Delays In Maternal Morbidity And Maternal Mortality At Facility Level Tigray Regional State

Each year, more than 500,000 women world wide die from complications related child birth.rnWith good quality obstetric care, approximately 90 percent of these deaths could be averted.rnThe assistance of skilled birth attendants during labor, delivery and the immediate postrnpartum period is one important component of quality of obstetric care. How ever little isrnknown about the cause of what is known as ‘the third delay” the delay in receiving medicalrnattention after a woman arrives at a health care facility.rnThrough this paper two major things were examined. The objective of the study was to assessrnthe delays in maternal mortality and morbidity and to assess avoidability of maternal deaths.rnThe first were causes and circumstances of maternal deaths that have occurred in hospitals,rnthe second measured the patient delay and the hospital delay in case of emergency obstetricrncare. The studies were carried out between December 2005- may 2006 in Tigray, Ethiopia.rnThe maternal death audit as well the patient and hospital delay study were facility based. Thernmaternal death audit study assessed each death for the cause and circumstances of deaths,rnavoidable factors, by utilizing both review of patient and facility records and interviewingrnthose who were involved in the care of deceased woman.rnResults shows that 15 (44.1 %) were unavoidable maternal deaths and 12 (35.7%) werernpossibly avoidable maternal deaths, the leading causes of death were infection 16 (47. 1%)rnfollowed by haemorrhage 10 (29.4 %). The review also identified avoidable factors findingrnthat most of these factors related to hospital service or medical factors. Patient factors,rntransport factors were also noted. Among the hospital factors institutional delay like delay tornrefer for treatment, lack of blood, delay in transfusion, inappropriate institutional treatmentrnSamuel Hailu, The delays study virnand substandard care were also noted. The interval between the onset of signs and symptomsrnand arrival at the facility is measured and operationalized as patient delay and the intervalrnbetween arrival and initial evaluation is measured as hospital delay but no standards definernpatient delay and hospital delay. The median (range) for the patient and hospital delays isrn8(125) hrs and 0(6) hrs respectively. The qualities of medical records were very poor lackingrnmany key data items and time element was also a rare finding. Based on the findings it isrnrecommended implementing an initiative to improve medical record documentation at allrnhospitals. This would facilitate medical record review for quality purposes.rnIt is also recommended a quality improvement approach to strengthen the triage system thatrnis already in place. Maternal death audit as a system need to be institutionalized. Educationalrncampaigns are necessary to raise awareness of the community on danger signs of pregnancyrnso as to avoid patient delay and in-service training for care providers to avoid hospital delayrnand mismanagement.rnSince no standards define "delays" it was found to be difficult to judge whether delaysrnoccurred or not and where the delays has occurred. As a result it is recommended thatrnEvidence based standard should be developed. Further study on the cause of what is known asrn‘the third delay” the delay in receiving medical attention after a woman arrives at a healthrncare facility through Patient flow analysis needs to be done

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