Compliance to maternal care guidelines is high in patients with complications compared to patients without complications. The tip of an iceberg? A retrospective case-control study|
Utumatwishima, J. N.; Umukunzi, L. & Tayebwa, E.
BACKGROUND: Rwanda achieved Millennium Development Goal Five (MDG5) and continues to register improvements in
maternal health. Maternal death audit revealed that a great number of deaths were due to preventable causes in hospitals.
OBJECTIVE: To identify preventable causes of severe maternal outcomes linked to poor guideline utilization in hospitals.
METHODS: A retrospective case-control study was conducted. Data were collected for 196 controls (discharged without
complications) and 100 cases with severe maternal outcomes (dead or discharged after complications) between 2016 to
2018 at Ruhengeri Referral Hospital in Musanze, Northern Province, Rwanda. Medical case files were reviewed, and
outcomes were compared.
RESULTS: Guideline utilization in diagnosis during ward rounds was 59% and 54% respectively. Correct guideline utilization
[76% vs. 51%, OR: 3.21; 95% CI: 1.69-6.28)], noting of vital signs [65% vs. 22%, OR: 6.50, 95% CI: 3.55-11.96), lab results [76%
vs. 48%, OR: 3.59, 95% CI: 2.09-6.21)] and regular ward rounds [76% vs. 39%, OR: 4.81 95% CI: 2.64-8.89)] were statistically
different between the two groups.
CONCLUSION: Guideline utilization was noted in complicated cases compared to patients without complications, post
discharge mortality of 59% could be improved by putting guidelines in place, and attention to the details. There is a need for
nationwide medical record review and implementation of a standardized guideline.
compliance; guidelines; causality; maternal mortality; preventive medicine