Chapter 12d. KwaZulu Natal

KwaZulu-Natal (KZN) is the most populous province. Although it has some major cities, the majority of the population is rural or semi-urban. KZN collected the most deaths of any province and has an effective collection system. Unfortunately, there are still a number of deaths not being reported and it is unknown how many deaths are occurring outside of the health services.

Table 12d.1 shows the pattern of disease in the province. The data clearly shows the impact HIV/AIDS is having on the province.

Avoidable factors, missed opportunities and substandard care are shown in Tables 12d.2-4. Problems in the collection of data occurred at various institutions in KZN. Discord as to whose responsibility it is to fill in the maternal death notification form, assessors not receiving copies of the files, (sometimes because of budget constraints in photostat paper) and poor or lack of notes, resulted in the inability of the assessors to assess cases for substandard care. Despite this however, a relatively clear picture of the major problems have emerged.

The major patient avoidable factor was delay in the patient seeking help from the health services, which occurred in 23% of cases; this was followed by non-attendance of antenatal care at 18%. Problems with transport (20%) and lack of termination of pregnancy services (33%) were the most common administrative problems. These factors probably reflect the rural nature of the province, with patients having difficulty in getting to health services and the ambulance services having similar problems. This may also be reflected in the delay in referral of patients (12%) and managing patients at inappropriate institutions (11%).

The most common health worker avoidable factor was not following standard protocols (41%) and problems with patient monitoring in 23%.

Solutions

  1. Personal visits to institutions by the MCWH personnel will solve the problems of discord about who fills in the notification forms, the failure to send copies of the files, hopefully poor note keeping and reporting of all maternal deaths.
  2. The provision of guidelines and protocols for managing obstetric emergencies is urgently required. This should be coupled with in-service training of the health workers on the protocols. The protocols should include appropriate referral criteria and the specific institutions to which the patients need to be referred.
  3. The lack of infrastructure regarding ambulance services is also a major problem. The potential of using community-based transport systems needs to be explored. The rating of obstetric referrals will need to be discussed with the ambulance services.
  4. A skills and human resources audit will need to be conducted to address the problems of lack of monitoring

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