An unmatched case-control study will be conducted using the MaatHRI platform. Cases will be 1500 pregnant women with moderate-severe anaemia who had a heart failure during pregnancy or delivery in the 15 participating hospitals. Controls will be two pregnant women per case (total 3000) with moderate-severe anaemia (haemoglobin concentration <10 g/dl) who did not have heart failure and delivered immediately before the case. The primary exposures of interest are haemoglobin concentration, pre-existing cardiac disease, management of labour and delivery, mode of delivery, duration of labour, and delay in receiving adequate in-hospital care.
2.2 In-depth case reviews
Qualitative in-depth document review of hospital and antenatal care records of a random sample of cases of maternal deaths and severe morbidity due to anaemic heart failure will be conducted in each of the 15 hospitals to identify factors (related to health systems, in-hospital management, antenatal care, socio-demographic, etc) that contributed to the death of some women and the positive elements that saved the lives of others. Lessons identified will be combined with evidence from work stream 2.1 to develop an action plan/ tool for prevention and management of anaemic heart failure.