{
    "abstract": "We sought to determine the causes and characteristics maternal deaths that occur in health facilities in Malawi.\nForty-three maternal deaths were reviewed in 9 hospitals in 3 districts in Central Malawi over a 1-year period. Causes and avoidable factors of maternal deaths were identified during the review, and recommendations made and implemented.\nThere were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect obstetric deaths. The major causes of maternal deaths were postpartum hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were referred either from another health facility (51.2%) or by a traditional birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on admission. Four groups of factors that contributed to maternal deaths were identified: 1) health worker factors, 2) administrative factors, 3) patient/family factors, and 4) TBA factors. The major health worker factors were inadequate resuscitation (69.8%), lack of obstetric life-saving skills (60.5%), inadequate monitoring (55.8%), initial assessment incomplete (46.5%), and delay in starting treatment (46.5%). The most common administrative factor was lack of blood for transfusion (20.9%). The major problems encountered include shortage of staff and other resources, difficulty in maintaining anonymity, poor quality of data, and difficulty in implementing recommendations.\nAdequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles.",
    "authors": [
        {
            "affiliation": "Child and Reproductive Health Group, Liverpool School of Tropical Medicine, United Kingdom. kongnyuy@liverpool.ac.uk",
            "firstname": "Eugene J",
            "initials": "EJ",
            "lastname": "Kongnyuy"
        },
        {
            "affiliation": null,
            "firstname": "Grace",
            "initials": "G",
            "lastname": "Mlava"
        },
        {
            "affiliation": null,
            "firstname": "Nynke",
            "initials": "N",
            "lastname": "van den Broek"
        }
    ],
    "conclusions": "Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles.",
    "copyrights": null,
    "doi": "10.1016/j.whi.2008.09.008",
    "journal": "Women's health issues : official publication of the Jacobs Institute of Women's Health",
    "keywords": [],
    "methods": null,
    "publication_date": "2008-12-30",
    "pubmed_id": "19111783",
    "results": null,
    "title": "Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths.",
    "xml": "<Element 'PubmedArticle' at 0x7885053b7380>"
}