Confidential inquiries into maternal deaths: Modifications and adaptations in Ghana and Indonesia

Julia Hussein, Lucia D'Ambruoso, Margaret Armar-Klemesu, Endang Achadi, Daniel Arhinful, Yulia Izati, Janet Ansong-Tornui

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia. Methods: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected. Results: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11 000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours. Conclusion: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners.
Original languageEnglish
Pages (from-to)80-84
Number of pages5
JournalInternational Journal of Gynecology & Obstetrics
Issue number1
Early online date9 May 2009
Publication statusPublished - Jul 2009


  • confidential inquiries into maternal deaths
  • maternal death review
  • obstetric complications


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