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Using Audit to Enhance Quality of Maternity Care in Resource Limited Countries: Lessons Learnt from Rural Tanzania.

Nyamtema, A. S., de Jong, A. B., Urassa, D. P. and van Roosmalen, J. (2011) Using Audit to Enhance Quality of Maternity Care in Resource Limited Countries: Lessons Learnt from Rural Tanzania. BMC pregnancy and childbirth, 11. p. 94. ISSN 1471-2393

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Abstract

Although clinical audit is an important instrument for quality care improvement, the concept has not yet been adequately taken on board in rural settings in most resource limited countries where the problem of maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions. Methods are informed by the principles of operations research. An audit system was established, all patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and strategic action plans for improvement were developed and implemented. There were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care. Patients, health workers and administration related substandard care factors were identified in 50% - 61% of women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the workforce for health care, referral system improvement and upgrading of health centres located in hard to reach areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result of audit. Our findings indicate that audit can be implemented in rural resource limited settings and suggest that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are limited if strategic interventions are implemented.

Item Type: Article
Keywords: Quality of Maternity Care, Resource Limited Countries, Rural Tanzania
Subjects: Maternal & Neonatal Health > Maternal Mortality & Morbidity
Divisions: Other
Depositing User: Mr Joseph Madata
Date Deposited: 15 Aug 2013 09:07
Last Modified: 15 Aug 2013 09:07
URI: http://ihi.eprints.org/id/eprint/1734

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