Maternal death review practices among Northern zone Hospitals in Malawi.

Abstract

Background: Globally, about 287,000 maternal deaths occur each year. Sub-Saharan Africa has the highest maternal mortality ratio of 546 maternal deaths per 100,000 live births compared to a global maternal mortality ratio of 216 despite that 80% of maternal deaths are avoidable. WHO recommends Maternal Death Review as one of the cost effective, adaptable and evidence-based strategy for low resources countries to reduce maternal deaths. In Malawi despite institutionalizing the Maternal Death Reviews, maternal mortality remained unacceptably high, 574/100,000 in 2014. This study explored Maternal Death Review practices among hospitals in Malawi. Method: This was a qualitative study done in the Northern Health Zone of Malawi. Eight Focus Group Discussions were conducted between January and February 2017 with Maternal Death Review committees and midwives working in maternity ward from four sampled hospitals. Three officers from the Northern Health Zone also participated in in-depth interview. Both Focus Group and in-depth interviews were audio recorded and transcribed. Ethical approval was sought from Moi/MTRH IREC and National Commission for Science and Technology, Malawi. Thematic analysis was used to create subthemes and themes. Results: Nine themes emerged namely; comprehending MDR concepts, responding to maternal death, improving quality of care, closing knowledge and skill gaps, avenue for blaming game, logistic challenges, limited understanding of MDR process, poor implementation of MDR action plan and making MDR effective. Findings of the study show that there are still gaps with Maternal Death Review process in all the four hospitals. These include poor feedback, lack of personnel commitment, blaming and limited financial resources. Conclusion: Despite many perceived benefits, Maternal Death Review practices in district hospitals in Northern Health Zone need improvement. Maternal Death Review teams require more technical and financial support. Recommendation: The study recommends need for sustainable financial resources for the implementation of Maternal Death Reviews action plans in district hospitals. Capacity building on Maternal Death Review processes should be done to all clinical staff members to enhance their understanding. The criteria based clinical audits and near miss reviews should be made formal in all facilities to eliminate fault finding