Perinatal audit using the 3-delays model in western Tanzania

published online 13 May 2009.

Abstract

Objective

To audit intrapartum fetal and early neonatal deaths of infants weighing ≥2000 g in a regional hospital in western Tanzania.

Methods

The 3-delays methodology was applied to a cohort of perinatal deaths from July 2002 to July 2004.

Results

The overall perinatal mortality rate in the hospital was 38 per 1000 live births, and in just over half of these cases the birth weight was ≥2000 g. The leading clinicopathologic causes of death were birth asphyxia (19.0%), prolonged or obstructed labor (18.5%), antepartum hemorrhage (11.5%), and uterine rupture (9.0%). First delays occurred in 19.0% of the cases, second delays occurred in 21.5%, and third delays occurred in 72.5%.

Conclusion

For women who delivered in this hospital, most of the substandard care occurred after admission to the health facility. The improvement of institutional health care may have a significant impact on the decision to attend health institutions and, thereby, reduce first delays.

Keywords: Perinatal audit, Substandard care, Tanzania, 3-delays model

a Department of Obstetrics and Gynaecology, Regional Hospital, Maweni, Kigoma, Tanzania

b Division of International Health (IHCAR), Karolinska Institute, Stockholm, Sweden

c Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands

d Section of Health Care and Culture, VU University Medical Centre, Amsterdam, The Netherlands

e Mailman School of Public health, AMDD program, Columbia University, New York, USA

Corresponding author. Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. Tel.: +31 71 5262872; fax: +31 71 5266741.

PII: S0020-7292(09)00237-9

doi:10.1016/j.ijgo.2009.04.008

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