Components of Maternal Healthcare Delivery System Contributing to Maternal Deaths in Malawi: A Descriptive Cross-Sectional Study

Viva Combs Thorsen, Tarek Meguid, Johanne Sundby, Address Malata

Abstract

In Malawi, it has been observed that some women are dying even when they reach a comprehensive emergency obstetric care facility where the quality is expected to be high and the maternal mortality low. The objective of this study was to describe shortcomings within the maternal healthcare delivery system that might have contributed to maternal deaths in the district of Lilongwe. Retrospectively, 14 maternal deaths that occurred between January 1, 2011 and June 30, 2011 were reviewed. Interviews were conducted with healthcare workers who provided care to the deceased women. Triangulated data from the respective medical charts and interview transcripts were analyzed using a directed approach to content analysis. Excerpts were categorized according to three main components of the maternal healthcare delivery system: skill birth attendant (SBA), enabling environment (EE) and referral system (RS). Most of the shortcomings identified were grouped under SBA. They included inadequate clinical workups and monitoring, missed and incorrect diagnoses, delayed or incorrect treatment, delayed referrals and transfers, patients not being stabilized before being referred and outright negligence. The SBA component should be investigated further. Interventions based on evidence from these investigations may have a positive impact on maternal mortality. (Afr J Reprod Health 2014; 18[1]: 15-25).

Keywords: maternal mortality; maternal death review; healthcare delivery system; skilled birth attendant; Malawi

Résumé

Au Malawi, il a été remarqué que certaines femmes meurent encore, même quand elles arrivent à un établissement de soins obstétricaux d'urgence complets où l'on s'attend à une qualité élevée et à une faible mortalité maternelle. L'objectif de cette étude était de décrire les lacunes dans le système de prestation de soins de santé maternelle qui aurait pu contribuer à la mortalité maternelle dans le district de Lilongwe. Rétrospectivement, 14 décès maternels survenus entre le 1er Janvier 2011 et le 30 Juin 2011 ont été examinés. Les entrevues ont été menées auprès de travailleurs de la santé qui dispensent des soins aux femmes décédées. Des données triangulées des dossiers médicaux respectifs et des transcriptions des entrevues ont été analysées à l'aide d'une approche dirigée à l'analyse de contenu. Des extraits ont été classés en fonction de trois principaux composants du système de prestation de soins de la santé maternelle: des accoucheuses compétentes (AC), un environnement favorable (EF) et le système de référence (SR). La plupart des lacunes identifiées ont été regroupées sous les CA. Ils comprenaient une croisière d'endurance et la surveillance clinique insuffisante, des diagnostics ratés ou mauvaise qualité, un traitement incorrect ou retardé, les orientations vers les spécialistes et les transferts différés, les patients n’étant pas stabilisés avant d'être orienté vers les spécialistes et la négligence pure et simple. La composante de CA devrait être examinée davantage. Les Interventions fondées sur des données de ces enquêtes peuvent avoir un impact positif sur la mortalité maternelle. (Afr J Reprod Health 2014; 18[1]: 15-25).

Mots-clés: mortalité maternelle, examen de la mortalité maternelle; système de prestation de soins de santé; accoucheuse qualifiée, Malawi

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