title: Facility Death Review of Maternal and Neonatal Deaths in Bangladesh.
abstract: OBJECTIVE
  To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.
  
  
  METHODS
  This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.
  
  
  RESULTS
  FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.
  
  
  CONCLUSIONS
  FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.
authors.affiliation: Department of Public Health Science, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.|Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
authors.forename: Animesh
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
authors.forename: Fazlur
authors.initials: F
authors.lastname: Rahman
authors.affiliation: Department of Public Health Science, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Charli
authors.initials: C
authors.lastname: Eriksson
authors.affiliation: Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
authors.forename: Abdul
authors.initials: A
authors.lastname: Halim
authors.affiliation: Department of Public Health Science, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Koustuv
authors.initials: K
authors.lastname: Dalal
mesh_terms: D001459:Bangladesh; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006268:Health Facilities / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D063130:Maternal Death / Q000706:statistics & numerical data*; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data*; D066087:Perinatal Death; D011247:Pregnancy; D036301:Qualitative Research