This 2014 paper critically reflects on a facility-based maternal death review study in Lilongwe, Malawi, using the five step mortality surveillance cycle framework that was used for the study, and highlights the methodological challenges faced while doing such reviews.
Although studies using maternal death audit methodologies are widely available, few discuss the challenges in their implementation. This study was conducted at comprehensive emergency obstetric care units of a secondary hospital and a tertiary hospital. It found that there were gaps in identifying and reporting on maternal deaths that may have happened in units/wards other than the maternity unit, which may have led to under-reporting.
Data was also found to be as being poorly maintained, missing or incomplete in many cases, as there was no system in place for health information collection and storage in cases of maternal mortality. Whilst language barriers and cultural norms were thought to have potentially influenced data from the communities, busy schedules and fear of blame were some of the issues faced at the facility level.
Decisions around assigning cause of death and classifying deaths according to the International Classification of Diseases – 10, in the absence of reliable clinical or laboratory data to supplement diagnostic procedures led to differences in judgement between reviewers and clinicians. This paper, while highlighting the potential methodological challenges, also provides some recommendations to help resolve them.
Thorsen, V.C., Sundby, J., Meguid, T., & Malata, A. (2014). Easier said than done: methodological challenges with conducting maternal death review research in Malawi, by T, in BMC Medical Research Methodology, Vol14 (open access)