title: Maternal death reviews at a rural hospital in Malawi.
abstract: OBJECTIVE
  To analyze maternal deaths at Nkhoma Church of Central Africa Presbyterian (CCAP) Hospital and identify factors causing delays in care.
  
  
  METHODS
  Maternal death audits are performed after every maternal death at Nkhoma CCAP Hospital. Information regarding the care provided at the health facility, the referral process, and any delays in the community was collected by an audit team using a structured approach. Data from August 2007 to September 2011 were analyzed retrospectively.
  
  
  RESULTS
  In total, 61 maternal deaths occurred during the study period, of which 58 were analyzed. Most deaths were categorized as indirect (n=34 [58.6%]). Non-pregnancy-related infections were the leading cause of indirect death (n=22), with meningitis the most common (n=13). Most patients experienced a delay in seeking care (n=37 [63.8%]), a transport delay (n=43 [74.1%]), or a delay in receiving adequate care (n=34 [58.6%]).
  
  
  CONCLUSIONS
  Most maternal deaths had indirect causes and were associated with delays in all phases. An audit makes clear which part of the referral chain needs to be strengthened. Nkhoma CCAP Hospital has taken steps to address all phases of delay.
authors.affiliation: Department of Gynecology and Obstetrics, Maasstad Ziekenhuis, Rotterdam, Netherlands. naomivink@gmail.com
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Vink
authors.forename: Hendrik C C
authors.initials: HC
authors.lastname: de Jonge
authors.forename: Reynier
authors.initials: R
authors.lastname: Ter Haar
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Chizimba
authors.forename: Jelle
authors.initials: J
authors.lastname: Stekelenburg
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008295:Malawi; D063130:Maternal Death / Q000209:etiology*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011251:Pregnancy Complications, Infectious / Q000401:mortality*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult