Education, audit, and outreach to prevent maternal mortality

摘要

Although progress has been made in reducing global maternal mortality, an estimated 287 000 women still died in 2010. Maternal mortality disproportionately affects families living in low-income and middle-income countries, and most of these deaths are preventable. Effective and cheap interventions exist to prevent death from the major causes, including haemorrhage, hypertensive disease, sepsis, and septic abortion. What is lacking is evidence on implementation in view of local contexts, resource constraints, and cultural norms. For many years, WHO has championed multidisciplinary maternal mortality audit as essential for reducing deaths. For audit to achieve change, there must be willingness to identify problems, with leadership capable and motivated to institute changes. Audit involves far more than just counting deaths. Perhaps not surprisingly given the complexity of multidisciplinary audit, to date evidence from randomised trials that show a reduction in maternal deaths has been poor.