Increase days between maternal death at Dessie Comprehensive Specialized Hospital, Amhara region, Ethiopia

Maternal mortality is an area of particular concern in public health, especially in Africa, maternal deaths are the highest in the world. Globally, 287 000 women died during and following pregnancy and childbirth, almost 95% of all maternal deaths occurred in low and lower middle-income countries. Ethiopia is one of the countries struggling to reduce high maternal mortality from 412 deaths per 100 000 live births to 70 deaths per 100 000 live births. Ethiopia has implemented various initiatives to handle delays related to maternal death and availing free transport and maternity service. Despite all this effort, however, the number of maternal deaths remains unacceptably high. However, none of the quality improvement (QI) projects tested and implemented to reduce maternal mortality at facility level. In response to this gap, this QI project is aimed at increasing days between maternal death at Dessie Comprehensive Specialized Hospital, Amhara region, Ethiopia.

Model for Improvement method was applied. As a baseline, we collected 1 year maternal mortality data, 6 months of chart review to assess the quality of care and 1 year's data collected during implementation.

The T-chart shows the average days between maternal deaths at Dessie Comprehensive Specialized Hospital increased from 14 days to 39 days. When we compared the absolute numbers, there were 21 maternal deaths within 1 year after implementing the interventions, which was only nine maternal deaths compared with the same period in the previous year. When we calculated the maternal mortality ratio, we reduced it from 327 per 100 000 live births to 162 per 100 000 live births.

The project involved three successful interventions: conducting consultations within 20 min, using the E-MOTIVE bundle checklist and implementing the pre-eclampsia/eclampsia bundle checklist. Additionally, through our Plan-Do-Study-Act cycles, we learnt that a short consultation process, having one intensive care unit bed ready for mothers, ensuring the availability of essential medicines like tranexamic acid, using bundles, maintaining strong communication, engaging senior management in QI activities and holding frequent meetings of the QI committee were all helpful in improving our QI project.