Abstract
BackgroundEffective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved.MethodsA cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed.ResultsOverall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed.ConclusionsMaternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.
Highlights
Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome
Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care
Fundamental changes are urgently needed for successful audit systems in these institutions
Summary
Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. From the Safe Motherhood Initiative perspectives, one of the simplest and cost effective strategic interventions to reduce maternal and perinatal deaths is to improve the quality of care in the existing health institutions [4]. This has been achieved through establishment of effective maternal and perinatal audit systems [5,6]. Process is the utilization of these resources in the provision of health care, and outcome refers to the result of the health care provision process [10] In such reviews the audit panel determines the causes of death, areas of substandard care and any other preventable factors and recommends how to improve future management
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