Audit Data Research Articles

A Blockchain-Based Multi-Cloud Storage Data Auditing Scheme to Locate Faults

The advent of network storage services has revolutionized user experiences worldwide, offering unparalleled convenience, cost-effectiveness, and robust availability. However, relying solely on a single service provider entails inherent risks. To address this, sophisticated multi-cloud storage systems have emerged, aiming to mitigate data corruption risks. Nevertheless, ensuring data integrity in such systems necessitates robust auditing schemes. Traditional approaches often depend on centralized entities like third-party auditors (TPAs) or cloud service organizers, leaving users vulnerable to malicious actors during disputes. In response, we propose a blockchain-based multi-cloud storage auditing framework. By leveraging blockchain technology, we establish an immutable ledger to record interactions among users, service providers, and organizers, serving as indisputable evidence. Smart contracts are employed to detect and resolve service disputes, compelling untrusted organizers to accurately identify malicious providers. Additionally, we utilize blockchain networks and homomorphic verifiable tags to facilitate low-cost batch verification without the need for TPAs. Theoretical analyses and empirical evaluations demonstrate the scheme's efficacy and cost-effectiveness in multi-cloud environments, promising enhanced data integrity and dispute resolution mechanisms. Keywords—Multi-cloud storage, blockchain, data auditing, dispute arbitration

Water Infrastructure System Leakage Analysis: Evaluation of Factors Impacting System Performance and Opportunity Cost

Concerns over both water quality and quantity continue to increase globally. As the need for useable and potable water becomes more of a widespread issue, there is an opportunity to review and consider alternatives to how water is used, consumed, and sustained for future use by the world’s population. A review of data across cities within North America shows improvement opportunities in water infrastructure systems. Using water audit and loss control data from the American Water Works Association (AWWA) and the Water Research Foundation (WRF), an analysis is provided to define opportunities for mitigating water losses among select North American Water Infrastructure systems in the U.S. states of Georgia and California. The research methodology used includes statistical analysis data while grouping utility sizes to identify utility cost opportunities. Variables on water loss and customer cost that have a positive impact on overall and long-term water system sustainability are identified. The analysis shows California, while having firm water guidance and higher rates compared to Georgia, also demonstrates less overall water loss. The results of the analysis are presented, showing comparison characteristics and opportunities for additional change to improve utility funding.

Real-World Data and Evidence in Lung Cancer: A Review of Recent Developments.

Conventional cancer clinical trials can be time-consuming and expensive, often yielding results with limited applicability to real-world scenarios and presenting challenges for patient participation. Real-world data (RWD) studies offer a promising solution to address evidence gaps and provide essential information about the effects of cancer treatments in real-world settings. The distinction between RWD and data derived from randomized clinical trials lies in the method of data collection, as RWD by definition are obtained at the point of care. Experimental designs resembling those used in traditional clinical trials can be utilized to generate RWD, thus offering multiple benefits including increased efficiency and a more equitable balance between internal and external validity. Real-world data can be utilized in the field of pharmacovigilance to facilitate the understanding of disease progression and to formulate external control groups. By utilizing prospectively collected RWD, it is feasible to conduct pragmatic clinical trials (PCTs) that can provide evidence to support randomized study designs and extend clinical research to the patient's point of care. To ensure the quality of real-world studies, it is crucial to implement auditable data abstraction methods and develop new incentives to capture clinically relevant data electronically at the point of care. The treatment landscape is constantly evolving, with the integration of front-line immune checkpoint inhibitors (ICIs), either alone or in combination with chemotherapy, affecting subsequent treatment lines. Real-world effectiveness and safety in underrepresented populations, such as the elderly and patients with poor performance status (PS), hepatitis, or human immunodeficiency virus, are still largely unexplored. Similarly, the cost-effectiveness and sustainability of these innovative agents are important considerations in the real world.

Securing synthetic faces: A GAN-blockchain approach to privacy-enhanced facial recognition

In recent years, facial recognition technology has become increasingly integrated into society, making privacy protection crucial. Previous techniques offered minimal secrecy safeguards through simple obscuration methods. This paper addresses the strict privacy requirements of face image data by developing a novel framework that synergistically integrates Generative Adversarial Networks (GANs), clustering algorithms, and Blockchain technology. The methodology proposes a cutting-edge Privacy-Preserving Self-Attention GAN (PPSA-GAN) to generate realistic synthetic facial imagery. An integrated mini-batch K-means clustering algorithm anonymizes these images into distinct groupings, maximizing privacy preservation. Blockchain integration complements the system by fortifying trust through decentralized ledgers for transparent yet secure data storage and auditing. Rigorous benchmarking on the CelebA dataset confirms the PPSA-GAN architecture’s state-of-the-art performance, attaining an impressive Inception Score of 13.99 and a Fréchet Inception Distance of 35.50. The mini-batch clustering forms 125 distinct clusters, effectively anonymizing facial attributes within the synthetic images. Blockchain integration further bolsters privacy assurances via tamper-proof historical records, showcasing precision, recall, F1-score, and accuracy values of 0.948, 0.938, 0.943, and 0.947, respectively. This multifunctional framework represents a novel contribution, fostering an ethical technological ecosystem that balances progress and privacy. Prospective deployment horizons encompass identity verification, surveillance infrastructure, and augmentation of medical image repositories, seeding an enlightening future for facial recognition domains.

Network analysis of stroke systems of care in Korea

BackgroundThe landscape of stroke care has shifted from stand-alone hospitals to cooperative networks among hospitals. Despite the importance of these networks, limited information exists on their characteristics and functional attributes.MethodsWe...

A retrospective and explorative analysis of dietary and behavioural factors on weight loss and well-being following a 12-week lifestyle education program promoting anti-inflammatory dietary principles

It is estimated that one-quarter of the world’s population has Metabolic Syndrome (MS)(1), a key driver of growth in healthcare expenditure. Traditional approaches to treating MS through the application of standard dietary recommendations and caloric restriction have had limited success. More recent evidence suggests that novel, anti-inflammatory approaches such as replacing refined carbohydrates and ultra-processed food with unprocessed or minimally processed, lower carbohydrate foods and adapting meal timing and frequency may be more effective(2). The aim of the study was twofold: 1) To determine the effectiveness of anti-inflammatory dietary strategies for long-term weight loss and improvement in metabolic health and 2) To examine the relationships between eating behaviours and long-term weight loss. Twelve-month audit data from a UK based 12-week lifestyle program that focuses the principles of consuming an anti-inflammatory diet was analysed using repeated-measures ANOVA to examine the effects of the program on changes in weight and waist circumference. A quantitative, survey-based research design was used to retrospectively identify relationships between eating behaviours and both anti-inflammatory and pro-inflammatory dietary patterns. Multivariate regression using stepwise method was used to examine differences in weight change based on eating patterns and behaviours. Six hundred and forty-two (N = 642) participants (age = 50.4 ± 12.5 years, female 63.6%, weight = 96.1 kg ± 22.1, BMI 35.2 kg/m2 ± 7.5) demonstrated a weight loss average of 4.49 kg ± 3.78 post-lifestyle program (12 weeks). Survey respondents (N = 64) reported a maximum long term weight loss of 13.9 kg ± 11.9. Weight loss and percentage weight loss after the program was significantly predicted by daily consumption of sweet drinks and grain-based foods. The model predicted one unit increase in daily serving consumption of these foods resulted in less weight lost [2.3 kg (4.5%)]. Seventy one percent of survey respondents had maintained most or all their weight loss for more than 6 months. The model predicted change in consumption of grain-based foods, TFEQ-emotional eating score, consumption of savoury ultra-processed foods, and following an alternative dietary approach after the program were statistically significant in predicting weight loss maintenance (R2 = 0.803, F(4, 20) = 20.376, p < 0.001). The preliminary findings suggest that anti-inflammatory dietary approaches are effective and sustainable for weight loss. Eating behaviour may both support and hinder long term changes in eating patterns and whilst there are significant relationships between eating behaviour and eating patterns, the extent to which dietary patterns drive eating behaviour remains unclear.

An innovative low-cost breast pump-hire program to enhance breastfeeding rates in a neonatal intensive care unit.

To evaluate the outcomes of a low-cost hospital-grade breast pump hire program for women experiencing financial hardship with infants in neonatal intensive care. A multi-method evaluation including data audits and surveys. Twenty-four electric breast pumps were purchased and rented to mothers at a cost of $1/day. To be eligible, mothers needed to have given birth to an infant <32 weeks and/or <1500 g and self-identified as experiencing financial hardship. Data were collected by (1) a retrospective audit to evaluate infant feeding and clinical outcomes at hospital discharge; (2) prospective telephone surveys to evaluate women's satisfaction with the program; and (3) analysis of the breast pump register to determine any loss or damages. Twenty-four mothers of 26 infants participated in the program. More than half of the infants were exclusively breastmilk fed at hospital discharge, and more than three-quarters were fed a combination of breastmilk and formula. Women who intended to formula feed were supported to provide breastmilk to their infants in the first few weeks of life. Most participants were highly satisfied with the program. Women reported that accessibility to a hospital-grade breast pump improved their ability to provide expressed breastmilk to their infants. Most participants were 'extremely satisfied' with the performance of the breast pump. One-quarter of the women reported that they would have exclusively formula-fed if they did not have access to the breast pump hire program. The audit of the equipment register showed no reported technical issues, loss or damages. The findings suggested that the low-cost breast pump hire program supported equitable care, increasing women's ability to provide expressed breastmilk for their infants. Providing access to low-cost hospital-grade breast pumps to mothers of vulnerable infants is likely to prevent poor infant clinical outcomes and improve women's care satisfaction. Nil.

Developing Compliant Audit Information System for Information Security Index: A Study on Enhancing Institutional and Organizational Audits using Web-based Technology and ISO 25010:2011 Total Quality of Use Evaluation

This study aimed to develop the KAMI 4.1 Index system application based on web application technology to provide a platform for controlled audit implementation and improve data management. The primary goals were to independently assess organizations' ability to obtain ISO 27001:2013 and enhance the audit process's effectiveness and efficiency. The research utilized web application technologies as materials. It employed a systematic approach, focusing on developing a web-based application using the waterfall model's stages of communication, planning, modeling, construction, and deployment. The resulting KAMI 4.1 Index system application introduced a new and efficient platform for controlled audit implementation, featuring an improved user experience and enhanced ease of use by incorporating existing audit calculations from the KAMI 4.1 index. Evaluation based on the ISO 25010:2011 quality of use model yielded a high total quality of use rate of 81.45%, indicating a "very good" categorization. However, areas requiring further research and improvement were identified, including data security, content coverage, freedom from risk, and error tracking. The study also suggested exploring integration possibilities of the audit system with other ISO audit needs, such as a quality assurance system complying with ISO 9001. Further research is necessary to gather information about user criteria and needs in different organizational contexts, ensuring the audit application system meets their requirements. Overall, this research contributes to developing the KAMI 4.1 Index system application and highlights directions for further enhancement and exploration in controlled audit implementation and data management.

Towards a GDPR-compliant cloud architecture with data privacy controlled through sticky policies.

Data privacy is one of the biggest challenges facing system architects at the system design stage. Especially when certain laws, such as the General Data Protection Regulation (GDPR), have to be complied with by cloud environments. In this article, we want to help cloud providers comply with the GDPR by proposing a GDPR-compliant cloud architecture. To do this, we use model-driven engineering techniques to design cloud architecture and analyze cloud interactions. In particular, we develop a complete framework, called MDCT, which includes a Unified Modeling Language profile that allows us to define specific cloud scenarios and profile validation to ensure that certain required properties are met. The validation process is implemented through the Object Constraint Language (OCL) rules, which allow us to describe the constraints in these models. To comply with many GDPR articles, the proposed cloud architecture considers data privacy and data tracking, enabling safe and secure data management and tracking in the context of the cloud. For this purpose, sticky policies associated with the data are incorporated to define permission for third parties to access the data and track instances of data access. As a result, a cloud architecture designed with MDCT contains a set of OCL rules to validate it as a GDPR-compliant cloud architecture. Our tool models key GDPR points such as user consent/withdrawal, the purpose of access, and data transparency and auditing, and considers data privacy and data tracking with the help of sticky policies.

Research and Prospect of Big Data Audit Technology

In the era of big data, technology is constantly innovated. For the audit industry, the combination of big data technology and audit should be the development trend of The Times. The joint application and combination of various technologies will promote the further development of audit. This paper mainly expounds some basic technologies of big data audit, explores and discusses the problems and corresponding solutions in the development process of big data audit in today’s society, and looks forward to the trend of big data audit in the future.

Lymphangioleiomyomatosis in patients with tuberous sclerosis: a national centre audit

BackgroundLymphangioleiomyomatosis (LAM) is common in tuberous sclerosis complex (TSC) yet under recognised with management mostly based upon evidence obtained from patients with sporadic LAM. We performed a prospective audit of patients with TSC-LAM attending a national referral centre to inform management guidelines.MethodsThe UK LAM Centre was established in 2011 and conducts a prospective audit of pre-defined quality outcomes for all subjects. Audit data are reported on all patients with TSC-LAM and a comparator population of patients with sporadic LAM.ResultsBetween 2011 and 2022, 73 patients were seen with TSC-LAM. All were women with a mean (SD) age of 39 (12) years. Referral rates were similar over the study period including after the introduction of CT screening. Median age of diagnosis with TSC was 11 years (range 0–70) with one third diagnosed with TSC as adults. Compared with all TSC patients in the ‘TOSCA’ registry, TSC-LAM patients tended to have been diagnosed with TSC at an older age, had fewer neuro-cognitive manifestations and were more likely to have angiomyolipoma. The most common presentations of TSC-LAM were following workup for angiomyolipoma, pneumothorax or dyspnoea with only one fifth detected after CT screening. Baseline FEV1 and DLCO at first assessment were reduced to 77 and 63% predicted respectively and were similar to patients with sporadic LAM. During follow-up, FEV1 fell by a mean of 81 ml/year and DLCO fell by 0.309 mmol/ml/kPa/year in patients not being treated with an mTOR inhibitor. 55% required treatment with either sirolimus or Everolimus for LAM or angiomyolipoma respectively. For those treated with an mTOR inhibitor, mean FEV1 fell by 3 ml/year and DLCO increased by 0.032 mmol/ml/kPa/year and was similar to sporadic LAM. Risk of death due to LAM or need for lung transplant in patients with TSC-LAM was 0.67%/year.ConclusionsDespite screening recommendations, LAM is often diagnosed in TSC after symptoms develop which may delay treatment. Complications including pneumothorax and loss of lung function are significant and similar to sporadic LAM. Work is needed to implement the recommended CT screening for LAM and improve respiratory care for TSC-LAM.

Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities - the PROMPt Study.

A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care-testing (POCT) on testing rates, linkage to care, treatment and acceptability of testing in three priority settings in Australia. Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service (MHS), and inpatient alcohol and other drug (AOD) unit-between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert® HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control. 1,549 participants received a HCV antibody test with 17% (264/1,549) receiving a positive result, of which 21% (55/264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by three-fold (RR:2.57 95% CI: 2.32, 2.85) for HCV antibody testing and four-fold (RR:1.62; 95% CI:1.31, 2.01) for RNA testing. Treatment uptake was higher during the POCT intervention (86%, 47/55; P=0.010) compared to the historical controls (61%, 27/44). This study demonstrated across three settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake linkage to care. The testing model was highly acceptable for most participants. ACTRN-12621001578897.

Breast Imaging Reporting and Data System (BI-RADS®): a success history and particularities of its use in Brazil.

BI-RADS® is a standardization system for breast imaging reports and results created by the American College of Radiology to initially address the lack of uniformity in mammography reporting. The system consists of a lexicon of descriptors, a reporting structure with final categories and recommended management, and a structure for data collection and auditing. It is accepted worldwide by all specialties involved in the care of breast diseases. Its implementation is related to the Mammography Quality Standards Act initiative in the United States (1992) and breast cancer screening. After its initial creation in 1993, four additional editions were published in 1995, 1998, 2003 and 2013. It is adopted in several countries around the world and has been translated into 6 languages. Successful breast cancer screening programs in high-income countries can be attributed in part to the widespread use of BI-RADS®. This success led to the development of similar classification systems for other organs (e.g., lung, liver, thyroid, ovaries, colon). In 1998, the structured report model was adopted in Brazil. This article highlights the pioneering and successful role of BI-RADS®, created by ACR 30 years ago, on the eve of publishing its sixth edition, which has evolved into a comprehensive quality assurance tool for multiple imaging modalities. And, especially, it contextualizes the importance of recognizing how we are using BI-RADS® in Brazil, from its implementation to the present day, with a focus on breast cancer screening.

Evaluation of Fast-Food Restaurant Kids’ Meal Beverage Offerings 1 Year After a State-Level Healthy Beverage Default Policy

Ordering from kids' menus and children's restaurant consumption is associated with greater purchasing and intake, respectively, of sugar-sweetened beverages. In response, policymakers have enacted strategies to improve the healthfulness of kids' meal offerings. This study investigated restaurant kids' meal beverage offerings and compliance with an Illinois healthy beverage default act, effective from January 1, 2022. Using a pre-post intervention (Illinois)-comparison (Wisconsin) site research design, fast-food restaurant audit data were collected before and 1 year after the Illinois Healthy Beverage Default Act from 6 platforms: restaurant interior and drive-thru menu boards and websites/applications and 3 third-party ordering platforms (DoorDash, Uber Eats, and Grubhub). Analyses included 62-110 restaurants across platforms. Difference-in-differences-weighted logistic regression models with robust SEs, clustered on restaurants, were estimated to assess pre to 1-year postpolicy changes in overall compliance for each audit setting in Illinois relative to that in Wisconsin. This study found no statistically significant (p<0.05) changes in the compliance of kids' meal beverage default offerings associated with the enactment of the Illinois Healthy Beverage Default Act in Illinois relative to that in Wisconsin at fast-food restaurants. There were some observed differences in results in the restaurants' physical locations versus online that are worth noting. That is, after the enactment of the Illinois Healthy Beverage Default Act, the results showed greater odds of fast-food restaurants exclusively offering healthy beverage defaults with kids' meals on restaurant interior (OR=1.83, 95% CI=0.93, 3.58) and drive-thru (OR=2.38, 95% CI=0.95, 5.96) menus, with weak statistical significance (p<0.10). However, the policy was not associated with either meaningful or statistically significant changes in healthy beverage default offerings on restaurant websites or third-party online ordering platforms. This study found limited evidence of changes in kids' meal beverage offerings attributable to the Illinois Healthy Beverage Default Act. Future investigations of communication channels that support awareness and implementation and the resources required for implementation and enforcement may provide insight that is key to improving compliance.

Prevalence, risks and outcomes of frailty in People Experiencing Homelessness: a protocol for secondary analysis of Health Needs Audit data.

Frailty describes a health state related to ageing where people become less resilient to health challenges and more likely to have adverse outcomes if they become unwell. People experiencing homelessness (PEH) are known to have poor health, with research suggesting that many become frail at a younger age than the general population. Previous research using small-scale primary data collection suggests that the prevalence of frailty in homeless populations varies widely (16-55%), with variations in sample sizes and settings partially accounting for differences in current estimates. The prevalence, risks, and outcomes of frailty in PEH are poorly understood. We propose to carry out a secondary analysis of existing health survey data collected from 2,792 PEH. This will involve creating a Frailty Index (FI) to identify frail people within the dataset. Regression analyses will be used to identify associations between potential risk factors and outcomes of frailty in this population. This protocol will: 1) Outline the creation of a FI to assess the frailty prevalence within a dataset of health information collected from a cohort of PEH and 2) Describe proposed methods of regression analysis for identification of associations between frailty and risks factors/outcomes of frailty in the cohort of PEH within the dataset. The processes described in this paper can inform future development of FIs in other datasets. It is expected that the FI created will be an appropriate and robust method for identifying frailty in a cohort of PEH and results of the secondary data analysis will provide a more robust estimate of the associations between frailty and risk factors/outcomes.

The Royal College of Ophthalmologists' National ophthalmology database study of cataract surgery: Report 14, cohort analysis - the impact of CapsuleGuard® utilisation on cataract surgery posterior capsule rupture rates.

The aim of this study was to investigate whether the use of the silicone tipped irrigation/aspiration (I/A) handpiece CapsuleGuard® (Bausch + Lomb, Laval, Canada) reduced rates of posterior capsule rupture (PCR) during cataract surgery. Royal College of Ophthalmologists' National Ophthalmology Database (NOD) Cataract Audit data from 01/04/2010 and 31/03/2021 and Bausch + Lomb sales figures were combined to identify centres participating in national cataract audit who have routinely adopted the silicone tipped I/A handpiece, CapsuleGuard®. Data were included only from centres with eligible cataract operations recorded on the NOD both before and after adopting CapsuleGuard®. Review of the literature was undertaken to estimate the proportion of PCR that occurs during I/A, to evaluate the impact of adoption of CapsuleGuard® on PCR occurring in this phase of surgery. Within the study period, 267 371 eligible cataract operations were performed in 14 centres with >50 eligible operations both before and after adopting CapsuleGuard®. Within centres adopting CapsuleGuard®, the rate of PCR occurrence reduction was 16.4%. Before and after the adoption of CapsuleGuard® the median change of PCR was 21.7% reduction (IQR: 4.8% to 37.7% reduction). A reduction in the rate of PCR was seen after regular adoption of CapsuleGuard® during cataract operations. Review of published studies attributing PCR to various components of the cataract operation suggest around 25% of PCR may occur during I/A; adoption of CapsuleGuard may, therefore, be associated with avoidance of a substantial proportion of the PCR during that phase of surgery.

Revolutionizing collaborative auditing: A dynamic blockchain-based cloud storage framework for data updates and assurance

Effective data management has arisen as a major concern in today’s era of ubiquitous data generation from a plethora of intelligent gadgets. While data proliferation promises unparalleled benefits, it imposes significant storage and computing constraints, particularly on end-users with limited capabilities. To solve these difficulties, this article investigates the confluence of cloud storage, blockchain technology, public auditing, reputation systems, and dynamic auditing. Because of their low-cost data storage and processing capabilities, cloud computing services have grown in popularity, leading customers to embrace data outsourcing to reduce local administrative overhead. This study digs into a novel paradigm for ensuring the integrity and security of data stored in cloud environments using blockchain technology. Integrating public auditing systems enables visible and verifiable data audits, ensuring consumers of data trustworthiness. A reputation system is also included to build trust among cloud service providers and users, improving the overall trustworthiness of the ecosystem. The suggested system also includes dynamic auditing, which allows for real-time changes and data verification, reacting to the changing nature of cloud-stored information. This study provides a thorough examination of the architectural components, techniques, and protocols used in this novel approach. We illustrate the feasibility and usefulness of our approach in ensuring data integrity, security, and reliability in cloud storage systems through empirical analysis and case studies. The findings show the potential benefits of this integrated strategy to solving the issues posed by the modern digital landscape’s tremendous proliferation of data. Through the synergistic integration of cloud storage, blockchain technology, public auditing, reputation systems, and dynamic auditing, this research provides a holistic solution for managing data in the cloud while ensuring data integrity, security, and trust. This comprehensive strategy lays the way for a more robust and dependable cloud data management ecosystem, increasing user trust in cloud-based services.

Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback

Inpatient hyperglycaemia is associated with an increase in morbidity and mortality, number of rehospitalisations and length of hospitalisation. Although the advantages of proper glycaemic control in hospitalised patients with diabetes...

Geographic Information Systems—A Scavenger Hunt for Accounting and Auditing

ABSTRACT This experiential exercise provides an opportunity for students to learn how accounting and audit practices can be augmented using Geographic Information Systems (GIS). We illustrate how GIS aids in the collection of accounting data, verification of assets, risk assessment, and internal controls. Using a GIS field collection app, the students were provided a list of assets to locate and audit at their college/university. After completing the exercise, 70 senior-level accounting students at a public university provided feedback related to their experience and the effectiveness of GIS as a data collection and audit tool. The results of the questionnaire revealed that students found the GIS technology useful in data collection and analysis for both accounting and auditing, as well as for reinforcing the audit concepts taught in the classroom. Data Availability: Efficacy data are available from the authors upon request.

Maternal mortality review in a major tertiary referral hospital in Liberia, 2018–2021

ObjectivesAnecdotal evidence showed increased maternal deaths at the major tertiary hospital over the past two years (2020–2021). We reviewed the maternal death audit data, identified the main causes of maternal death, and associated risk factors. Findings were shared with policymakers to help reduce maternal mortality. Study designWe conducted a secondary data review and descriptive analysis of maternal death at the tertiary hospital located in Monrovia. MethodThe maternal death data were extracted from patient medical records, including death certificates and maternal audit records. The record of live births was obtained from the delivery register. Data were analyzed using Epi Info version 7.2 Maternal mortality ratio (MMR) was estimated, the leading direct and indirect causes of maternal death were identified, and the factors associated with maternal death were explored using logistic regression at a 5% level of significance. ResultsThere are a total of 233 maternal deaths and 14, 879 live births giving a maternal mortality ratio (MMR) of 1565 per 100,000 live births during the period under review. The median age of the mothers at death was 29 (14–45) years. About 40.3% (94/233) of cases died within <1 day of admission, referrals accounted for 59% (137/233) of the cases. Direct causes of death accounted for 66% (147/223). Hemorrhage [30.6% (45/147)], Eclampsia [(30/147) 20.6%] and Sepsis [(30/147) 20.6%] were the main direct causes of death while cardiovascular-related [18.4% (14/76)] and HIV/AIDS [16% (12/76)] were the leading indirect cause of death. Patients from referred other facilities were 7.9 times more likely to die as compared to non-referral (pOR:7.9, 95%CI: 5.9–10.6, p < 0.001). ConclusionThe maternal mortality ratio remained high. Referrals were done late. The Liberia Ministry of Health should equip more secondary-level health facilities and tertiary hospitals to handle maternal emergencies and sensitize the populace and healthcare workers on prompt identification and referral of obstetric emergencies. The MoH also needs to improve the blood transfusion services to help in the management of postpartum hemorrhage.