Quality and Effect of Maternal Death Reviews on Annual Trends of Maternal Mortality Ratio at a Tertiary Referral Hospital in Western Kenya

Introduction: The Global maternal mortality ratio remains high despite various strategies to lower it. More than two-thirds of global maternal deaths occur in Sub-Saharan Africa. Kenya’s maternal mortality ratio estimate is 355 deaths per 100,000 live births. To achieve below 70 deaths per 100,000 live births by 2030, Kenya’s Ministry of Health recommended the use of maternal death reviews as a mortality reduction strategy. The quality of MDR is an area of concern as to whether it achieves its desired goal. We sought to assess the quality and effect of maternal death reviews on annual trends of maternal mortality ratio at a tertiary hospital in Western Kenya between 2019 and 2023. Methods: A five-year retrospective chart review of 111 maternal death review forms was done, with variables being completeness of the forms, timeliness of review, and notification of maternal deaths. Statistical analyses were done using R version 4.4.1. To assess for quality, variables were dichotomised into either a yes or a no. Completeness sought to review if all sections of the review form were filled, while timeliness aimed to establish if a death was either notified within 24hours or not, and also reviewed by at least 40 percent of the relevant committee. Results: Median (Interquartile range) age of the parturients who had maternal death was 26 (22,33) with gestational age median of 33(30,37) weeks. Only 7% of the forms were complete, with 57.6% notified and 16.2% reviewed within seven days as per Ministry of Health guidelines. Across the five years, the average quality score was 1.89 (47.3%) with no effect on either decline or increase of maternal mortality ratio (P=0.482). Conclusion: The Quality of Maternal death reviews didn’t meet the set standards. As a result, no impact was observed on the maternal mortality trends as a result of the reviews over the period of evaluation. Recommendation: We recommend electronic notification of all maternal deaths and filling of all the forms, as this will ensure compliance with timeliness and completeness of filling of maternal death review forms.