Assessment of the implementation of maternal death audits in Arua district, Uganda
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Background: Maternal death audits (MDA) have existed in Uganda since 2000 but data on their performance is limited. This study assessed knowledge, attitudes and practices; structure, processes, enhancers, and barriers towards MDA systems in Arua district Uganda from 2007 to 2012. Methodology: A cross-sectional descriptive study was conducted in 26 health facilities in Arua district in 2013. Eleven Key Informant interviews were conducted with key health leaders and audit committee members. Semi-structured questionnaires administered to 145 health workers and records reviewed from two hospitals. Results: About half (52.4%, 71/115) of the respondents were knowledgeable about maternal audits and gave relevant reasons for its establishment. Nearly three quarters (77.2%) did not remember the main objective of the audits. A third (33.8%) reported fear of being audited and two thirds (66.9%) reported having positive attitudes. Only 15.9% of respondents were involved in maternal audits, of whom 82.6% reported this as a learning experience while 17.4% viewed this as intimidating. Of the 26 facilities assessed, MDAs existed in only in Arua and Kuluva hospitals. However, the structures and processes varied from the policy guidelines. Enhancers included demand by various authorities for audits, use of MDAs as a performance tool, allowances and refreshments, plus desire to learn. Key barriers were understaffing, work overload, negative staff attitudes, lack of resources and community hostility. Conclusions & Recommendations: Apart from attitude, knowledge and practice about maternal audits in Arua district remains very low and the structure and process are not consistent with the policy guidelines. Maternal death audits should therefore be expanded gradually to all facilities while involving all stakeholders.