Identifying and addressing the factors that impact maternal and perinatal deaths using facility-based death audit review system and integrating community engagement: A Mixed-Methods Study

Identifying and addressing the factors that impact maternal and perinatal deaths using facility-based death audit review system and integrating community engagement: A Mixed-Methods Study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 20 May 2025 V1 Latest version Share on Identifying and addressing the factors that impact maternal and perinatal deaths using facility-based death audit review system and integrating community engagement: A Mixed-Methods Study Authors : Zahid Memon , Wardah Ahmed , Shah Muhammad , Sajid Soofi , Shanti Chouhan , Arjumand Rizvi , Paul Barach , and Zulfiqar Bhutta 0000-0003-0637-599X [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174772823.35641347/v1 220 views 116 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: To identify and address factors impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement for implementing doable solutions. Design: Mixed methods approach Setting: District Matiari, Sindh, Pakistan. Population : Cases of maternal deaths, neonatal deaths and stillbirth Methods: Facility-based death audit review system integrated with community engagement based on WHO guidelines, established in three secondary level care health facilities. The ”Four Delays Model” was applied to identify and address factors contributing to maternal and perinatal deaths. Main outcome measures: Factors contributing to delays in maternal and newborn care; implemented doable solutions addressing these delays. Results: Using the “Four Delays Model” key factors identified were i) Lack of education and awareness (Delay 1-2), ii) Inadequate transport mechanism (Delay 3), iii) Multiple referrals (overlapping Delay 3-4), and iv) Limited facility operational hours and delayed medical care (Delay 4). Local audit committee recommended and implemented doable solutions including community awareness sessions engaging both men and women, ambulance services, improved referral systems, and facility-level administrative measures such as providing antenatal cards, maintaining DHIS records, and enhancing inter-facilities communications. Conclusion: Local community engagement influenced the willingness of policymakers to implement actionable solutions. Health systems need to improve women’s access and availability of healthcare facilities during and after pregnancy. Scaling up audit review systems with feedback loops is recommended for future reduction in mortality rates in resource constrained settings particularly where comprehensive national-level mortality data is lacking. Supplementary Material File (manuscript_main document_revised.docx) Download 102.47 KB Information & Authors Information Version history V1 Version 1 20 May 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords audit: regional basic science epidemiology: perinatal health services research maternal mortality maternity services paediatrics: neonatal Authors Affiliations Zahid Memon The Aga Khan University Department of Community Health Sciences View all articles by this author Wardah Ahmed The Aga Khan University Department of Community Health Sciences View all articles by this author Shah Muhammad The Aga Khan University Department of Paediatrics and Child Health View all articles by this author Sajid Soofi The Aga Khan University Department of Paediatrics and Child Health View all articles by this author Shanti Chouhan The Aga Khan University Department of Paediatrics and Child Health View all articles by this author Arjumand Rizvi The Aga Khan University Department of Paediatrics and Child Health View all articles by this author Paul Barach Sigmund Freud PrivatUniversitat Wien View all articles by this author Zulfiqar Bhutta 0000-0003-0637-599X [email protected] The Aga Khan University Department of Paediatrics and Child Health View all articles by this author Metrics & Citations Metrics Article Usage 220 views 116 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Zahid Memon, Wardah Ahmed, Shah Muhammad, et al. Identifying and addressing the factors that impact maternal and perinatal deaths using facility-based death audit review system and integrating community engagement: A Mixed-Methods Study. Authorea . 20 May 2025. DOI: https://doi.org/10.22541/au.174772823.35641347/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.174772823.35641347/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ffa70a198b241e2',t:'MTc3OTQzODQyOA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();