{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:39:14Z","timestamp":1774611554422,"version":"3.50.1"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"crossref","award":["0000000000"],"award-info":[{"award-number":["0000000000"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["KL2TR003099"],"award-info":[{"award-number":["KL2TR003099"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Equity Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Maternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed the impact of an MDR program at a district-level hospital in rural Zambia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a mixed methods convergent study using hospital data on maternal mortality and audit reports of 106 maternal deaths from 2007 to 2011. To evaluate the overall impact of MDR on maternal mortality, we compared baseline (2007) to late (2010\u201311) post-intervention inpatient maternal mortality indicators. MDR committee reports were coded and dominant themes were extracted in a qualitative analysis. We assessed potential risk factors for maternal mortality in a before-and-after design comparing the periods 2008\u201309 and 2010\u201311.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In-hospital maternal mortality declined from 23 per thousand live births in 2007 to 8 per thousand in 2010\u201311 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.01). Maternal case fatality for puerperal sepsis and uterine rupture decreased significantly from 63 and 32% in 2007 to 10 and 9%\u00a0in 2010\u201311 (P\u2009&lt;\u20090.01). No significant reduction was seen in case fatality due to postpartum hemorrhage. Qualitative analysis of risk factors for maternal mortality revealed four core themes: standards of practice, health systems, accessibility, and patient factors. Specific risk factors included delayed referral, missed diagnoses, intra-hospital delays in care, low medication inventory, and medical error. We found no statistically significant differences in the prevalence of risk factors between the before-and-after periods.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Implementation of MDR was accompanied by a significant decrease in maternal mortality with\u00a0reductions in maternal death from puerperal sepsis and uterine rupture, but not postpartum hemorrhage. Qualitative analysis of audit reports identified several modifiable risk factors within four core areas. Comparisons of potential explanatory factors did not show any differences over time. These results imply that MDR offers a means for hospitals to curtail maternal deaths, except deaths due to postpartum hemorrhage, suggesting additional interventions are needed. Documentation of MDR meetings provides an instrument to guide further quality improvements.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12939-020-01185-5","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T16:06:44Z","timestamp":1594310804000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study"],"prefix":"10.1186","volume":"19","author":[{"given":"Jean-Bertin Bukasa","family":"Kabuya","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Mataka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Chongo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc Kambale","family":"Kamavu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla N\u2019gandu","family":"Chola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Manyando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"De Brouwere","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5615-6440","authenticated-orcid":false,"given":"Matthew M.","family":"Ippolito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"issue":"1","key":"1185_CR1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1258\/om.2008.080019","volume":"1","author":"G Lewis","year":"2008","unstructured":"Lewis G. Maternal mortality in the developing world: why do mothers really die? Obstet Med. 2008;1(1):2\u20136.","journal-title":"Obstet Med"},{"issue":"9542","key":"1185_CR2","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/S0140-6736(06)69380-X","volume":"368","author":"C Ronsmans","year":"2006","unstructured":"Ronsmans C, Graham WJ. Lancet maternal survival series steering g. maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189\u2013200.","journal-title":"Lancet"},{"key":"1185_CR3","volume-title":"Maternal mortality: levels and trends 2000 to 2017","author":"World Health Organization","year":"2019","unstructured":"World Health Organization. Maternal mortality: levels and trends 2000 to 2017. Geneva: World Health Organization; 2019."},{"key":"1185_CR4","volume-title":"The Millenium development goals report","author":"United Nations","year":"2015","unstructured":"United Nations. The Millenium development goals report. New York: United Nations; 2015."},{"key":"1185_CR5","unstructured":"United Nations. Transforming Our World. New York: The 2030 Agenda for Sustainable Development: United Nations; 2015."},{"issue":"9543","key":"1185_CR6","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/S0140-6736(06)69381-1","volume":"368","author":"OM Campbell","year":"2006","unstructured":"Campbell OM, Graham WJ. Lancet maternal survival series steering g. strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284\u201399.","journal-title":"Lancet"},{"key":"1185_CR7","unstructured":"World Health Organization. Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Pregnancy Safer. Geneva: World Health Organization; 2004."},{"key":"1185_CR8","unstructured":"Ministry of Health. Report on Confidential Enquiries into Maternal Deaths in England and Wales, 1952\u201354. London: CEMACH; 1957."},{"key":"1185_CR9","unstructured":"World Health Organization. Time to respond: A report on the global implementation of Maternal Death Surveillance and Response Switzerland. Geneva: World Health Organization; 2016."},{"key":"1185_CR10","first-page":"CD012982","volume":"3","author":"ML Willcox","year":"2020","unstructured":"Willcox ML, Price J, Scott S, et al. Death audits and reviews for reducing maternal, perinatal and child mortality. Cochrane Database Syst Rev. 2020;3:CD012982.","journal-title":"Cochrane Database Syst Rev"},{"key":"1185_CR11","first-page":"CD002961","volume":"4","author":"RC Pattinson","year":"2005","unstructured":"Pattinson RC, Say L, Makin JD, Bastos MH. Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity. Cochrane Database Syst Rev. 2005;4:CD002961.","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"1185_CR12","first-page":"147","volume":"85","author":"HR Ward","year":"1995","unstructured":"Ward HR, Howarth GR, Jennings OJ, Pattinson RC. Audit incorporating avoidability and appropriate intervention can significantly decrease perinatal mortality. S Afr Med J. 1995;85(3):147\u201350.","journal-title":"S Afr Med J"},{"issue":"2","key":"1185_CR13","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ijgo.2014.02.014","volume":"126","author":"JJ Hofman","year":"2014","unstructured":"Hofman JJ, Mohammed H. Experiences with facility-based maternal death reviews in northern Nigeria. Int J Gynaecol Obstet. 2014;126(2):111\u20134.","journal-title":"Int J Gynaecol Obstet"},{"issue":"6","key":"1185_CR14","doi-asserted-by":"crossref","first-page":"e20776","DOI":"10.1371\/journal.pone.0020776","volume":"6","author":"T van den Akker","year":"2011","unstructured":"van den Akker T, van Rhenen J, Mwagomba B, Lommerse K, Vinkhumbo S, van Roosmalen J. Reduction of severe acute maternal morbidity and maternal mortality in Thyolo District, Malawi: the impact of obstetric audit. PLoS One. 2011;6(6):e20776.","journal-title":"PLoS One"},{"issue":"3","key":"1185_CR15","doi-asserted-by":"crossref","first-page":"218","DOI":"10.2471\/BLT.05.023903","volume":"84","author":"A Dumont","year":"2006","unstructured":"Dumont A, Gaye A, de Bernis L, et al. Facility-based maternal death reviews: effects on maternal mortality in a district hospital in Senegal. Bull World Health Organ. 2006;84(3):218\u201324.","journal-title":"Bull World Health Organ"},{"issue":"9887","key":"1185_CR16","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/S0140-6736(13)60593-0","volume":"382","author":"A Dumont","year":"2013","unstructured":"Dumont A, Fournier P, Abrahamowicz M, et al. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial. Lancet. 2013;382(9887):146\u201357.","journal-title":"Lancet"},{"key":"1185_CR17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1471-2393-13-24","volume":"13","author":"CM Pirkle","year":"2013","unstructured":"Pirkle CM, Dumont A, Traore M, Zunzunegui MV, group Q. Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal. BMC Pregnancy Childbirth. 2013;13:24.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"6","key":"1185_CR18","doi-asserted-by":"crossref","first-page":"424","DOI":"10.2471\/BLT.14.144683","volume":"93","author":"ER Allanson","year":"2015","unstructured":"Allanson ER, Pattinson RC. Quality-of-care audits and perinatal mortality in South Africa. Bull World Health Organ. 2015;93(6):424\u20138.","journal-title":"Bull World Health Organ"},{"issue":"1","key":"1185_CR19","first-page":"21","volume":"18","author":"M Maresh","year":"1998","unstructured":"Maresh M. Quality in obstetrics and gynaecology: the example of the enquiries into maternal mortality. J Qual Clin Pract. 1998;18(1):21\u20138.","journal-title":"J Qual Clin Pract"},{"issue":"12","key":"1185_CR20","doi-asserted-by":"crossref","first-page":"e0188392","DOI":"10.1371\/journal.pone.0188392","volume":"12","author":"F Okonofua","year":"2017","unstructured":"Okonofua F, Imosemi D, Igboin B, et al. Maternal death review and outcomes: an assessment in Lagos state, Nigeria. PLoS One. 2017;12(12):e0188392.","journal-title":"PLoS One"},{"key":"1185_CR21","unstructured":"Ministry of Health of the Government of the Republic of Zambia. Republic of Zambia Roadmap for Accelerating the Attainment of the Millenium Development Goals Related to Maternal Newborn and Child Health in Zambia. Lusaka: Ministry of Health; 2007."},{"key":"1185_CR22","volume-title":"Roadmap for accelerating reduction of maternal, newborn and child mortality, 2013\u20132016","author":"Ministry of Community Development","year":"2013","unstructured":"Ministry of Community Development. Roadmap for accelerating reduction of maternal, newborn and child mortality, 2013\u20132016. Lusaka: Ministry of Health of the Government of the Republic of Zambia; 2013."},{"issue":"8","key":"1185_CR23","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/0277-9536(94)90226-7","volume":"38","author":"S Thaddeus","year":"1994","unstructured":"Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091\u2013110.","journal-title":"Soc Sci Med"},{"key":"1185_CR24","volume-title":"Designing and conducting mixed methods research","author":"JW Creswell","year":"2017","unstructured":"Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3d ed. Thousand Oaks: Sage Publications, Inc.; 2017.","edition":"3d"},{"key":"1185_CR25","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","volume":"15","author":"HF Hsieh","year":"2005","unstructured":"Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277.","journal-title":"Qual Health Res"},{"issue":"1","key":"1185_CR26","first-page":"1","volume":"2","author":"J Aronson","year":"1994","unstructured":"Aronson J. A pragmatic view of thematic analysis. Qual Rep. 1994;2(1):1\u20133.","journal-title":"Qual Rep"},{"key":"1185_CR27","first-page":"CD000259","volume":"6","author":"N Ivers","year":"2012","unstructured":"Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6:CD000259.","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"1185_CR28","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.wombi.2008.08.002","volume":"21","author":"EJ Kongnyuy","year":"2008","unstructured":"Kongnyuy EJ, Leigh B, van den Broek N. Effect of audit and feedback on the availability, utilisation and quality of emergency obstetric care in three districts in Malawi. Women Birth. 2008;21(4):149\u201355.","journal-title":"Women Birth"},{"issue":"2","key":"1185_CR29","first-page":"75","volume":"13","author":"RT Strand","year":"2009","unstructured":"Strand RT, de Campos PA, Paulsson G, de Oliveira J, Bergstrom S. Audit of referral of obstetric emergencies in Angola: a tool for assessing quality of care. Afr J Reprod Health. 2009;13(2):75\u201385.","journal-title":"Afr J Reprod Health"},{"issue":"9516","key":"1185_CR30","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/S0140-6736(06)68397-9","volume":"367","author":"KS Khan","year":"2006","unstructured":"Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066\u201374.","journal-title":"Lancet"},{"issue":"6","key":"1185_CR31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0156717","volume":"11","author":"J Pinchoff","year":"2016","unstructured":"Pinchoff J, Chaponda M, Shields TM, et al. Individual and household level risk factors associated with malaria in Nchelenge District, a region with perennial transmission: a serial cross-sectional study from 2012 to 2015. PLoS One. 2016;11(6):e0156717.","journal-title":"PLoS One"},{"issue":"6","key":"1185_CR32","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.4269\/ajtmh.15-0735","volume":"94","author":"S Das","year":"2016","unstructured":"Das S, Muleba M, Stevenson JC, Norris DE. Habitat partitioning of malaria vectors in Nchelenge District, Zambia. Am J Trop Med Hyg. 2016;94(6):1234\u201344.","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"1185_CR33","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.apjtb.2016.01.010","volume":"6","author":"F Masaninga","year":"2016","unstructured":"Masaninga F, Bwalya M, Malumo S, et al. Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006\u20132012): potential determinants and highlight of lessons learnt. Asian Pac J Trop Biomed. 2016;6(7):620\u20134.","journal-title":"Asian Pac J Trop Biomed"},{"issue":"2","key":"1185_CR34","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S1473-3099(07)70022-1","volume":"7","author":"SJ Rogerson","year":"2007","unstructured":"Rogerson SJ, Hviid L, Duffy PE, Leke RF, Taylor DW. Malaria in pregnancy: pathogenesis and immunity. Lancet Infect Dis. 2007;7(2):105\u201317.","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"1185_CR35","first-page":"61","volume":"12","author":"JW Snelgrove","year":"2009","unstructured":"Snelgrove JW. Postpartum haemorrhage in the developing world a review of clinical management strategies. Mcgill J Med. 2009;12(2):61.","journal-title":"Mcgill J Med"},{"issue":"2","key":"1185_CR36","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ijgo.2004.11.026","volume":"88","author":"A Paxton","year":"2005","unstructured":"Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. Int J Gynaecol Obstet. 2005;88(2):181\u201393.","journal-title":"Int J Gynaecol Obstet"},{"key":"1185_CR37","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1186\/s12884-015-0695-9","volume":"15","author":"E Anastasi","year":"2015","unstructured":"Anastasi E, Borchert M, Campbell OM, et al. Losing women along the path to safe motherhood: why is there such a gap between women's use of antenatal care and skilled birth attendance?. A mixed methods study in northern Uganda. BMC Pregnancy Childbirth. 2015;15:287.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"1185_CR38","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/bmb\/ldw056","volume":"121","author":"F Mgawadere","year":"2017","unstructured":"Mgawadere F, Kana T, van den Broek N. Measuring maternal mortality: a systematic review of methods used to obtain estimates of the maternal mortality ratio (MMR) in low- and middle-income countries. Br Med Bull. 2017;121(1):121\u201334.","journal-title":"Br Med Bull"},{"issue":"10","key":"1185_CR39","first-page":"656","volume":"71","author":"JO Martey","year":"1994","unstructured":"Martey JO, Djan JO, Twum S, Browne EN, Opoku SA. Maternal mortality and related factors in Ejisu District, Ghana East. Afr Med J. 1994;71(10):656\u201360.","journal-title":"Afr Med J"},{"issue":"1","key":"1185_CR40","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1258\/td.2009.080207","volume":"40","author":"OU Umeora","year":"2010","unstructured":"Umeora OU, Egwuatu VE. The role of unorthodox and traditional birth care in maternal mortality. Trop Dr. 2010;40(1):13\u20137.","journal-title":"Trop Dr"},{"issue":"3","key":"1185_CR41","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2307\/3583322","volume":"5","author":"AK Mbonye","year":"2001","unstructured":"Mbonye AK. Risk factors associated with maternal deaths in health units in Uganda. Afr J Reprod Health. 2001;5(3):47\u201353.","journal-title":"Afr J Reprod Health"},{"issue":"1","key":"1185_CR42","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s13643-017-0503-x","volume":"6","author":"M Kyei-Nimakoh","year":"2017","unstructured":"Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev. 2017;6(1):110.","journal-title":"Syst Rev"},{"key":"1185_CR43","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1186\/s12913-015-1005-y","volume":"15","author":"KN Atuoye","year":"2015","unstructured":"Atuoye KN, Dixon J, Rishworth A, Galaa SZ, Boamah SA, Luginaah I. Can she make it?. Transportation barriers to accessing maternal and child health care services in rural Ghana. BMC Health Serv Res. 2015;15:333.","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"1185_CR44","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/00005237-200212000-00006","volume":"16","author":"S Gennaro","year":"2002","unstructured":"Gennaro S, Dugyi E, Doud JM, Kershbaumer R. Health promotion for childbearing women in Rubanda, Uganda. J Perinat Neonatal Nurs. 2002;16(3):39\u201350.","journal-title":"J Perinat Neonatal Nurs"},{"issue":"1","key":"1185_CR45","first-page":"44","volume":"1","author":"M Brennan","year":"1988","unstructured":"Brennan M. Training traditional birth attendants reduces maternal mortality and morbidity. Trop J Obstet Gynaecol. 1988;1(1):44\u20137.","journal-title":"Trop J Obstet Gynaecol"},{"issue":"20","key":"1185_CR46","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1056\/NEJMsa042830","volume":"352","author":"AH Jokhio","year":"2005","unstructured":"Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. N Engl J Med. 2005;352(20):2091\u20139.","journal-title":"N Engl J Med"},{"issue":"1","key":"1185_CR47","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0266-6138(03)00053-6","volume":"20","author":"L Sibley","year":"2004","unstructured":"Sibley L, Ann ST. What can a meta-analysis tell us about traditional birth attendant training and pregnancy outcomes? Midwifery. 2004;20(1):51\u201360.","journal-title":"Midwifery"},{"issue":"27","key":"1185_CR48","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0968-8080(06)27225-2","volume":"14","author":"N Gerein","year":"2006","unstructured":"Gerein N, Green A, Pearson S. The implications of shortages of health professionals for maternal health in sub-saharan Africa. Reprod Health Matters. 2006;14(27):40\u201350.","journal-title":"Reprod Health Matters"},{"key":"1185_CR49","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/1478-4505-11-38","volume":"11","author":"J Okal","year":"2013","unstructured":"Okal J, Kanya L, Obare F, et al. An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda. Health Res Policy Syst. 2013;11:38.","journal-title":"Health Res Policy Syst"},{"issue":"Suppl 1","key":"1185_CR50","first-page":"S83","volume":"85","author":"VD Tsu","year":"2004","unstructured":"Tsu VD, Shane B. New and underutilized technologies to reduce maternal mortality: call to action from a Bellagio workshop. Int J Gynaecol Obstet. 2004;85(Suppl 1):S83\u201393.","journal-title":"Int J Gynaecol Obstet"}],"container-title":["International Journal for Equity in Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-020-01185-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12939-020-01185-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-020-01185-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T23:40:18Z","timestamp":1625787618000},"score":1,"resource":{"primary":{"URL":"https:\/\/equityhealthj.biomedcentral.com\/articles\/10.1186\/s12939-020-01185-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,9]]},"references-count":50,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1185"],"URL":"https:\/\/doi.org\/10.1186\/s12939-020-01185-5","relation":{},"ISSN":["1475-9276"],"issn-type":[{"value":"1475-9276","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,9]]},"assertion":[{"value":"21 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This quality improvement study received ethical approval from the Tropical Diseases Research Centre Ethics Review Committee and was undertaken with the support of St. Paul\u2019s General Hospital and the Nchelenge District Health Office leadership.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JBK previously served as the former hospital medical officer-in-charge, and these data were included in a dissertation that was written as part of his master\u2019s\u00a0degree curriculum at the Institute of Tropical Medicine, Antwerp, Belgium. LKK currently serves as the hospital medical officer-in-charge. GC is the current director of the Nchelenge District Health Office. Other authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"119"}}