How Kabarole Hospital in western Uganda saved mothers’ lives through team-based problem-solving
While the maternal mortality ratio (MMR) has declined globally in recent years, 99% of maternal deaths occur in developing countries. Most (75%) maternal deaths are due to severe bleeding, infections, pre-eclampsia and eclampsia, complications of obstructed and prolonged labor, and unsafe abortions.
In Uganda (2013), the MMR was 360 per 100 000 live births compared with 210 per 100 000 live births globally. Kabarole Hospital, a private, not-for-profit general hospital in Kabarole District, was among the high-volume facilities prioritized by ASSIST for a maternal, neonatal and child health (MNCH) quality improvement (QI) initiative in four districts of Western Uganda.
In May 2013, maternity staff at Kabarole Hospital recognized the hospital faced a challenge of handling cases with eclampsia, which was among the leading causes of maternal deaths in the hospital. Between January and June 2013, there were six maternal deaths among 682 deliveries (880/100 000 live births), two of which resulted from eclampsia.
By applying improvement methods to change how care was organized, the team at Kabarole Hospital was able to improve outcomes in maternal and newborn health. Between January and June 2013, the hospital conducted 682 deliveries and experienced six maternal deaths (institutional MMR of 880/100 000 deliveries) with seven mothers (7/682 deliveries) diagnosed with high blood pressure in pregnancy (1%). During the following 6 months, as they increased diagnosis and treatment of high blood pressure among pregnant women to 3.3% (15/460 deliveries), they reduced the number of maternal deaths occurring at their health facility by 75% to one (institutional MMR of 217/100 000 live births). Similarly, the number of pre-discharge newborn deaths (0–7 days) decreased by 44% from 11 (18/1000 live births) between January and June 2013 to 4 newborn deaths (10/1000 live births) from July to December 2013.