Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of crite rion-based clinical audit of the assessment and management of five major ob stetric complications is being studied in Ghana and Jamaica. In order to es tablish case definitions and clinical audit criteria, a systematic review o f the literature was followed by three expert panel meetings. A modified no minal group technique was used to develop consensus among experts on a fina l set of case definitions and criteria. Five main obstetric complications w ere selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modif ication and approval of 37 of these for the next stage of audit. Criterion- based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selec tion of audit criteria for such settings requires local expert opinion to b e considered in addition to research evidence, so as to ensure that the cri teria are realistic in relation to conditions in the field. Practical metho ds for achieving this are described in the present paper.