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Please cite this paper as: Drost E, van Lonkhuijzen L, Meguid T, Landis Lewis D, Zeeman G. Implementing safe motherhood: a low-cost intervention to improve the management of eclampsia in a referral hospital in Malawi. BJOG 2010;117:1553-1557. We evaluated the effect of so-called monitoring and treatment charts on the management of eclampsia in a referral hospital in Malawi. Baseline characteristics, clinical management, as well as overall maternal and perinatal outcome were compared by reviewing the medical files of two groups, before and after introduction of the charts in 2006. The use of the charts has resulted in improved monitoring of women with eclampsia and may have contributed to the reduction in the planned prelabour caesarean section rate from 87% to 33%, as more women underwent induction of labour after stabilisation ( P = 0.020). Overall maternal and perinatal outcomes were similar. [ABSTRACT FROM AUTHOR]

Background: To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers., Methods: Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians ('medical assistants' and 'clinical officers')., Results: Factors contributing to facility-based obstetric hemorrhage mentioned by participants were categorized into four major areas: (1) limited availability of basic supplies, (2) lack of human resources, (3) inadequate clinical skills of available health workers and (4) substandard referrals by traditional birth attendants and lack of timely self-referrals of patients., Conclusion: Health workers in this district mentioned important community, system and provider related factors that need to be addressed in order to reduce the impact of obstetric hemorrhage.