Abstract
BackgroundMaternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality. To support MDR, an adequate MDR instrument is required to accurately identify the underlying causes of maternal deaths. We conducted a systematic review and meta-analysis to determine the reliability of maternal death instruments for conducting the MDR process.MethodThree databases: PubMed, ProQuest and EBSCO were systematically searched to identify related research articles published between January 2004 and July 2019. The review and meta-analysis involved identification of measurement tools to conduct MDR in all or part of maternal audit. Eligibiliy and quality of studies were evaluated using the Modified Quality Appraisal of Diagnostic Reliability (QAREL) Checklist: Reliability Studies.ResultsOverall, 242 articles were identified. Six articles examining the instrument used for MDR in 4 countries (4 articles on verbal autopsy (VA) and 2 articles on facility-based MDR) were included. None of studies identified reliability in evaluation instruments assessing maternal audit cycle as a comprehensive approach. The pooled kappa for the MDR instruments was 0.72 (95%CI:0.43–0.99; p < 0.001) with considerable heterogeneity (I2 = 96.19%; p < 0.001). Subgroup analysis of MDR instruments showed pooled kappa in VA of 0.89 (95%CI:0.52–1.25) and facility-based MDR of 0.48 (95%CI:0.15–0.82). Meta-regression analysis tended to show the high heterogeneity was likely associated with sample sizes, regions, and year of publications.ConclusionsThe MDR instruments appear feasible. Variation of the instruments suggest the need for judicious selection of MDR instruments by considering the study population and assessment during the target periods.
Highlights
Maternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality
Variation of the instruments suggest the need for judicious selection of MDR instruments by considering the study population and assessment during the target periods
From several studies concerning MDR and other obstetrics audits conducted in Nigeria, synthesis findings reported that problems including delayed caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion service stand out as contributing factors of facility based-maternal deaths in the region
Summary
Maternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality. Evidence has shown that the preventable maternal mortality events can be managed through proven health-care interventions including antenatal care, skilled care during delivery and care and support in the postnatal period [1, 3]. This evidence should be considered to support more proactive policy-making to prevent maternal deaths. From several studies concerning MDR and other obstetrics audits conducted in Nigeria, synthesis findings reported that problems including delayed caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion service stand out as contributing factors of facility based-maternal deaths in the region. Research in Indonesia identified that poor implementation of standard operating procedures is the main problem found in root-cause analysis in the facility-based maternal deaths [9, 10]
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