Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

Abstract

BackgroundWhile there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking.MethodsWe reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality.ResultsMaternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed.ConclusionsHealth workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil

“…Perinatal mortality is an important indicator of maternal and child health because it reflects the socioeconomic conditions, reproductive health, and quality of care provided in the prenatal period, during labour, and to the newborn (1)(2) . Child mortality has dropped significantly around the world.…”

An Assessment of High Delivery Load Facilities under the Dakshata Program

“…A study in Ghana also suggested that trainings to the health worker with follow up mechanism to ensure the quality of data can improve the further planning to achieve reduce the maternal mortality outcomes [21]. Kerber et al [22] stated that health workers are the main source of collecting data at every steps in health care system to identify the best practices and flaws and that leads to create responsibility based health system not only at managers level but also at other level to reduce the systemic challenges.…”

Measuring maternal, foetal and neonatal mortality: Challenges and solutions

“…There is evidence that audits and feedback can lead to quality improvement, (68) and positive effects have been observed on maternal health services in settings where the audit system is underpinned by a national framework with properly implemented feedback mechanisms, leadership both from committed health professionals and the ministry of health, an enabling legal framework, and a workplace culture which promotes learning. (69,70) Despite the link between maternal, fetal and neonatal mortality, perinatal reviews have not been as widely adopted as maternal death reviews. (70,71) A policy review found that of the 51 "Countdown to 2015 for Maternal, Newborn and Child Health" priority countries which had a policy for maternal death notification, only 17 had a similar policy for perinatal death reviews in 2014.…”

“…(69,70) Despite the link between maternal, fetal and neonatal mortality, perinatal reviews have not been as widely adopted as maternal death reviews. (70,71) A policy review found that of the 51 "Countdown to 2015 for Maternal, Newborn and Child Health" priority countries which had a policy for maternal death notification, only 17 had a similar policy for perinatal death reviews in 2014. (70) Even in countries with a national policy on perinatal review, they are not necessarily implemented.…”

“…(70,71) A policy review found that of the 51 "Countdown to 2015 for Maternal, Newborn and Child Health" priority countries which had a policy for maternal death notification, only 17 had a similar policy for perinatal death reviews in 2014. (70) Even in countries with a national policy on perinatal review, they are not necessarily implemented. For example, a qualitative study of maternal and perinatal death reviews in one region of Tanzania found that perinatal deaths are rarely reviewed.…”