Retrospective review of maternal deaths in Hawassa Comprehensive Specialised Hospital, in Southern Ethiopia

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Study Justification:
– The study aimed to evaluate the causes and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH) in Southern Ethiopia.
– Maternal deaths are preventable, yet maternal mortality rates remain high in the region.
– There was a lack of adequate information about the maternal death rate in the study setting.
Study Highlights:
– A total of 77 maternal deaths out of 82 reviewed met the inclusion criteria.
– The overall facility-based maternal mortality rate (MMR) at HRCSH was 910 deaths per 100,000 live births.
– The majority of maternal deaths (89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading cause.
– Eight avoidable factors were identified, with patient-oriented and transport/referral factors being the most common.
Study Recommendations:
– Provide prenatal patients with information about danger signs to aid in early detection of health problems and encourage seeking healthcare.
– Improve management initiation after admission to reduce delays in providing necessary care.
– Address transport and referral factors to improve access to timely healthcare services.
– Enhance practical skills for managing pregnancy-related complications like hypertension.
– Promote intersectoral collaboration to address transportation issues.
Key Role Players:
– Healthcare providers and staff at HRCSH
– Maternal health experts and specialists
– Policy makers and government officials
– Community leaders and advocates for maternal health
Cost Items for Planning Recommendations:
– Training programs for healthcare providers on managing pregnancy-related complications
– Development and implementation of educational materials for prenatal patients
– Improvement of transportation infrastructure and services
– Intersectoral collaboration initiatives
– Monitoring and evaluation systems to track progress and outcomes
Please note that the cost items provided are general categories and not actual cost estimates. The specific costs will depend on the context and resources available in the study setting.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides specific data on maternal deaths at Hawassa Comprehensive Specialised Hospital and identifies avoidable factors contributing to the deaths. However, the study is limited to a single health facility and a relatively short time period. To improve the strength of the evidence, future research could include a larger sample size and a longer study duration to provide a more comprehensive understanding of maternal deaths in the region. Additionally, conducting a multi-center study would increase the generalizability of the findings.

The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility–based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact StatementWhat is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting. What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths. What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems.

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Based on the retrospective review of maternal deaths at Hawassa Comprehensive Specialised Hospital in Southern Ethiopia, the following innovations can be developed to improve access to maternal health:

1. Patient education innovation: Develop a mobile application or interactive website that provides prenatal patients with information about danger signs during pregnancy. This innovation can include interactive quizzes, videos, and educational materials to help pregnant women detect health problems early and seek appropriate healthcare.

2. Transport and referral systems innovation: Implement a mobile-based transportation booking system specifically for pregnant women. This innovation can allow pregnant women to easily book transportation options, such as ambulances or designated vehicles, to access healthcare facilities. Additionally, establish a digital referral system that enables healthcare providers to quickly and efficiently refer high-risk pregnancies to specialized care centers.

3. Healthcare facility management innovation: Develop a digital triage and admission system that reduces delays in initiating management after admission. This innovation can include electronic patient records, automated alerts for healthcare providers, and real-time monitoring of patient flow. Additionally, provide online training modules for healthcare providers to enhance their knowledge and skills in managing pregnancy-related complications.

4. Intersectoral collaboration innovation: Establish a collaborative platform that brings together the healthcare sector, transportation sector, and infrastructure sector to address transportation challenges faced by pregnant women. This innovation can facilitate discussions, resource sharing, and joint initiatives to develop sustainable solutions for improving access to maternal healthcare services.

By implementing these innovations, it is expected that access to maternal health services will be improved, leading to a reduction in maternal mortality rates and better overall maternal health outcomes.
AI Innovations Description
Based on the retrospective review of maternal deaths at Hawassa Comprehensive Specialised Hospital in Southern Ethiopia, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Improve patient education: Provide prenatal patients with information about danger signs during pregnancy that could help them detect health problems early and seek appropriate healthcare. This can be done through educational materials, counseling sessions, and community outreach programs.

2. Strengthen transport and referral systems: Address the transportation challenges faced by pregnant women in accessing healthcare facilities. This can be achieved by improving the availability and reliability of transportation options, such as ambulances or designated vehicles for pregnant women. Additionally, establish effective referral systems to ensure timely and appropriate care for high-risk pregnancies.

3. Enhance healthcare facility management: Implement strategies to reduce delays in initiating management after admission. This may involve improving the efficiency of triage and admission processes, ensuring adequate staffing levels, and providing training to healthcare providers on prompt and effective management of pregnancy-related complications.

4. Foster intersectoral collaboration: Recognize that solving transportation problems requires collaboration between the healthcare sector and other relevant sectors, such as transportation and infrastructure. Work together to develop sustainable solutions that address the specific needs of pregnant women in accessing maternal healthcare services.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to a reduction in maternal mortality rates and better overall maternal health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline Data Collection: Gather data on the current state of access to maternal health services in the study area, including information on maternal mortality rates, transportation challenges, healthcare facility management, and patient education levels.

2. Intervention Implementation: Implement the recommended interventions in a targeted manner. This could involve providing patient education materials, conducting counseling sessions, organizing community outreach programs, improving transportation options, establishing referral systems, and enhancing healthcare facility management.

3. Data Monitoring: Continuously collect data on key indicators related to access to maternal health services, such as maternal mortality rates, transportation utilization, healthcare facility wait times, patient knowledge about danger signs, and healthcare provider adherence to management protocols.

4. Comparative Analysis: Compare the data collected after the implementation of the interventions to the baseline data. Analyze the changes in the key indicators to assess the impact of the interventions on improving access to maternal health services.

5. Stakeholder Feedback: Gather feedback from stakeholders, including pregnant women, healthcare providers, transportation providers, and community members, to understand their perceptions of the interventions and identify any additional areas for improvement.

6. Iterative Refinement: Based on the findings from the comparative analysis and stakeholder feedback, refine and adjust the interventions as necessary to further improve access to maternal health services.

7. Evaluation and Reporting: Summarize the findings of the simulation, including the impact of the interventions on access to maternal health services, any challenges encountered, and lessons learned. This information can be used to inform future interventions and policies aimed at improving maternal health outcomes.

By following this methodology, researchers and policymakers can gain insights into the potential impact of the recommended interventions on improving access to maternal health services and make informed decisions about their implementation.

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