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Maternal Death Audit

Maternal Death Audit. Why is it important and how is it done?. Background. It is critical to determine the levels and causes of maternal mortality This will tell us the public health importance of specific maternal health problems

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Maternal Death Audit

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  1. Maternal Death Audit Why is it important and how is it done?

  2. Background • It is critical to determine the levels and causes of maternal mortality • This will tell us the public health importance of specific maternal health problems • We can then design appropriate interventions to reduce maternal mortality

  3. Background • For example, a large number of maternal deaths due to hemorrhage will point to the need for: • Early management of bleeding • Timely referral • Access to emergency transport

  4. Background • Or, high levels of maternal death due to puerperal sepsis, for example, may indicate the need for: • Improved management during delivery • Improved management after delivery

  5. Method • Maternal Death Audit What is Maternal Death Audit? • Step 1: Examine case records and interview staff • Step 2: Interview the household of the deceased person • Step 3: Use this information to reconstruct the circumstances leading to the death • Step 4: Assign a Cause of Death

  6. Step 1: Examine case records and interview staff • Visit the health premises where she was treated to examine case records and interview staff • Take note of the recorded obstetric history • Ask staff about any special circumstances regarding the death

  7. Step 2: Interview the household of the deceased person • Meet the relatives of the deceased to collect information on: • the location of the death • the economic, social and educational profile of the family • the deceased’s obstetric history and record of antenatal, delivery and postnatal care, referral and • the circumstances of death

  8. Step 3: Reconstruct the circumstances of the death • Obstetrician to analyze the direct and indirect obstetrical causes which led to death • Other team members to examine non-medical causes of death: antenatal care, risk factors, complications, delay in referral or in initiation of treatment, non-availability of specialists, equipment, blood, etc. • Highlight system failures

  9. Step 4: Assign a Cause of Death • Use all the information to assign, as a team, the primary cause of death • Ask yourselves - Was it preventable? • Ask yourselves – Was it because of a systems failure?

  10. The Process (1) Step 1: Report the death to the Deputy Director of Health Services at the District level • When? Within 24 hours of death • Who will do it? • If the death occurs at home, in transit, at the sub-center: ANM to PHC Medical Officer • At the PHC: PHC Medical Officer • Public Hospital or Private Hospital: Respective hospital authorities

  11. The Process (1) contd… • Report deaths of all pregnant women, including due to abortion, suicide, accidents etc.

  12. The Process (2) Step 2: Form a Maternal Death Investigation Team at PHC • When? Within 15 days of the death • Who will be in the team? • PHC Medical Officer • Administrator • 1 Nursing Staff • BHE

  13. The Process (3) • Place the findings of the team before the district-level Maternal Deaths Medical Audit Committee on a monthly basis • Place all reports before the District RCH Committee chaired by the District Collector, which receives relatives of the deceased who give their account of the events • Place the minutes of both meetings before the Commissioner, H&FW

  14. The Process (4) • Provide feedback to relevant FRUs and PHCs • Provide feedback to relevant personnel involved in the case • Conduct annual analysis of maternal deaths to understand causes of death and formulate appropriate response

  15. Analysis – What does the Maternal Death Audit tell you? (TN example)

  16. Analysis – What does the Maternal Death Audit tell you? • Poor distribution of first referral units (FRUs) • Unnecessary referrals • Poor quality of care • Delay in accessing emergency transport • Obstetric first aid not provided before referral • etc

  17. Analysis – Possible Solutions • Making FRUs functional by contracting in additional staff • Ensuring emergency transport – either by using untied funds to establish a tie-up with local transport facility or by setting up an ambulance facility

  18. Analysis – Possible Solutions • Establishing blood storage facilities at the PHCs • Providing additional training to PHC staff in emergency obstetric care • Ensuring that all staff are aware of Emergency Obstetric Care protocols

  19. Follow-up • Medical Officer and Administrator to place the findings of the Audit before the Arogya Raksha Samithi (ARS) • ARS to present the findings to the next Gram Sabha in the presence of the Medical Officer and Administrator • ARS to facilitate the process of PHC staff and community taking ownership of the findings of the Audit

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