Abstract
BackgroundUganda like many developing countries still experiences high levels of maternal and perinatal deaths despite a decade of maternal and perinatal death review (MPDR) program. Oyam district has been implementing MPDR since 2008 with varying successes among the health facilities. This paper presents the factors that influence the conduct of maternal and perinatal death reviews in Oyam District, Uganda.MethodsThis was a cross-sectional study where both qualitative and quantitative data were collected. Semi-structured interviews were administered to 66 health workers and ten key informants (KIs) to assess the factors influencing the conduct of MPDR. Univariate and Bivariate analysis of quantitative data was done using SPSS version 17.0. A Pearson Chi-Square test was done to determine factors associated with conduct of MPDR. Factors with a p-value < 0.05 were considered statistically significant. Qualitative data was analyzed using content analysis.ResultsOnly 34.8 % of the health workers had ever participated in MPDR. The factors that influenced conduct of MPDR were existence of MPDR committees (p < 0.001), attendance of review meetings (p < 0.001) and knowledge of objectives of MPDR (p < 0.001), implementation of MPDR recommendations (p < 0.001), observed improvement in maternal and newborn care (p < 0.001) and provision of feedback (p < 0.001). Hindrance to conduct of MPDR was obtained from KIs: the health workers were not made aware of the MPDR process, committee formation and training of MPDR committee members was not effectively done, inadequate support supervision, and lack of financial motivation of MPDR committee members. Challenges to MPDR included: heavy workload to health workers, high number of perinatal deaths, and non-implementation of recommendations.ConclusionThe proportion of maternal and perinatal death reviews conducted in Oyam was low. This was due to poor initiation of the review process and a lack of support supervision. The district and Ministry of Health needs to put more emphasis on monitoring the conduct of maternal and perinatal death reviews by: forming and training MPDR committees and ensuring they are financially supported, providing overall coordination, and ensuring effective support supervision.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-016-0315-5) contains supplementary material, which is available to authorized users.
Highlights
Uganda like many developing countries still experiences high levels of maternal and perinatal deaths despite a decade of maternal and perinatal death review (MPDR) program
The actual maternal mortality ratio of Oyam district is not known but data from the district health office puts it at 309/100,000 live births and perinatal mortality rate of 43.8/1000 live births, with the proportion of health facility deliveries estimated at 38.9 % [10, 11]
Sixty-six (66) health workers working in the maternity, children’s wards and outpatient departments during the period of study were interviewed
Summary
Uganda like many developing countries still experiences high levels of maternal and perinatal deaths despite a decade of maternal and perinatal death review (MPDR) program. This paper presents the factors that influence the conduct of maternal and perinatal death reviews in Oyam District, Uganda. The major killers include postpartum haemorrhage, sepsis, severe pre-eclampsia/ eclampsia, abortion complications and obstructed labour. This is attributed to poor quality of care associated with absence of skilled health personnel during pregnancy and childbirth, the lack of emergency obstetric and newborn care services to deal with the complications, and ineffective referral systems [1, 2]. MPDR is considered an important monitoring tool in the Uganda National Roadmap for the accelerated reduction of maternal and newborn mortality
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