ArticleThe Lancet. Global health2020
Quality of care and maternal mortality in a tertiary-level hospital in Mozambique: a retrospective study of clinicopathological discrepancies.
Article in The Lancet. Global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Factors influencing implementation of point-of-care tests for maternal and newborn screening and diagnosis in low-resource settings: a systematic review.BMC global and public health · 2026Pooled it
- Advanced responder training priorities in Kenya: A Delphi study with implications for low- and middle- income countries.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Article
- Bridging the diagnostic gap: diagnostic capacity and pediatric quality of care in LMICs.BMC medicine · 2025Article
- Diagnostic Errors in Obstetric Morbidity and Mortality: Methods for and Challenges in Seeking Diagnostic Excellence.Journal of clinical medicine · 2024Review
- Clinicopathological discrepancies in the diagnoses of childhood causes of death in the CHAMPS network: An analysis of antemortem diagnostic inaccuracies.BMJ paediatrics open · 2024Article
- Observational
- Verbal Autopsy to Assess Postdischarge Mortality in Children With Suspected Sepsis in Uganda.Pediatrics · 2023Article
- Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network.EClinicalMedicine · 2023Article
- Antibiotic Use in Pregnancy: A Global Survey on Antibiotic Prescription Practices in Antenatal Care.Antibiotics (Basel, Switzerland) · 2023Article
- International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions.BMC pregnancy and childbirth · 2022Article
- The Lancet Commission on diagnostics: transforming access to diagnostics.Lancet (London, England) · 2021Review
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18 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough an increasing number of pregnant women in resource-limited areas deliver in health-care facilities, maternal mortality remains high in these settings. Inadequate diagnosis and management of common life-threatening conditions is an important determinant of maternal mortality. We analysed the clinicopathological discrepancies in a series of maternal deaths from Mozambique and assessed changes over 10 years in the diagnostic process. We aimed to provide data on clinical diagnostic accuracy to be used for improving quality of care and reducing maternal mortality.
methodsWe did a retrospective analysis of clinicopathological discrepancies in 91 maternal deaths occurring from Nov 1, 2013, to March 31, 2015 (17 month-long period), at a tertiary-level hospital in Mozambique, using complete diagnostic autopsies as the gold standard to ascertain cause of death. We estimated the performance of the clinical diagnosis and classified clinicopathological discrepancies as major and minor errors. We compared the findings of this analysis with those of a similar study done in the same setting 10 years earlier.
findingsWe identified a clinicopathological discrepancy in 35 (38%) of 91 women. All diagnostic errors observed were classified as major discrepancies. The sensitivity of the clinical diagnosis for puerperal infections was 17% and the positive predictive value was 50%. The sensitivity for non-obstetric infections was 48%. The sensitivity for eclampsia was 100% but the positive predictive value was 33%. Over the 10-year period, the performance of clinical diagnosis did not improve, and worsened for some diagnoses, such as puerperal infection.
interpretationDecreasing maternal mortality requires improvement of the pre-mortem diagnostic process and avoidance of clinical errors by refining clinical skills and increasing the availability and quality of diagnostic tests. Comparison of post-mortem information with clinical diagnosis will help monitor the reduction of clinical errors and thus improve the quality of care.
fundingBill & Melinda Gates Foundation and Instituto de Salud Carlos III.
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