Using audit to enhance quality of maternity care in resource limited countries: lessons learnt from rural Tanzania

BMC Pregnancy and Childbirth

Research Article

David P Urassa¹  Alise Bartsch de Jong²  Jos van Roosmalen³  Angelo S Nyamtema⁴ 

[1] Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Department of Medical Humanities, EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands;Department of Medical Humanities, EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands;Department of Obstetrics, Leiden University Medical Centre, The Netherlands;Saint Francis Designated District Hospital, Ifakara, Tanzania;

关键词: Maternal Mortality;    Maternal Death;    Severe Morbidity;    Resource Limited Country;    Severe Maternal Morbidity;   

DOI  :  10.1186/1471-2393-11-94

 received in 2011-09-20, accepted in 2011-11-16,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAlthough clinical audit is an important instrument for quality care improvement, the concept has not yet been adequately taken on board in rural settings in most resource limited countries where the problem of maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions.MethodsMethods are informed by the principles of operations research. An audit system was established, all patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and strategic action plans for improvement were developed and implemented.ResultsThere were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care. Patients, health workers and administration related substandard care factors were identified in 50% - 61% of women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the workforce for health care, referral system improvement and upgrading of health centres located in hard to reach areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result of audit.ConclusionsOur findings indicate that audit can be implemented in rural resource limited settings and suggest that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are limited if strategic interventions are implemented.

【 授权许可】

CC BY   
© Nyamtema et al; licensee BioMed Central Ltd. 2011