Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA
Obstetrics and Gynecology, Michigan State Universtiy, Lansing, Michigan, USA.
BMJ Open Qual. 2023 Apr;12(2). doi: 10.1136/bmjoq-2022-002147.
While the medical contributors to maternal mortality are well known, the contextual contributors are less known and understudied. Liberia has one of the highest maternal mortality rates in sub-Saharan Africa, with recent increases in maternal deaths in rural Bong County. The purpose of this study was to better classify the contextual factors leading up to maternal deaths and to develop a list of recommendations to prevent future similar deaths.
A retrospective mixed method study was conducted examining 35 maternal deaths in Bong County, Liberia using verbal autopsy reports from 2019. An interdisciplinary death audit team reviewed and analysed the maternal deaths to determine the contextual causes of the maternal death.
This study identified three contextual causes: limited resources (materials, transportation, facility, staff), inadequate skills and knowledge (staff, community, family, patient), and ineffective communication (between providers, between health facilities and hospitals, and between provider and patient/family). Of these, inadequate patient education (54.28%), inadequate staff education and training (51.42%), ineffective communication between health facilities and hospitals (31.42%), and inadequate materials (28.57%) were most frequently mentioned.
Maternal mortality remains an issue in Bong County, Liberia, due to addressable contextual causes. Interventions to ameliorate these preventable deaths include ensuring availability of resources and transportation through improved supply chain and health system accountability. Recurring training should be provided to healthcare workers which involves husbands, families and communities. Innovative means for providers and facilities to communicate clearly and consistently should also be prioritised to prevent future maternal deaths in Bong County, Liberia.
尽管导致孕产妇死亡的医学因素广为人知，但导致孕产妇死亡的背景因素却鲜为人知，也尚未得到充分研究。利比里亚是撒哈拉以南非洲孕产妇死亡率最高的国家之一，最近邦县农村地区的孕产妇死亡人数有所增加。本研究旨在更好地分类导致孕产妇死亡的背景因素，并制定一系列建议，以防止未来发生类似的死亡事件。
本研究采用回顾性混合方法，使用 2019 年的口头尸检报告，对利比里亚邦县的 35 例孕产妇死亡病例进行了研究。一个跨学科的死亡审计小组对孕产妇死亡进行了审查和分析，以确定孕产妇死亡的背景原因。
本研究确定了三个背景原因：资源有限（物资、交通、设施、人员）、技能和知识不足（人员、社区、家庭、患者）以及沟通不畅（提供者之间、医疗机构和医院之间以及提供者和患者/家庭之间）。其中，患者教育不足（54.28%）、员工教育和培训不足（51.42%）、医疗机构和医院之间沟通不畅（31.42%）以及物资不足（28.57%）是最常被提及的原因。
由于可解决的背景原因，孕产妇死亡仍然是利比里亚邦县的一个问题。为了缓解这些可预防的死亡，干预措施包括通过改善供应链和卫生系统问责制，确保资源和交通的可用性。应向医疗保健工作者提供经常性培训，包括丈夫、家庭和社区。还应优先考虑提供者和医疗机构之间进行清晰、一致沟通的创新手段，以防止利比里亚邦县未来发生孕产妇死亡。
