Underreporting of maternal and neonatal complications: A comparison of information in maternity registers and client charts at a rural community hospital in Malawi

Aim: To determine the rate and types of unreported maternal and neonatal complications in a rural community hospital in Malawi. Background: The problem of maternal and neonatal morbidity and mortality may be underestimated, with underreporting of complications often noted. Reliable data is needed to make key decisions at the local, district, and national level. This study investigated whether there were unreported complications among women receiving intrapartum care at a rural community hospital in Malawi. Methods: A retrospective cross-sectional study was conducted comparing maternity register records to client charts from January-March 2018. Descriptive data analysis using SPSS v20 was performed to calculate percentages and frequencies. Results: 360 client cases were identified, of which 33 cases were excluded from analysis due to missing charts. Of the remaining 327 cases included in the final analysis, only 34% (n = 31) of maternal and 34% (n = 33) of neonatal complications were recorded in both the maternity register and the chart. When the additional complications found in the chart review were included, the rates of maternal and neonatal complications tripled from 9.5% (n = 31) and 10% (n = 33) to 28% (n = 90) and 30% (n = 98), respectively. Conclusions: There was poor record keeping, underreporting of maternal and neonatal complications, and discrepancies between the data recorded in the monthly maternity register and client charts in the first quarter of 2018. The actual rate of complications suggests a need to verify data at the facility level to prevent release and reporting of inaccurate data. Measures are needed to mitigate the gaps in data reporting.