | Specific case fatality rate (%) |
---|---|---|---|
Abruptio placenta | 19 | 3 | 16 |
Placenta praevia | 16 | 0 | 0 |
Postpartum haemorrhage | 67 | 2 | 3 |
Eclampsia | 101 | 9 | 9 |
Severe obstructed labour | 37 | 0 | 0 |
Ruptured uterus | 38 | 4 | 11 |
Complications of abortion | 25 | 6 | 24 |
Severe anaemia in pregnancy | 30 | 4 | 13 |
Puerperal sepsis | 15 | 2 | 13 |
Other severe morbidities | 15 | 6* | 40 |
Total | 363 | 36 | 10 |
Factors (exposure/control) | Total severe maternal morbidities†
n = 363 | Maternal deaths n = 36 | Risk Ratio (95% CI) |
---|---|---|---|
Places where the morbidity developed | |||
Before arrival at SFDDH | 214 (59%) | 29 | |
During hospital stay | 149 (41%) | 7 | 2.9 (1.3 - 6.3) |
Where the patients sought care in the first place after onset of complication(s) | |||
Traditional birth attendants | 5 (1%) | 1 | - |
Dispensary/Health centre | 137 (38%) | 12 | |
Hospital (SFDDH)* | 221 (61%) | 23 | 0.8 (0.4 - 1.6) |
Means of transport for patients with obstetric complications
Areas of substandard care
Substandard Care | Proportions n = 363 |
---|---|
Patient-related factors
| |
Presence of at least one substandard care | 180 (50%) |
Never/Poorly attended ANC | 52 (14%) |
Delayed to seek treatment | 111 (31%) |
Intoxication by local herbs | 3 (1%) |
Others | 31 (9%) |
Administration related substandard care
| |
Presence of at least one area of substandard care | 219 (60%) |
Absence of essential drugs, supplies and equipment | 22 (6%) |
Absence of/inadequate blood for transfusion | 10 (3%) |
Long distance from where the complications started to SFDDH (>50 km) | 32 (9%) |
Poor ANC, but difficult to judge whether care provider's or administration related factors. | 52 (14%) |
Lack of ambulance | 24 (7%) |
The facility had ambulance but was not readily available | 21 (6%) |
Others | 12 (3%) |
Areas of substandard care | First level HF* n = 137 | SFDDH n = 363 | Chi-squared test (P value) |
---|---|---|---|
Presence of at least one area of substandard care | 94 (69%) | 221 (61%) | 2.6 (0.11) |
Delayed treatment within the facility | 15 (11%) | 104 (29%) | 17.2 (0.00) |
Delayed referral to hospital with CEmOC services | 33 (24%) | NA | NA |
Referred while not on appropriate treatment | 27 (20%) | NA | NA |
Inadequate treatment or monitoring of labour | 17 (12%) | 77 (21%) | 5.0 (0.03) |
Wrong diagnosis | 6 (4%) | 22 (6%) | 0.66‡ |
Wrong treatment with a correct diagnosis | 7 (5%) | 36 (10%) | 0.11‡ |
Others | 1 (1%) | 26 (7%) | 0.00‡ |