[Maternal mortality audits in low-resource countries: analysis of 23 hospitals in Senegal and Mali (the QUARITE study)].
BACKGROUND
In 1990, the Society of Obstetricians and Gynaecologists of Canada joined the international movement for safe motherhood by adapting its ALARM programme to the needs of low-resource countries. The goal of the QUARITE (QUAlité des soins, gestion du RIsque et TEchniques obstétricales) trial is to evaluate the efficiency of the ALARM International programme in terms of maternal mortality reduction in 46 referral hospitals in Senegal and Mali.


OBJECTIVE
Evaluate the implementation of maternal death audits in the 23 hospitals that are part of the QUARITE trial's intervention group.


METHODS
Ten follow-up indicators have been identified to evaluate the implementation of maternal death audits. This article describes and analyzes these follow-up indicators during a 5-month implementation period, from September 23, 2008, to January 30, 2009. Data was gathered during a supervision visit at the end of that period with a standardized follow-up questionnaire and checklist. Key participants were interviewed. The programme's documents (procedure manual, meeting and supervision minutes, and logbook) were analyzed. An implementation score (on a scale from 1 to 10) was calculated for each centre.


RESULTS
The 23 centres we visited yielded a mean implementation score of 7.5 (minimum=4 and maximum=10). In each health structure, there is a multidisciplinary, functional subcommittee-maternal death audit committee whose members have been trained on the subject of maternal death audits. Overall, these subcommittees use the management tools but some of the forms are not well understood: thus, we must pinpoint the causes of this problem and eliminate them. Maternal death audit sessions had a slow start due to several factors: maternity personnel's workload, lack of confidence of local leaders, lack of cohesion within teams and lack of personnel availability.


CONCLUSIONS
Data analysis indicates that the process of implementing maternal death audits is slow but real and that quarterly supervision makes it possible to eliminate difficulties and to reinforce the skills of audit subcommittee members.
Dortonne
Jean Richard
JR
Gestionnaire du projet QUARITE, Société des obstétriciens et gynécologues du Canada.
Dumont
Alexandre
A
Institut de recherche pour le développement, Campus international de recherche UCAD/IRD, Dakar, Sénégal.
Traore
Mamadou
M
Médecin chef du Centre de santé de référence commune V, Bamako, Mali.
Perreault
Gilles
G
Médecin, Hôpital Saint-Jean-sur-Richelieu, Québec, Canada.
Couturier
François
F
Médecin, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada.
Kanouté
Kandakhassé
K
Division Santé de la reproduction, ministère de la Santé et de la Prévention, Dakar, Sénégal.
D026683:Advisory Committees; D003906:Developing Countries; D005260:Female; D006801:Humans; D008302:Mali; D008428:Maternal Mortality; D008429:Maternal Welfare; D008485:Medical Audit; D011247:Pregnancy; D012675:Senegal