The difficulties of conducting maternal death reviews in Malawi.
BACKGROUND
Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges.


METHODS
SWOT (strengths, weaknesses, opportunities and threats) analysis of the process of maternal death review during a workshop in Malawi.


RESULTS
Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement.


CONCLUSIONS
Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.
Kongnyuy
Eugene J
EJ
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy@gmail.com
van den Broek
Nynke
N
D001291:Attitude of Health Personnel; D002423:Cause of Death; D003219:Confidentiality; D036861:Delivery, Obstetric / Q000401:mortality; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D008485:Medical Audit; D010380:Peer Review; D011247:Pregnancy
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