title: A critical analysis of maternal morbidity and mortality in Liberia, West Africa.
abstract: OBJECTIVE
  To conduct a secondary analysis of maternal death and near-miss audits conducted at the community and facility level to explore the causes and circumstances surrounding maternal mortality and severe morbidity in one rural county in Liberia, West Africa.
  
  
  METHODS
  A non-experimental, descriptive design utilising maternal death and near-miss audit surveys was utilised for data collection. Thaddeus and Maine's Three Delays Model was used as a framework for analysis.
  
  
  METHODS
  One rural county in north-central Liberia.
  
  
  METHODS
  Interviews were conducted with (1) women who suffered a severe morbidity or nearmiss event, (2) family members of women who died or presented with a severe morbidity, and (3) community members or health workers involved in the care of the woman.
  
  
  METHODS
  (1) Maternal mortality, (2) near-miss events, and (3) delays related to problem identification, transportation challenges and delays after reaching the referral site.
  
  
  RESULTS
  120 near-miss events and 28 maternal mortalities were analysed. 16% of all deliveries at the referral hospital were classified as near-miss events. Near-miss events were six times more common than deaths. The majority of women experiencing a near-miss event (85%) were in critical condition upon arrival at the hospital suggesting important delays were encountered in reaching the facility.
  
  
  CONCLUSIONS
  Maternal mortality and near-miss audits allow exploration of medical and non-medical factors leading up to a severe complication or maternal death. Delays in reaching a referral hospital can have a significant impact on maternal survival rates.
  
  
  CONCLUSIONS
  Audits can stimulate a change in clinical practice and help identify areas for county health departments to focus their scant resources. Audits can be used as a quality improvement tool in facilities. Results can be used to identify communities with high rates of delay to target educational programmes.
authors.affiliation: University of Michigan, School of Nursing, 400N. Ingalls Bldg., Room 4320B, Ann Arbor, MI 48109-5482, USA. jrlori@umich.edu
authors.forename: Jody R
authors.initials: JR
authors.lastname: Lori
authors.forename: Amy E
authors.initials: AE
authors.lastname: Starke
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007988:Liberia; D008427:Maternal Health Services / Q000379:methods*; D008428:Maternal Mortality; D008429:Maternal Welfare / Q000706:statistics & numerical data; D008485:Medical Audit / Q000379:methods*; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000401:mortality*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult