Abstract
ObjectivesTo explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.MethodsThis was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.ResultsFDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.DiscussionFDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.
Highlights
Reducing maternal and newborn deaths is an integral part of the global agenda to achieve Millennium Development Goals (MDGs) 4 and 5 by 2015
facility death review (FDR) for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels
Recent data have shown that the majority of maternal and neonatal deaths occur in developing countries: as many as 95% of total maternal and child deaths occur in 75 low- and middle-income countries [1]
Summary
Reducing maternal and newborn deaths is an integral part of the global agenda to achieve Millennium Development Goals (MDGs) 4 and 5 by 2015. Recent data have shown that the majority of maternal and neonatal deaths occur in developing countries: as many as 95% of total maternal and child deaths occur in 75 low- and middle-income countries [1]. In 2010, Bangladesh received a United Nations award for its achievements in working towards attaining the MDGs, an acknowledgement of the great progress made in reducing maternal and neonatal mortality over the past two decades. Maternal mortality has reduced from 574 deaths per 100,000 live births in 1991 to 194 deaths in 2011. Neonatal mortality declined from 52 to 37 deaths per 1000 live births (38%) between 1989 and 2009 [4]. The Bangladesh Health and Demographic Survey showed that neonatal mortality had further reduced to 28 per 1000 live births [5]. Recent data in Bangladesh from the maternal death review highlighted that 47.8% of maternal deaths occurred in facilities [8] and that in most cases the deaths could have been prevented
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