Maternal mortality and quality of maternity care: implications for Pakistan
Choudhry, M.Tauqeer Mustafa (2005) Maternal mortality and quality of maternity care: implications for Pakistan. Masters thesis, Karolinska Institutet, Sweden.
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This study is a literature review, to look at the relationship between quality of maternity care and maternal mortality. The aim of the study was to find out different aspects, perspectives and necessities of a quality maternity care department and then to analyze the interventions implemented in different countries to improve quality of maternity care. Finally how has this improvement in quality affected maternal mortality, and which of these interventions could prove to be effective in Pakistan. The main sources of information were online journals, through Pub Med and Medline. Additionally, WHO publications, books from KI library and some websites were also consulted. Quality of maternity care was found to be defined and assessed in three different aspects: structure, process and outcome. Then subcomponents of these three major aspects like physical structure, facilities, equipment, organizational form, Administrative structure, staff structure/qualifications, diagnosis, treatment, surgery, consultation/referral, coordination & continuity, health outcomes, mortality, complications, satisfaction etc. were found and finally necessities under each subcomponent were explored in detail. Then a number of studies carried out in different countries were analyzed for the strategies and interventions used to improve the quality of maternal care. Criterion-based clinical audit, quality of care, performance and quality improvement tool, facility based maternal death review, better management, multi-strategy approach, confidential enquiries into maternal deaths and near-miss case review were the approaches used in these studies for quality improvement. Then evidence was sought for a relationship between improved quality care and maternal mortality. As measurement of MMR is fraught to problems and underestimates, some process indicators like services utilization, met-needs, providers behavior etc. were used alternatively. It was evident from the results that improvement in quality of maternity care happened to decrease maternal mortality in all of the cases reviewed. It occurred either directly by the provision of better services to the complications brought to the facility, or by changing community behavior towards seeking maternity care , when required. Improvement of quality at maternity care services is an effective strategy to reduce maternal mortality in all types of setting. Furthermore, criterion-based clinical audit was proposed to improve the quality of maternal health services in Pakistan. However a pilot study is needed to assess the feasibility of tool in Pakistani context.
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