FACILITY-BASED MATERNAL DEATH REVIEW IN THREE DISTRICTS IN THE CENTRAL REGION OF MALAWI An Analysis of Causes and Characteristics of Maternal Deaths
FACILITY-BASED MATERNAL DEATH REVIEW IN THREE DISTRICTS IN THE CENTRAL REGION OF MALAWI An Analysis of Causes and Characteristics of Maternal Deaths
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DOI：
10.1016/j.whi.2008.09.008
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发表时间：
2009-01-01
影响因子：
3.2
通讯作者：
van den Broek, Nynke
中科院分区：
文献类型：
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作者：
Kongnyuy, Eugene J.;Mlava, Grace;van den Broek, Nynke
目的。我们试图确定马拉维卫生设施中发生的孕产妇死亡的原因和特征。在马拉维中部3个区的9家医院，对43例产妇死亡进行了为期一年的审查。在审查过程中确定了孕产妇死亡的原因和可避免的因素，并提出并实施了建议。主要发现。产科直接死亡28例(65.1%)，间接产科死亡15例(34.9%)。孕产妇死亡的主要原因是产后出血(25.6%)、产后败血症(16.3%)、HIV/AIDS(16.3%)、子宫破裂(7.0%)、流产并发症(7.0%)、贫血(7.0%)、产前出血(4.7%)、子痫(4.7%)。三分之二的妇女是从其他保健机构(51.2%)或由传统助产士(TBA；11.6%)转诊的，高达79.1%的妇女在入院时病情危重。确定了导致孕产妇死亡的四组因素：1)卫生工作者因素，2)行政因素，3)患者/家庭因素，4)TBA因素。医务人员的主要影响因素是复苏不充分(69.8%)、产科救生技能缺乏(60.5%)、监测不到位(55.8%)、初步评估不完整(46.5%)、延误治疗(46.5%)。最常见的管理因素是输血不足(20.9%)。面临的主要问题包括人员和其他资源短缺，难以保持匿名性，数据质量差，难以落实建议。在马拉维和社会经济状况相似的国家，适当的产科救生技能培训、解决艾滋病毒/艾滋病问题和提高社区认识，可能是降低产妇死亡率的重要因素。
Purpose. We sought to determine the causes and characteristics maternal deaths that occur in health facilities in Malawi.Methods. Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in Central Malawi over a 1-year period. Causes and avoidable factors of maternal deaths were identified during the review, and recommendations made and implemented.Main Findings. There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect obstetric deaths. The major causes of maternal deaths were postpartum hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were referred either from another health facility (51.2%) or by a traditional birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on admission. Four groups of factors that contributed to maternal deaths were identified: 1) health worker factors, 2) administrative factors, 3) patient/family factors, and 4) TBA factors. The major health worker factors were inadequate resuscitation (69.8%), lack of obstetric life-saving skills (60.5%), inadequate monitoring (55.8%), initial assessment incomplete (46.5%), and delay in starting treatment (46.5%). The most common administrative factor was lack of blood for transfusion (20.9%). The major problems encountered include shortage of staff and other resources, difficulty in maintaining anonymity, poor quality of data, and difficulty in implementing recommendations.Conclusion. Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles.