title: Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, United Kingdom. kongnyuy@liverpool.ac.uk
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Kongnyuy
authors.forename: Grace
authors.initials: G
authors.lastname: Mlava
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
mesh_terms: D000022:Abortion, Spontaneous / Q000401:mortality; D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000401:mortality; D002423:Cause of Death; D002585:Cesarean Section / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008428:Maternal Mortality; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000401:mortality; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000517:prevention & control; D011295:Prenatal Care / Q000706:statistics & numerical data; D012307:Risk Factors; D016387:Women's Health; D055815:Young Adult