Easier said than done!: methodological challenges with conducting maternal death review research in Malawi

This paper critically reflects on a facility-based maternal death review study in Lilongwe, Malawi, using the five step mortality surveillance cycle framework that was used for the study, and highlights methodological challenges experienced.BackgroundMaternal death audits are used to widely to identify contributing factors resulting in a maternal death.  Maternal death reviews are institutionalised in Malawi at the district level.MethodsThe five-step maternal mortality surveillance cycle was used as a research framework, with steps including: identifying cases, data collection, data analysis, recommendations and evaluation.  Data collection involved review of charts and facility- and community-based interviews.Key Findings:

• Majority of challenges identified related to the identification of cases, data collection and the analysis.
• Gaps in identifying and reporting on maternal deaths may have happened in units/wards other than the maternity unit, potentially leading to under-reporting.
• Data was also found to be as being poorly maintained, missing or incomplete in many cases, as there was no system in place for health information collection and storage in cases of maternal mortality. Whilst language barriers and cultural norms were thought to have potentially influenced data from the communities, busy schedules and fear of blame were some of the issues faced at the facility level.
• Decisions around assigning cause of death and classifying deaths according to the International Classification of Diseases – 10, in the absence of reliable clinical or laboratory data to supplement diagnostic procedures led to differences in judgement between reviewers and clinicians.

Key recommendations for each of the five-step surveillance cycle, and methods to overcome limitations or challenges in MDR research were shared.To read the article for free, click here. No subscription required.Thorsen, V.C., Sundby, J., Meguid, T., & Malata, A. (2014). Easier said than done!: methodological challenges with conducting maternal death review research in Malawi. BMC Medical Research Methodology, 14 (29), 1-15.