[Maternal mortality audits in low-resource countries: analysis of 23 hospitals in Senegal and Mali (the QUARITE study)]

In 1990, the Society of Obstetricians and Gynaecologists of Canada joined the international movement for safe motherhood by adapting its ALARM programme to the needs of low-resource countries. The goal of the QUARITE (QUAlité des soins, gestion du RIsque et TEchniques obstétricales) trial is to evaluate the efficiency of the ALARM International programme in terms of maternal mortality reduction in 46 referral hospitals in Senegal and Mali.

Evaluate the implementation of maternal death audits in the 23 hospitals that are part of the QUARITE trial's intervention group.

Ten follow-up indicators have been identified to evaluate the implementation of maternal death audits. This article describes and analyzes these follow-up indicators during a 5-month implementation period, from September 23, 2008, to January 30, 2009. Data was gathered during a supervision visit at the end of that period with a standardized follow-up questionnaire and checklist. Key participants were interviewed. The programme's documents (procedure manual, meeting and supervision minutes, and logbook) were analyzed. An implementation score (on a scale from 1 to 10) was calculated for each centre.

The 23 centres we visited yielded a mean implementation score of 7.5 (minimum=4 and maximum=10). In each health structure, there is a multidisciplinary, functional subcommittee-maternal death audit committee whose members have been trained on the subject of maternal death audits. Overall, these subcommittees use the management tools but some of the forms are not well understood: thus, we must pinpoint the causes of this problem and eliminate them. Maternal death audit sessions had a slow start due to several factors: maternity personnel's workload, lack of confidence of local leaders, lack of cohesion within teams and lack of personnel availability.

Data analysis indicates that the process of implementing maternal death audits is slow but real and that quarterly supervision makes it possible to eliminate difficulties and to reinforce the skills of audit subcommittee members.