Table 3.

Examples of audits and the outcome of the audit reported by ETATMBA trainees at interview

Audit topic*	Example of audit outcome reported at interview
Use of partographs	Trainee found that nurses/midwives were not completing the partograph routinely. After presenting audit findings at team meeting and providing training there was change in practice: So, what we see today is, any patient going to labour ward the nurse fill out the labour graph, and record and monitor. They now see that the monitoring aspect has a bearing on the outcome [9:3]
Management of pre-eclampsia and eclampsia	I went to the DNO with my findings…most of the health centres don't have magnesium sulphate…they are afraid to give magnesium sulphate and they cannot order the drug…For this year I have not seen any death from eclampsia…we are able to manage them there because they are stabilised (at the health centre) before they arrive (at the hospital) [T40:3]
Postabortion care	Trainee noted that current system was chaotic and that there was a lack of instruments (During the audit) in the pharmacy I found equipment, (lying unused)…I distributed it around the health centres…I conducted some training like to teach them how to do a vacuum extraction, how to take care of a vacuum extractor…for the instruments to stay longer. So, it has really given me a clue, of trying to check some things, doing this now and again as a way of improving services [T2:3] Another trainee's audit revealed patients were being sent for evacuations in theatre unnecessarily and so incurring unnecessary cost when MVAs were more appropriate …patients who were meant for MVA's were sent for evacuations in theatre. So, looking at the cost it was, actually the cost was high…just because maybe there wasn't enough equipment for MVA's, so I discussed that with the management and they bought some sets and we proceeded doing MVA's [T32:3]
Neonatal sepsis	An audit of neonatal services found high sepsis rates in neonates. Reporting findings back to the group had a positive impact on practice The sepsis (rate) has reduced by this time after the auditing [T12:3]
Neonatal resuscitation	Audit found clinical staff were not following the step-by-step procedure for neonatal resuscitation and not documenting the procedure. After sharing the results of the audit and training of colleagues there was improvement in the following of the step-by-step procedure …previously probably we were not putting things in order and then with the ETATMBA students they have drilled us to follow each step…we are resuscitating step by step…[NMW cascadee]
Postpartum haemorrhage	An audit revealed colleagues were not checking vital signs when patients were and the hospital did not have misoprostol for controlling the bleeding. After presenting to the management and colleagues the management agreed to stock misoprostol and he saw a change in practice in terms of checking for vital signs Another audit resulted in change in practice as follows: Every patient from now, whether from the health centre or not, if they can't get access for two IV (intravenous) lines they are able now to put even one at least, which is ok. Instead of leaving the patient alone with the driver (of car bringing the patient to hospital), at least they are able from the health centres to send somebody to accompany the patient in case of any problems [T9:3]

*Audit topics in descending order of frequency reported.

ETATMBA, enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa; MVA, manual vacuum aspirations.