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Using criteria-based audit to improve the management of postpartum haemorrhage in resource limited countries: A case study of Malawi

Kongnyuy, Eugene J., Mlava, G. and Van Den Broek, Nynke ORCID: (2009) 'Using criteria-based audit to improve the management of postpartum haemorrhage in resource limited countries: A case study of Malawi'. Maternal and Child Health Journal, Vol 13, Issue 6, pp. 873-878.

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Objective: The goal of this study was to assess and improve the management of postpartum haemorrhage (PPH) in maternity units in Malawi. The main objective was to determine whether criteria-based audit can improve adherence to standards for the management of PPH. Methods: We used a before-and-after design and univariate statistics for data analysis. A retrospective review of 40 consecutive cases of PPH was conducted in eight hospitals and the results compared with standards for PPH, established based on World Health Organisation manuals. Results of the audit were presented to healthcare providers who made and implemented recommendations for improvement. A re-audit (45 cases) was conducted 3 months later. Results: There was a significant improvement in adherence to three standards: typing and cross-match carried out (65.0% vs. 84.4%; P = 0.034), patient's hematocrit or haemoglobin established (67.5% vs. 86.7%; P = 0.029), and fluid intake/output chart maintained (0.0% vs 33.3%; P < 0.001). There was no significant change in close monitoring of vital signs (32.5% vs. 53.3%, P = 0.065) and case fatality rate (10.0% vs. 6.7%, P = 0.702), intravenous access achieved and intravenous fluids administered (100.0% vs. 97.8%; P = 0.735), and oxytocic drugs administered (100.0% vs. 95.6%; P = 0.357). Conclusion: Introduction of criteria-based audit can improve the management of postpartum haemorrhage in countries with limited resources. Future studies should consider using larger sample size to evaluate the effect of criteria-based audit on mortality. © Springer Science+Business Media, LLC 2008.

Item Type: Article
Additional Information: Export Date: 24 November 2009 Source: Scopus doi: 10.1007/s10995-008-0408-3 Language of Original Document: English Correspondence Address: Kongnyuy, E.J.; Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; email:
Uncontrolled Keywords: Criteria-based audit Malawi Obstetric emergency complication Postpartum haemorrhage Standards
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WQ Obstetrics > WQ 100 General works
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > Pregnancy > WQ 200 General works
WQ Obstetrics > WQ 20 Research (General)
WQ Obstetrics > Labor > WQ 330 Complications of labor
WQ Obstetrics > Labor > WQ 300 General works
WA Public Health > Health Administration and Organization > WA 525 General works
WQ Obstetrics > Obstetric Surgical Procedures > WQ 400 General works
Faculty: Department: Groups (2002 - 2012) > Child & Reproductive Health Group
Digital Object Identifer (DOI):
Depositing User: Users 19 not found.
Date Deposited: 27 May 2010 13:00
Last Modified: 17 Jul 2020 10:58


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