While maternal and perinatal mortality auditing has been strongly promoted by the World Health Organization (WHO), there has been very limited promotion or evaluation of child death auditing in low/middle-income settings. In 2017, a standardised child death review process was introduced in the paediatric department of the National Hospital in Honiara, Solomon Islands. We evaluated the process and outcomes of child death reviews. The child death auditing process was assessed through systematic observations made at each of the weekly meetings using the following standards for evaluation: (1) adapted WHO tools for paediatric auditing; (2) the five stages of the audit cycle; (3) published principles of paediatric audit; and (4) WHO and Solomon Islands national clinical standards of Hospital Care for Children. Thirty-three child death review meetings were conducted over 6 months, reviewing 66 neonatal and child deaths. Some areas of the process were satisfactory and other areas were identified for improvement. The latter included use of a more systematic classification of causes of death, inclusion of social risk factors and community problems in the modifiable factors and more follow-up with implementation of action plans. Areas for improvement were in communication, clinical assessment and treatment, availability of laboratory tests, antenatal clinic attendance and equipment for high dependency neonatal and paediatric care. Many of the changes recommended by audit require a quality improvement team to implement. Child death auditing can be done in resource-limited settings and yield useful information of gaps which are linked to preventable deaths; however, using the data to produce meaningful changes in practice is the greatest challenge. Audit is an iterative and evolving process that needs a structure, tools, evaluation, and needs to be embedded in the culture of a hospital as part of overall quality improvement, and requires a quality improvement team to follow-up and implement action plans.

Introduction Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis. Methodology All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated. Results Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy. Conclusions In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.