Background A needs assessment of women's health services was conducted in support of a WHO sponsored link between Guys and St. Thomas' Hospital, London, and Ndola Central Hospital, Zambia. Ndola Central Hospital is one of five tertiary hospitals in Zambia taking referrals from 23 surrounding rural clinics. The maternal mortality ratio for Zambia was 591/100000 in 2007.1

Methods Maternal deaths in Ndola Central Hospital under the ICD-10 definition were reviewed for the period of July 2010-June 2011; 13 cases in total. Case notes were reviewed and themes elicited.

Results The true number of maternal deaths for this time period was not known as the current record keeping system was not comprehensive. Themes elicited as causes of death were severe anaemia, end-stage HIV, blood loss and time delays. Time delays included: decisions to refer; transport to Ndola Central; review by a doctor; and accessing blood units, caesarean sections or investigation results. Maternal death rates in surrounding rural clinics were low as complicated cases were referred to Ndola Central Hospital. Therefore clinics were unable to assess their own care provision as adverse effects were mainly seen in Ndola Central.

Discussion Ndola Central Hospital will continue progress on a central record keeping system of maternal death cases that includes all deaths under the ICD-10 definition. A regular review process of these deaths, under the WHO ‘beyond the numbers’ scheme, is also planned, which includes dialogue between Ndola Central Hospital and the referring clinic.