A district-based audit of the causes and circumstances of maternal deaths in South Kalimantan, Indonesia

Supratikto, Gunawan; Wirth, Meg E.; Achadi, Endang; Cohen, Surekha; Ronsmans, Carine
March 2002
Bulletin of the World Health Organization;2002, Vol. 80 Issue 3, p228
Academic Journal
A district-based audit of maternal and perinatal mortality began during 1994 in three provinces of South Kalimantan, Indonesia. Both medical and non-medical factors were documented and an effort was made to progress from merely assessing substandard care to recommending improvements in access to care and the quality of care. Extensive discussions of cases of maternal death were held during regular meetings with providers, policy-makers and community members. The sources of information included verbal autopsies with family members and medical records. Between 1995 and 1999 the audit reviewed 130 maternal deaths. The leading causes of death were haemorrhage (41%) and hypertensive diseases (32%). Delays in decision-making and poor quality of care in health facilities were seen as contributory factors in 77% and 60% of the deaths, respectively. Economic constraints were believed to have contributed to 37% of the deaths. The distance between a patient's home and a health provider or facility did not appear to have a significant influence, nor did transport problems. The audit led to changes in the quality of obstetric care in the district. Its success was particularly attributable to the process of accountability of both health providers and policy-makers and to improved working relationships between health providers at different levels and between providers and the community. With a view to the continuation and further expansion of the audit it may be necessary to reconsider the role of the provincial team, the need of health providers for confidentiality, the added benefit of facility-based audits, the need to incorporate scientific evidence into the review process, and the possible consideration of severe complications as well as deaths. It may also be necessary to recognize that village midwives are not solely responsible for maternal deaths.


Related Articles

  • MATERNAL MORTALITY--A WAY TO REDUCE DEATHS.  // Women's International Network News;Spring2002, Vol. 28 Issue 2, p55 

    Discusses ways to prevent maternal deaths in several countries. Causes of maternal death; Ratio of maternal mortality in Asia-Pacific countries; Responsibility of governments in preventing maternal deaths.

  • Use and Effects of Malaria Control Measures in Pregnancy in Lagos, Nigeria. Efunshile, Michael; Amoo, A. O. J.; Akintunde, Grace B.; Ojelekan, Oluwole D.; König, Wolfgang; König, Brigitte // Korean Journal of Parasitology;Dec2011, Vol. 49 Issue 4, p365 

    In Nigeria, malaria causes up to 11% of maternal mortality. Our main aim was to find out the most common mosquito control measures employed by the pregnant women in Lagos and their effects on malaria infection. The study was carried out over a period of 6 months during which trained interviewers...

  • Double blind, cluster randomised trial of low dose supplementation with vitamin A or β carotene on mortality related to pregnancy in Nepal. West Jr., Keith P.; Katz, Joanne // BMJ: British Medical Journal (International Edition);02/27/99, Vol. 318 Issue 7183, p570 

    Discusses a study which examined the effects of vitamin A or beta carotene supplements on maternal mortality in Nepal. Characteristics of mothers during their pregnancy by supplement group; Serum retinol and beta carotene concentrations in women during mid-pregnancy; Impact of supplementation on...

  • Editorial. Moodley, J. // Obstetrics & Gynaecology Forum;May2012, Vol. 22 Issue 2, p1 

    The author offers information on the South African National Committee on Confidential Enquiries into Maternal Deaths' (NCCEMD) publication regarding triennial Saving Mothers Reports (SMR). The author shows reports illustrating the increased number of deaths of mothers. The author mentions the...

  • Determinants of skilled attendance for delivery in Northwest Ethiopia: a community based nested case control study. Mengesha, Zelalem Birhanu; Biks, Gashaw Andargie; Ayele, Tadesse Awoke; Tessema, Gizachew Assefa; Koye, Digsu Negesse // BMC Public Health;2013, Vol. 13 Issue 1, p1 

    Background: The fifth Millennium Development Goal calls for a reduction of maternal mortality ratio by 75% between 1990 and 2015. A key indicator to measure this goal is the proportion of births attended by skilled health personnel. The maternal mortality ratio of Ethiopia is 676 deaths per...

  • Maternal Mortality - A Legal Case Study. Halwani, Tharwat Mohammed // Internet Journal of Health;2009, Vol. 9 Issue 2, p17 

    These study legal case discuss a case of Maternal Mortality presented for litigation demonstrating the obstacles and shortcomings of instruments of justices and social constitutions to guarantee patient rights and safety.

  • Cardiopulmonary resuscitation in late pregnancy. Oates, Sharon; Williams, G.L.; Rees, G.A.D. // BMJ: British Medical Journal (International Edition);8/6/88, Vol. 297 Issue 6645, p404 

    Focuses on the applicability of resuscitation techniques to care late pregnancies among women in Great Britain. Details of the case reported; Implications of cardiopulmonary arrest on the delivery of the mother; Distinction of the technique for maternal mortality reduction.

  • Pregnancy-related Mortality in Southern Nepal Between 2001 and 2006: Independent Estimates From a Prospective, Population-based Cohort and a Direct Sisterhood Survey. Wee, David W.; Mullany, Luke C.; Katz, Joanne; Khatry, Subarna K.; LeClerq, Steven C.; Tielsch, James M. // American Journal of Epidemiology;Oct2010, Vol. 172 Issue 7, p855 

    Demographic household surveys in Nepal between 1996 and 2006 indicate potentially large decreases in the pregnancy-related mortality ratio and raise hopes that Nepal may be on track to meet Millennium Development Goal 5. Between 2002 and 2006, 23,478 pregnant women in Sarlahi District, Nepal,...

  • Maternal mortality initiative to fight "invisible epidemic".  // Bulletin of the World Health Organization;Oct2004, Vol. 82 Issue 10, p810 

    Focuses on initiatives to combat maternal mortality during pregnancy and childhood birth in developing countries. Potency of training and education for mortality prevention; Financial planning; Assessment on maternal death rate trends.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics