Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care.
BACKGROUND
Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria's high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care.


METHODS
We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000-2014. A 'best-fit' framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score.


RESULTS
Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services.


CONCLUSIONS
Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions.
Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland. j.hussein@abdn.ac.uk.
Julia
J
Hussein
Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
Atsumi
A
Hirose
Women's Health and Action Research centre (WHARC), KM 11 Benin-Lagos Expressway, Igue-Iheya, Benin City, Edo State, Nigeria.
Oluwatoyin
O
Owolabi
Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
Mari
M
Imamura
Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
Lovney
L
Kanguru
Women's Health and Action Research centre (WHARC), KM 11 Benin-Lagos Expressway, Igue-Iheya, Benin City, Edo State, Nigeria.
Friday
F
Okonofua
D000328:Adult; D001771:Blood Banks / Q000600:supply & distribution; D002585:Cesarean Section / Q000009:adverse effects; D004636:Emergency Service, Hospital / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000600:supply & distribution / Q000627:therapeutic use; D008428:Maternal Mortality; D008485:Medical Audit; D008507:Medically Underserved Area; D009549:Nigeria / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D011787:Quality of Health Care; D061665:Time-to-Treatment; D015149:Tocolytic Agents / Q000600:supply & distribution / Q000627:therapeutic use; D065227:Transfusion Reaction
D015149:Tocolytic Agents; D008278:Magnesium Sulfate
Audit; Emergency obstetric care; Maternal death reviews; Maternal mortality; Quality improvement; Surveillance and response