Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed.Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed.Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.The persistently high maternal mortality ratio (MMR) of 572/100,000 live births in Dar es Salaam [1] together with a hospital based MMR of 1602/100,000 live births in 2004 and a perinatal mortality rate (PNMR) of 123/1000 births from 1999 to 2003 at Muhimbili National Hospital have been noted with great concern [2,3]. From the Safe Motherhood Initiative perspectives, one of the simplest and cost effective strategic interventions to reduce maternal and perinatal deaths is to improve the quality of care in the existing health institutions [4]. This has been achieved thr