Reduction of Severe Acute Maternal Morbidity and Maternal Mortality in Thyolo District, Malawi: The Impact of Obstetric Audit

BACKGROUND: Critical incident audit and feedback are recommended interventions to improve the quality of obstetric care. To evaluate the effect of audit at district level in Thyolo, Malawi, we assessed the incidence of facility-based severe maternal complications (severe acute maternal morbidity (SAMM) and maternal mortality) during two years of audit and feedback. METHODOLOGY/PRINCIPAL FINDINGS: Between September 2007 and September 2009, we included all cases of maternal mortality and SAMM that occurred in Thyolo District Hospital, the main referral facility in the area, using validated disease-specific criteria. During two- to three-weekly audit sessions, health workers and managers identified substandard care factors. Resulting recommendations were implemented and followed up. Feedback was given during subsequent sessions. A linear regression analysis was performed on facility-based severe maternal complications. During the two-year study period, 386 women were included: 46 died and 340 sustained SAMM, giving a case fatality rate of 11.9%. Forty-five cases out of the 386 inclusions were audited in plenary with hospital staff. There was a reduction of 3.1 women with severe maternal complications per 1000 deliveries in the district health facilities, from 13.5 per 1000 deliveries in the beginning to 10.4 per 1000 deliveries at the end of the study period. The incidence of uterine rupture and major obstetric hemorrhage reduced considerably (from 3.5 to 0.2 and from 5.9 to 2.6 per 1000 facility deliveries respectively). CONCLUSIONS: Our findings indicate that audit and feedback have the potential to reduce serious maternal complications including maternal mortality. Complications like major hemorrhage and uterine rupture that require relatively straightforward intrapartum emergency management are easier to reduce than those which require uptake of improved antenatal care (eclampsia) or timely intravenous medication or HIV-treatment (peripartum infections)

Rethinking spatial costs and benefits of fisheries in marine conservation

International audienceFishing catch is often used as a cost in marine conservation planning to avoid areas of high fishing activity when identifying potential marine reserve locations. However, the theory of marine reserves indicates that reserves are more likely to benefit fisheries in areas of heavy fishing activity that would otherwise be overfished. Whether or not fishing catch is calculated as a cost depends on the balance of conservation and fisheries goals for a reserve, and thus is critical for policymakers to consider when designing marine reserve networks. This research shows the utility of running an inverted cost model of fishery catches during marine reserve spatial prioritization as a first step in a marine planning process oriented towards stabilizing local fisheries. This technique serves as a heuristic tool that may help conservation planners explore regions that would otherwise be overlooked if fisheries data were absent or integrated purely as a cost in the planning process. Drawing on data from Madagascar to illustrate our approach, this research demonstrates that the regions most frequently selected using the inverted cost model not only meet conservation targets, but are also those most accessible to community-based resource managers, the dominant management paradigm in Madagascar as well as in many developing countries

TwoEagles: A Model Transformation Tool from Architectural Descriptions to Queueing Networks

We present the implementation of a methodology for the modeling, analysis, and comparison of software architectures based on their performance characteristics. The implementation is part of a software tool that is called TwoEagles, which extends the architecture-centric tool TwoTowers – based on the stochastic process algebraic description language AEmilia – and integrates it into Eclipse. The extension consists of a Java-coded plugin that we have called AEmilia to QN. This plugin transforms AEmilia descriptions into queueing network models expressed in the XML schema PMIF, which can then be rendered via the QN Editor tool or analyzed by multiple queueing network solvers that can be invoked through the Weasel web service