Abstract
BackgroundMaternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria’s high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care.MethodsWe searched for maternal death reviews and obstetric care audits reported in the published literature from 2000–2014. A ‘best-fit’ framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score.ResultsOf the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services.ConclusionsObstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions.
Highlights
Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care
Maternal death reviews and obstetric audits are quality improvement investigations which support the identification and analysis of causes and circumstances related to occurrence of maternal deaths or serious complications
The World Health Organization produced a guideline for conducting maternal death surveillance and response (MDSR), which builds on maternal death reviews and emphasises the continuous action cycle and ongoing monitoring necessary to link the health information system with quality improvement processes [3]
Summary
Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Maternal death reviews and obstetric audits are quality improvement investigations which support the identification and analysis of causes and circumstances related to occurrence of maternal deaths or serious complications. They have been conducted for many years in various settings, there have been recent efforts to promote their implementation, especially in low and middle income countries [1, 2]. There is clear commitment in Nigeria to improve maternal health and reduce maternal mortality, with various national initiatives being implemented at national and state levels such as health insurance programmes, community health worker development and improvements in midwifery services [6, 9,10,11,12]
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