The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor?
OBJECTIVE
To illustrate how maternal mortality audit identifies different causes of and contributing factors to maternal deaths in different settings in low- and high-income countries and how this can lead to local solutions in reducing maternal deaths.


METHODS
Descriptive study of maternal mortality from different settings and review of data on the history of reducing maternal mortality in what are now high-income countries.


METHODS
Kalabo district in Zambia, Farafenni division in The Gambia, Onandjokwe district in Namibia, and the Netherlands.


METHODS
Population of rural areas in Zambia and The Gambia, peri-urban population in Namibia and nationwide data from the Netherlands.


METHODS
Data from facility-based maternal mortality audits from three African hospitals and data from the latest confidential enquiry in the Netherlands.


METHODS
Maternal mortality ratio (MMR), causes (direct and indirect) and characteristics.


RESULTS
MMR ranged from 10 per 100,000 (the Netherlands) to 1,540 per 100,000 (The Gambia). Differences in causes of deaths were characterized by HIV/AIDS in Namibia, sepsis and HIV/AIDS in Zambia, (pre-)eclampsia in The Netherlands and obstructed labour in The Gambia.


CONCLUSIONS
Differences in maternal mortality are more than just differences between the rich and poor. Acknowledging the magnitude of maternal mortality and harnessing a strong political will to tackle the issues are important factors. However, there is no single, general solution to reduce maternal mortality, and identification of problems needs to be promoted through audit, both national and local.
van Dillen
Jeroen
J
Onandjokwe Lutheran Hospital, Namibia.
Stekelenburg
Jelle
J
Schutte
Joke
J
Walraven
Gijs
G
van Roosmalen
Jos
J
D002391:Catchment Area, Health; D019049:Developed Countries / Q000191:economics* / Q000706:statistics & numerical data; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005714:Gambia / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007182:Income / Q000145:classification*; D008428:Maternal Mortality; D008485:Medical Audit; D009276:Namibia / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012494:Sampling Studies; D015024:Zambia / Q000453:epidemiology