Evaluation of Maternal Death Audit Activities in Mulanje District in Malawi Open Access

Nepiyala, Nkhondo (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/fq977v269?locale=en
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Abstract

Abstract

Evaluation of Maternal Death Audit Activities in Mulanje District in Malawi

High maternal deaths(MD)is one of the poor health indicators prevalent in developing countries. The underlying causes of the MD are greatly associated with factors that are embedded in the communities and the health care delivery system. Studies have touted maternal death audits(MDA) to be one of the strategies to curb the needless loss of maternal life during perinatal period. However, much has not been done to examine the specifics on how health facilities establish and operationalize the MDA systems.

The study looks into how the prevailing contextual factors influence the conduct of facility based MDA in Mulanje district in Malawi. A total of fifteen (15) in-depth interviews were conducted with MDA committee members from both Mulanje District and Mulanje Mission hospitals.The study revealed the key issues affecting MDA, namely;no induction or orientation done to person appointed into the MDA committee, lack of comprehensive mechanism to disseminate MDA findings to various stakeholders, no monitoring and evaluation system to track progress made on MDA, and no incentives given to the MDA committee members.

Results indicate that, as narrated by study participants, instituting a robust MDA mechanism would ensure that the audits generate credible information that health systems would use to improve maternal health services in order to reduce the high MD. Future studies on MDA should therefore, include a component that examines the specifics on how MDA systems are established as well as conducted in the health facilities.

Table of Contents

Table of Contents

Acknowledgements.......................................................................................................................................................... iv

Abbreviations.................................................................................................................................................................. v

Abstract....................................................................................................................................................................... vii

Chapter 1: Introduction.................................................................................................................................................. 1

1.1 Problem Statement/Need.......................................................................................................................................1

1.2 Purpose Statement/Goal....................................................................................................................................... 3

1.3 Significance Statement.........................................................................................................................................4

1.4 Objectives and Aims of the Study........................................................................................................................... 5

1.5 Study Questions..................................................................................................................................................5

1.6 The Conceptual Framework................................................................................................................................... 6

Chapter 2: Literature Review.......................................................................................................................................... 7

2.1 Maternal Deaths(MD)............................................................................................................................................8

2.2 Maternal Death Audits(MDA)..................................................................................................................................13

2.3 General Impression of the Literature........................................................................................................................20

Chapter 3: Methods........................................................................................................................................................ 22

3.1 Ethical Considerations...........................................................................................................................................22

3.2 Research Context.................................................................................................................................................23

3.3 Study Design.......................................................................................................................................................26

3.4 Study Population..................................................................................................................................................27

3.5 Data Collection Methods........................................................................................................................................28

3.6 Data Collection Process.........................................................................................................................................29

3.7 Data Analysis.......................................................................................................................................................32

Chapter 4: Study Findings................................................................................................................................................ 40

4.1 Facilities do not induct MDA committee members when appointed to serve in the MDR committee.........................................40

4.2 MDA committee members are not given incentives for conducting MDA ctivities.................................................................41

4.3 Multi-disciplinary committee membership of the MDR.....................................................................................................42

4.4 There is no regular MDA committee at Mulanje mission hospital.......................................................................................43

4.5 MDA are condcuted on a regulary basis......................................................................................................................43

4.6 MDA committee administrative meetings have no schedule and are rarely conducted..........................................................44

4.7 Monitoring and evaluation mechanism for MDA are not in place.......................................................................................44

4.8 MDA findings are not comprehensively disseminated to various stakeholders......................................................................45

4.9 MDA activities in the district face common challenges...................................................................................................47

4.10 Use of national and facility guidelines.......................................................................................................................48

4.11 Summary of the findings........................................................................................................................................49

Chapter 5: Discussion....................................................................................................................................................... 50

Chapter 6: Study limitations.............................................................................................................................................. 54

6.1 Time factor........................................................................................................................................................... 54

6.2 Qualitative research methodology.............................................................................................................................. 54

6.3 Generalizability of the findings................................................................................................................................... 54

6.4 Mixed methods....................................................................................................................................................... 54

Chapter 7: Recommendations............................................................................................................................................. 55

Chapter 8: Conclusion........................................................................................................................................................ 56

Chapter 9: Appendices....................................................................................................................................................... 57

Appendix 1: Emory IRB approval letter.............................................................................................................................. 57

Appendix 2: NHSRC approval letter................................................................................................................................... 58

Appendix 3: Field supervisor letter of support..................................................................................................................... 59

Appendix 4: Mulanje District Health Office approval letter...................................................................................................... 61

Appendix 5: Code Book................................................................................................................................................... 62

Appendix 6: In-depth interview guide................................................................................................................................ 63

Appendix 7: Interviews included in the analysis................................................................................................................... 67

Chapter 10: References....................................................................................................................................................... 68

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