Background
Methods
Eligibility
Search strategy
Quality scoring
Statistical analysis and reporting
Results
Search results
Authors | Country | Year | Population | Mortality rate/ratio in sample | No. of audits | % avoidable mortality | Methods | Quality score |
---|---|---|---|---|---|---|---|---|
Ozumba BC, Nwogu-Ikojo EE [29] | Nigeria | 2003-2005 | Maternal | 2,397/100,000 | 47 | 70 | Retrospective case record review at a university-associated tertiary care hospital | 4 |
Suprakito G, Wirth ME, Achadi E [30] | Indonesia | 1998-1999 | Maternal | - | 130 | - | Prospective case record review, staff interviews, and verbal autopsy in 3 districts comprising 5 hospitals and 55 community health centers | 5.5 |
Jacques S, Edgard-Marius O, Bruno D [31] | Benin | 2003 | Maternal | 1,735/100,000 | 231 | 55-72 | Retrospective case record review at 4 referral hospitals | 5 |
Vangeenderhuysen C, Banos JP, Mahaman T [32] | Niger | 1993-1994 | Maternal | 1,547/100,000 | 25 | 84 | Prospective case record review, staff interviews, and family interviews in a group of urban hospitals | 4 |
El Amin S, Langhoff-Roos J, Bodker B, et al. [33] | Sudan | 2000 | Perinatal | 82/1,000 | 43 | 58-82 | Prospective external audit by multidisciplinary team through case presentations and grading forms at a maternity hospital | 7.5 |
Mbaruku G, van Roosmalen J, Kimondo I, et al. [34] | Tanzania | 2002-2004 | Perinatal | 38/1,000 | 200 | - | Retrospective audit by case record review and family interviews at a regional hospital | 5.5 |
Bouvier-Colle MH, Ouedraogo C, Dumont A [35] | West Africa | 1994-1996 | Maternal | 311/100,000 | 55 | 69 | Prospective survey using questionnaires and verbal autopsy in 6 West African countries: Ivory Coast, Mali, Niger, Mauritania, Burkina Faso, and Senegal. Deaths occurred in hospitals, in health centers, and at home | 6 |
Chigbu CO, Okezie OA, Odugu BU [36] | Nigeria | 1999-2007 | Perinatal | 89/1,000 | 316 | - | Retrospective case record review, physician interview, and midwife interview at a university teaching hospital | 3 |
van Roosmalen J [37] | Tanzania | 1971-1976 | Perinatal | 48/1,000 | 137 | 25 | Retrospective case record review at a district hospital | 2 |
De Muylder X [38] | Zimbabwe | 1984-1986 | Perinatal | 31/1,000 | 319 | 76 | Prospective medical record review, family interviews, laboratory evaluation, and necropsy at 6 peripheral birth centers and a referral district hospital | 3 |
Cham M, Vangen S, Sundby J [39] | Gambia | 2002 | Maternal | 279/100,000 | 42 | “Majority” | Prospective medical record review, health worker interviews, and verbal autopsy in one rural district involving 17 birth facilities and one hospital | 6 |
Dumont A, Tourigny C, Fournier P [40] | Senegal | 2004-2005 | Maternal | - | 69 | 48 | Prospective medical record review, health worker interviews, and family interviews at 5 referral hospitals | 7 |
Frost O [26] | Ethiopia | 1980 | Maternal | 780/100,000 | 30 | - | Prospective medical record review and health worker interviews at a national referral hospital | 4 |
Frost O [26] | Ethiopia | 1980 | Perinatal | 9/1,000 | 291 | 8 | Prospective medical record review and health worker interviews at a national referral hospital | 4 |
Price TG [41] | Tanzania | 1983 | Maternal | 250/100,000 | 115 | - | Prospective case record review and questionnaires in a region comprising of hospitals, health centers, and dispensaries | 5 |
Adetoro OO [42] | Nigeria | 1972-1983 | Maternal | 450/100,000 | 624 | - | Retrospective medical record review at a national referral center | 3 |
Bullough CH [43] | Malawi | 1977 | Maternal | 263/100,000 | 109 | 88 | Prospective questionnaires completed by physicians and midwives at 1 central hospital, 8 district hospitals, 6 mission hospitals, and 92 rural birth facilities | 4 |
Johnstone FD, Ochiel SO [44] | Kenya | 1976-1977 | Perinatal | 97/1,000 | 393 | - | Retrospective case record review at a national referral hospital | 3 |
Hinderaker SG, Olsen BE, Bergsjo PB, et al. [45] | Tanzania | 1996-1996 | Perinatal | 27/1,000 | 136 | 51-65 | Prospective interviews of antenatal care attendees combined with retrospective household surveys using verbal autopsy and medical records in 7 rural communities. Deaths occurred at home and in rural health facilities. | 7 |
D’Ambruoso L, Byass P, Qomariyah SN, et al.[25] | Indonesia | 2002-2006 | Maternal | - | 104 | - | Retrospective review of verbal autopsies in a community with a district hospital and 19 health centers | 6 |
D’Ambruoso L, Byass P, Qomariyah SN, et al.[25] | Burkina Faso | 2002-2006 | Maternal | - | 70 | - | Retrospective review of verbal autopsies in a community with 5 hospitals and 66 health centers | 6 |
Hailu S, Enqueselassie F, Berhane Y [46] | Ethiopia | 2005-2006 | Maternal | - | 34 | 35 | Retrospective case record review and health worker interviews in 5 public hospitals | 5.5 |
Issah K, Nang-Beifubah A, Opoku CF [47] | Ghana | 2009 | Maternal | - | 47 | 49 | Prospective questionnaires completed by health workers in a community with 6 hospitals and 73 health centers | 5 |
Jafarey S, Rizvi T, Koblinsky M, et al.[48] | Pakistan | 2005-2007 | Maternal | - | 128 | - | Retrospective and prospective verbal autopsy in two districts at the community and hospital levels | 8 |
Kongnyuy E, Mlava G, van den Broek N [49] | Malawi | 2007 | Maternal | - | 43 | - | Prospective register review, referral note review, case record review, and family interviews in 9 hospitals | 5 |
Waiswa P, Kallander K, Peterson S, et al. [50] | Uganda | 2005-2008 | Perinatal | - | 64 | - | Retrospective case record review from volunteer collected data, and a standard verbal autopsy questionnaire. Study included home and hospital deaths. | 7 |
Sorensen BL, Elsass P, Nielsen BB, et al. [51] | Tanzania | 2006-2008 | Maternal | 549/100,000 | 62 | - | Retrospective case record review, staff observations, and staff interviews at a regional hospital | 4.5 |
Lori JR, Starke AE [52] | Liberia | 2008 | Maternal | - | 28 | - | Prospective case record review using a standard audit tool, combined with interviews conducted by trained nurses at the community and hospital level | 6 |
Granja AC, Machungo F, Bergstrom S [53] | Mozambique | 1989-1990 | Maternal | 340/100,000 | 106 | 40 | Retrospective medical record review at an urban referral hospital | 3 |
Granja AC, Machungo F, Gomes, A, et al. [54] | Mozambique | 1989-1993 | Maternal | 320/100,000 | 239 | 75 | Retrospective medical record review at an urban referral hospital | 2.5 |
Kidanto HL, Mogren I, van Roosmalen J, et al. [55] | Tanzania | 2007 | Perinatal | 92/1,000 | 133 | 52-75 | Retrospective multidisciplinary audit panel of internal and external reviewers using a structured assessment protocol and grading form at a national hospital | 7 |
Olsen BE, Hinderaker SG, Bergsjo P, et al. [56] | Tanzania | 1995-1996 | Maternal | - | 45 | 31 | Retrospective and prospective review of hospital records, village leader reported deaths, household surveys and antenatal clinic records at the community and hospital level. Verbal autopsy questionnaires were also used. | 5.5 |
Oladapo OT, Ariba AJ, Odusoga OL [28] | Nigeria | 1999-2004 | Maternal | 2508-2931/100,000* | 71 | - | Retrospective case record review at tertiary care hospital. Reviewed by committee of 3 consultants and 3 residents. | 4 |
Byaruhanga RN [57] | Uganda | 1997-1998 | Perinatal | 68/1000 | 235 | - | Prospective case record review by a team comprised of a pediatrician, obstetrician and three midwives at a tertiary referral hospital | 5 |
De Muylder X [58] | Zimbabwe | 1985-1987 | Maternal | 137/100,000 | 70 | 50 | Retrospective case record review by a multidisciplinary committee of deaths occurring at district and rural hospitals | 3.5 |
Bhatt RV [24] | India | 1967-1968 | Maternal | 1,448/100,000 | 43 | 10 | Prospective case record review combined with staff meetings and interviews of caregivers at a university teaching hospital | 6 |
Bhatt RV [24] | India | 1967-1968 | Perinatal | 115/1,000 | 342 | - | Prospective case record review combined with staff meetings and interviews of caregivers at a university teaching hospital | 6 |
Bhatt RV [24] | India | 1983-1984 | Maternal | 1,152/100,000 | 36 | 1.5 | Prospective case record review combined with staff meetings and interviews of caregivers at a university teaching hospital | 6 |
Bhatt RV [24] | India | 1983-1984 | Perinatal | 101/1,000 | 315 | - | Prospective case record review combined with staff meetings and interviews of caregivers at a university teaching hospital | 6 |
Mbarku G, Bergstrom S [27] | Tanzania | 1984-1991 | Maternal | 186 – 933/100,000* | 132 | - | Retrospective and prospective case record review with interventions in 1986 at a regional hospital | 3 |
Steklenberg J, van Roosmalen J [59] | Zambia | 1999-2001 | Maternal | 1,359/100,000 | 15 | - | Prospective case record review and regular maternal mortality review meetings at a district hospital. | 4.5 |
Ouedraogo C, Bouvier-Coller MH [60] | Burkinia Faso, Ivory Coast, Mauritania, Mali, Niger and Senegal | 1985-1997 | Maternal | Variable by country | 55 | - | Retrospective case record review combined with “verbal autopsy” using a questionnaires and a multidisciplinary team review of all cases at the hospital level | 5 |
Qazi GR [61] | Pakistan | 1992 | Maternal | - | 40 | - | Retrospective case record review at a university teaching hospital | 3 |
Rachid B, Abouchadi S, de Brouwere V, Belghiti A [62] | Morocco | 2009 | Maternal | - | 436 | 76 | Retrospective case record review for healthcare setting deaths, and verbal autopsy for home deaths | 2.5 |
Dataset characteristics
Avoidable factors
Health worker-oriented factors | Patient–oriented factors | Administrative/supply factors | Transport/ referral factors |
---|---|---|---|
Substandard health worker practice | Patient delay | Poor blood transfusion capacity or inappropriate administration | Unidentified lack or delay in transport |
Delay in care on admission to birth facility | Poor antenatal care | Medication shortage | Poor transport between facilities |
Delayed operative delivery | Use of herbal medicine | General supply/ equipment shortage | Poor transportation from home to facility |
Inadequate intrapartum monitoring of mother/fetus | Cultural inhibitions causing delay in seeking care | Unsanitary environment | |
Inadequate initial maternal assessment and management | Financial constraints | Inadequate operating theatre facilities | |
Unavailability of health worker for key intervention | No knowledge of danger symptoms | ||
Poor communication between health workers | |||
Missed or unskilled breech delivery | |||
Substandard health worker antenatal care practices | |||
Inadequate monitoring of mothers in hypovolemic or septic shock | |||
Poor neonatal resuscitation | |||
Inadequate management of hypertensive related disorders | |||
Failure to diagnose/ treat neonatal infection | |||
Failure to diagnose preterm labor | |||
Failure to diagnose/ treat syphilis | |||
Health worker related referral delay | |||
Inadequate management of 3rd stage of labor | |||
Poor postpartum maternal monitoring | |||
Inappropriate indication for operative delivery | |||
Inadequate partogram usage | |||
Failure to diagnose/treat maternal/fetal infection | |||
Anesthesia complications during operative delivery | |||
Inadequate response to poor labor progress | |||
Inadequate action taken for fetal distress | |||
Inadequate assessment of fetal distress | |||
Inadequate assisted vaginal delivery | |||
Inappropriate discharge when patient not well | |||
Health worker industrial strike |
Factor | Category | Datasets in which factor was an identified cause of death; n = 44 (%) | Estimate of the factor’s contribution to deaths in datasets in which it was identified; % (CI) | Total number of attributable deaths due to factor in the entire sample; n = 6205 (%) |
---|---|---|---|---|
Substandard health worker practice | Health worker-oriented factor | 18 (40.9) | 28.5 (19.5 – 39.7) | 688 (11.1) |
Patient delay | Patient-oriented factor | 23 (52.3) | 22.2 (16.0 – 30.0) | 665 (10.7) |
Poor blood transfusion capacity or inappropriate administration | Administrative/ supply factor | 21 (47.7) | 24.9 (18.5 – 32.6) | 634 (10.2) |
Delay in care on admission to birth facility | Health worker-oriented factor | 20 (45.5) | 26.6 (18.5 – 36.6) | 628 (10.1) |
Undefined lack of or delay in transport | Transport/ referral factor | 23 (52.3) | 23.7 (16.2 – 33.4) | 546 (8.8) |
Delayed operative delivery | Health worker-oriented factor | 12 (27.3) | 23.1 (11.0 – 42.1) | 442 (7.1) |
Inadequate intrapartum monitoring of mother/fetus | Health worker-oriented factor | 10 (22.7) | 24.3 (13.8 – 39.1) | 374 (6) |
Inadequate initial maternal assessment/ management | Health worker-oriented factor | 10 (22.7) | 20.0 (10.5 – 34.7) | 339 (5.5) |
Poor antenatal care | Patient-oriented factor | 11 (25.0) | 14.3 (7.0 – 27.0) | 301 (4.9) |
Unavailability of health worker for key intervention | Health worker-oriented factor | 10 (22.7) | 22.4 (10.6 – 41.2) | 251 (4) |