title: Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries.
abstract: Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications.
authors.affiliation: Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. veronique.filippi@lshtm.ac.uk
authors.forename: Véronique
authors.initials: V
authors.lastname: Filippi
authors.forename: Fabienne
authors.initials: F
authors.lastname: Richard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lange
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Ouattara
mesh_terms: D003219:Confidentiality; D003906:Developing Countries; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008485:Medical Audit; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000592:standards*