Abstract:
Background: Although clinical audit is an important instrument for quality care improvement, the concept has not
yet been adequately taken on board in rural settings in most resource limited countries where the problem of
maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated
District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions.
Methods: Methods are informed by the principles of operations research. An audit system was established, all
patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected
cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and
strategic action plans for improvement were developed and implemented.
Results: There were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making
institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care.
Patients, health workers and administration related substandard care factors were identified in 50% - 61% of
women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the
workforce for health care, referral system improvement and upgrading of health centres located in hard to reach
areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result
of audit.
Conclusions: Our findings indicate that audit can be implemented in rural resource limited settings and suggest
that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are
limited if strategic interventions are implemented.
