Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital
AbstractThis study analyses the contribution of system-related factors to maternal mortality in the low-resource setting of Mnazi Mmoja Hospital in Zanzibar, Tanzania. It is a retrospective cohort study including all maternal deaths (MD, n = 139) and maternal near-misses (MNM, n = 122) in Mnazi Mmoj...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-10-01
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| Series: | Journal of Obstetrics and Gynaecology |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/01443615.2022.2113769 |
| _version_ | 1797201082672218112 |
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| author | Eline D. Veenstra Tanneke Herklots Khairat Said Mbarouk Tarek Meguid Arie Franx Benoit Jacod |
| author_facet | Eline D. Veenstra Tanneke Herklots Khairat Said Mbarouk Tarek Meguid Arie Franx Benoit Jacod |
| author_sort | Eline D. Veenstra |
| collection | DOAJ |
| description | AbstractThis study analyses the contribution of system-related factors to maternal mortality in the low-resource setting of Mnazi Mmoja Hospital in Zanzibar, Tanzania. It is a retrospective cohort study including all maternal deaths (MD, n = 139) and maternal near-misses (MNM, n = 122) in Mnazi Mmoja Hospital with sufficient documentation during 2015 to 2018 (MD) and 2017 to 2018 (MNM). The number of admissions and surgical interventions per health care provider on the day of admission and the number of times vital signs were monitored per day were compared between MNM and MD cases using logistic regression. The mean number of times vital signs were monitored per day was associated with reduced odds of mortality (aOR 0.75, 95% CI 0.64–0.89), after adjustment for confounding factors such as severity of illness. The numbers of admissions or surgical procedures per health care provider were not associated with mortality. Concluding, the degree of monitoring of patients with life-threatening complications of pregnancy or childbirth is associated with the risk of mortality independent of the degree of severity. Preventing maternal mortality requires going beyond availability of essential interventions to tackle system-related factors that have a direct impact on the capacity to provide comprehensive care.Impact StatementWhat is already known on this subject? Root cause analyses of maternal deaths have identified many system-related factors, such as availability of health care providers, adequate training, and motivation to sustain high intensity monitoring (Madzimbamuto et al. 2014; Mahmood et al. 2018).What do the results of this study add? This is the first study to attempt to quantify the contribution of these system-related factors by comparing cases of maternal death with cases of maternal near-miss. We show that the degree of monitoring of patients with life-threatening complications is associated with the odds of mortality independent of the degree of severity. Even though this relation should not be regarded as causative, monitoring of vital signs can be seen as reflective of many system-related factors which hamper or facilitate comprehensive care.What are the implications of these findings for clinical practice and/or further research? This study helps increase general understanding of the factors leading to progression from severe disease to death in a high-volume low-income setting. |
| first_indexed | 2024-04-24T07:41:53Z |
| format | Article |
| id | doaj.art-e600bfc8840d4877b98b61d8f28fbd74 |
| institution | Directory Open Access Journal |
| issn | 0144-3615 1364-6893 |
| language | English |
| last_indexed | 2024-04-24T07:41:53Z |
| publishDate | 2022-10-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Obstetrics and Gynaecology |
| spelling | doaj.art-e600bfc8840d4877b98b61d8f28fbd742024-04-19T13:43:21ZengTaylor & Francis GroupJournal of Obstetrics and Gynaecology0144-36151364-68932022-10-014272917292310.1080/01443615.2022.2113769Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral HospitalEline D. Veenstra0Tanneke Herklots1Khairat Said Mbarouk2Tarek Meguid3Arie Franx4Benoit Jacod5Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the NetherlandsDepartment of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the NetherlandsMnazi Mmoja Hospital, Zanzibar, United Republic of TanzaniaMnazi Mmoja Hospital, Zanzibar, United Republic of TanzaniaDepartment of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the NetherlandsOLVG Hospital, Amsterdam, the NetherlandsAbstractThis study analyses the contribution of system-related factors to maternal mortality in the low-resource setting of Mnazi Mmoja Hospital in Zanzibar, Tanzania. It is a retrospective cohort study including all maternal deaths (MD, n = 139) and maternal near-misses (MNM, n = 122) in Mnazi Mmoja Hospital with sufficient documentation during 2015 to 2018 (MD) and 2017 to 2018 (MNM). The number of admissions and surgical interventions per health care provider on the day of admission and the number of times vital signs were monitored per day were compared between MNM and MD cases using logistic regression. The mean number of times vital signs were monitored per day was associated with reduced odds of mortality (aOR 0.75, 95% CI 0.64–0.89), after adjustment for confounding factors such as severity of illness. The numbers of admissions or surgical procedures per health care provider were not associated with mortality. Concluding, the degree of monitoring of patients with life-threatening complications of pregnancy or childbirth is associated with the risk of mortality independent of the degree of severity. Preventing maternal mortality requires going beyond availability of essential interventions to tackle system-related factors that have a direct impact on the capacity to provide comprehensive care.Impact StatementWhat is already known on this subject? Root cause analyses of maternal deaths have identified many system-related factors, such as availability of health care providers, adequate training, and motivation to sustain high intensity monitoring (Madzimbamuto et al. 2014; Mahmood et al. 2018).What do the results of this study add? This is the first study to attempt to quantify the contribution of these system-related factors by comparing cases of maternal death with cases of maternal near-miss. We show that the degree of monitoring of patients with life-threatening complications is associated with the odds of mortality independent of the degree of severity. Even though this relation should not be regarded as causative, monitoring of vital signs can be seen as reflective of many system-related factors which hamper or facilitate comprehensive care.What are the implications of these findings for clinical practice and/or further research? This study helps increase general understanding of the factors leading to progression from severe disease to death in a high-volume low-income setting.https://www.tandfonline.com/doi/10.1080/01443615.2022.2113769Severe maternal outcomematernal mortalitymaternal morbiditymaternal near-misslow-income setting |
| spellingShingle | Eline D. Veenstra Tanneke Herklots Khairat Said Mbarouk Tarek Meguid Arie Franx Benoit Jacod Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital Journal of Obstetrics and Gynaecology Severe maternal outcome maternal mortality maternal morbidity maternal near-miss low-income setting |
| title | Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital |
| title_full | Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital |
| title_fullStr | Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital |
| title_full_unstemmed | Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital |
| title_short | Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital |
| title_sort | too busy to care analysing the impact of system related factors on maternal mortality in zanzibar s referral hospital |
| topic | Severe maternal outcome maternal mortality maternal morbidity maternal near-miss low-income setting |
| url | https://www.tandfonline.com/doi/10.1080/01443615.2022.2113769 |
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