Contribution of Indirect Causes to Maternal Mortalities Based on a Methodological Approach to Clinical Epidemiology in Iran

Authors

1 Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran

2 Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran

4 Social Security Organization of Shahrekord, Imam Ali (peace be upon him) Hospital, Shahrekord, Iran

Abstract

Introduction: Level of mothers’ literacy, pregnancy history of more than four times, residence in villages, lack of receiving intensive care during pregnancy, as well as inaccessibility to obstetric emergency services have been reported, in Iran and the world, as major factors for maternal mortality. Considering significance of identifying indirect causes of maternal mortalities, the present study was aimed to determine the contribution of indirect causes to maternal mortalities in Markazi province, Iran.
Methods: This retrospective, descriptive-analytical study analyzes root causes and sentinel events through describing a case of maternal mortality reported in Markazi province. The data were gathered through interviews and documents’ investigation, and Bayesian analysis and calculation of conditional probability in Netica 5.08 software were used.
Results: Findings on a 36-year-old mother, in the 37th week of her third pregnancy and suffering from cardiomyopathy, indicated that lack of receiving prenatal care on time, insensitivity of health and medical personnel to pursuing the patient’s timely referrings according to Ministry of Health and Medical Education guidelines, lack of coordination and monitoring on the part of team of specialists responsible for the pregnant mother’s treatment in hospital, and indifference toward appropriate management of treatment were determined as indirect causes of the mother’s death.
Conclusion: While cardiomyopathy was registered as direct cause of death, according to root cause analysis indirect causes had a 43% contribution to the mother’s death. Thus, planning for determination of major causes and eliminating indirect causes are very important for reducing maternal mortalities.

Keywords

References

1. Moazzeni MS. Maternal Mortality in the Islamic Republic of Iran: On Track and in Transition. Maternal and child health journal. 2013:1-4.
2. Organization. WH. World Health Statistics 2010 and 2013. WHO Press, 2013.
3. Zolala F, Haghdoost AA. A gap between policy and practice: A case study on maternal mortality reports, Kerman, Iran. International journal of preventive medicine. 2011;2(2):88.
4. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The Lancet. 2010;375(9726):1609-23.
5. Pathmanathan I LJ, Martins J M, Rajapaksa L C, Lissner C, de Silva A, et al. Investing in maternal health: Learning from Malaysia and Sri Lanka. Washington, DC. Health, Nutrition and Popula-tion Series. 2013:112.
6. Abbasi MJ, Mehryar A, Jones G, McDonald P. Revolution, war and modernization: Population policy and fertility change in Iran. Journal of Population Research. 2002;19(1):25-46.
7. Aghajanian A MA. The Pace of Fertility Decline in Iran: Finding from the De-mographic and Health Survey. J Comp Fam Stud. 2007;38(2):55.
8. Yavangi M, Sohrabi M-R, Alishahi Tabriz A. Effect of Iranian Ministry of Health Protocols on Cesarean Section Rate: A Quasi-Experimental Study. Journal of Research in Health Sciences. 2013;13(1).
9. Daneshbod K BG, Sajadi H, Hamidzadeh MM. Survey of maternal deaths in South Iran: analysis of 96 autopsies. J Obstet Gynaecol Br Commonwealth. 1990;77.
10. GHolami-Taramsari M. Ten-Years Evaluation of Maternal Mortalities in Kohgiluyeh and Boyerahmad Province. Knowledge & Health Journal. 2008;3(2):33-7.
11. Khajeian A AA, Ghaed Hamoudy Z. Factors associated with maternal mortality in the province from 2000 to 2007 years. Matern Infant Health Period. 11. 2009;18.
12. Azemikhah A AM, Jalilvand P, Emami Afshar N, Radpooyan L, Changizi N. National Maternal Surveillance System in Iran. Iran J Pub-lic Health. Iran J Public Health. 2009;38(1).
13. Abdolahpour P BM, Gasemi YM. Causes of Maternal Mortality in Pregnant Women in Urban and Rural Areas of Ilam, Iran. J Health Res Syst. 2011;7(6):1278.
14. Zolala F, Heidari F, Afshar N, Haghdoost AA. Exploring maternal mortality in relation to socioeconomic factors in Iran. Singapore medical journal. 2012;53(10):684.
15. Tajik P, Nedjat S, Afshar NE, Changizi N, Yazdizadeh B, Azemikhah A, et al. Inequality in maternal mortality in Iran: an ecologic study. International journal of preventive medicine. 2012;3(2):116.
16. Mahto D, Kumar A. Application of root cause analysis in improvement of product quality and productivity. Journal of Industrial Engineering and Management. 2008;1(2):16-53.
17. Smetzer J, Baker C, Byrne FD, Cohen MR. Shaping systems for better behavioral choices: lessons learned from a fatal medication error. Joint Commission Journal on Quality and Patient Safety. 2010;36(4):152.
18. Giardina TD, King BJ, Ignaczak AP, Paull DE, Hoeksema L, Mills PD, et al. Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients. Health Affairs. 2013;32(8):1368-75.
19. Dolansky MA, Druschel K, Helba M, Courtney K. Nursing Student Medication Errors: A Case Study Using Root Cause Analysis. Journal of Professional Nursing. 2013;29(2):102-8.
20. Bowie P, Skinner J, de Wet C. Training health care professionals in root cause analysis: a cross-sectional study of post-training experiences, benefits and attitudes. BMC health services research. 2013;13(1):50.
International Journal of Travel Medicine and Global Health
Volume 1, Issue 3 - Serial Number 3
November 2013
Pages 125-131

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History

  • Receive Date: 25 September 2013
  • Accept Date: 25 September 2013

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