Delays in Maternal Morbidity and Maternal Mortality at Facility Level, Tigray Regional State,
Creators: name: Hailu, Samuel
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2006

description: Each year, more than 500,000 women world wide die from complications related child birth. With good quality obstetric care, approximately 90 percent of these deaths could be averted. The assistance of skilled birth attendants during labor, delivery and the immediate post partum period is one important component of quality of obstetric care. How ever little is known about the cause of what is known as 'the third delay" the delay in receiving medical attention after a woman arrives at a health care facility. Through this paper two major things were examined. The objective of the study was to assess the delays in maternal mortality and morbidity and to assess avoidability of maternal deaths. The first were causes and circumstances of maternal deaths that have occurred in hospitals, the second measured the patient delay and the hospital delay in case of emergency obstetric care. The studies were carried out between December 2005- may 2006 in Tigray, Ethiopia. The maternal death audit as well the patient and hospital delay study were facility based. The maternal death audit study assessed each death for the cause and circumstances of deaths, avoidable factors, by utilizing both review of patient and facility records and interviewing those who were involved in the care of deceased woman. Results shows that 15 (44.1 %) were unavoidable maternal deaths and 12 (35.7%) were possibly avoidable maternal deaths, the leading causes of death were infection 16 (47. 1%) followed by haemorrhage 10 (29.4 %). The review also identified avoidable factors finding that most of these factors related to hospital service or medical factors. Patient factors, transport factors were also noted. Among the hospital factors institutional delay like delay to refer for treatment, lack of blood, delay in transfusion, inappropriate institutional treatment Samuel Hailu, The delays study vi and substandard care were also noted. The interval between the onset of signs and symptoms and arrival at the facility is measured and operationalized as patient delay and the interval between arrival and initial evaluation is measured as hospital delay but no standards define patient delay and hospital delay. The median (range) for the patient and hospital delays is 8(125) hrs and 0(6) hrs respectively. The qualities of medical records were very poor lacking many key data items and time element was also a rare finding. Based on the findings it is recommended implementing an initiative to improve medical record documentation at all hospitals. This would facilitate medical record review for quality purposes. It is also recommended a quality improvement approach to strengthen the triage system that is already in place. Maternal death audit as a system need to be institutionalized. Educational campaigns are necessary to raise awareness of the community on danger signs of pregnancy so as to avoid patient delay and in-service training for care providers to avoid hospital delay and mismanagement. Since no standards define "delays" it was found to be difficult to judge whether delays occurred or not and where the delays has occurred. As a result it is recommended that Evidence based standard should be developed. Further study on the cause of what is known as 'the third delay" the delay in receiving medical attention after a woman arrives at a health care facility through Patient flow analysis needs to be done