Feasibility of community neonatal death audits in rural Uttar Pradesh, India

Abstract

Objective: Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits.Study Design: During November-December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions.Result: Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified.Conclusion: Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.

Reducing intrapartum-related deaths and disability: Can the health system deliver?

“…There are also some experiences with community-based audit [23,24]. Our new meta-analysis of 8 studies suggests a 31% effect on perinatal mortality from effective audit, linked to action [23].…”

Perinatal mortality audit: Counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries

“…Social audits may be used at the community level as a tool to identify strategies for community motivation of behavior change, or for addressing delays and promoting linkages for care. Community audit can be difficult to implement because of multiple role-players, but if conducted in a culturally acceptable and participatory process, audit is feasible, empowering, and may lead to behavior change [38]. This can be a descriptive process to gather information, as seen in Guinea and Uganda, or a participatory activity involving community members in implementing change as in rural Uttar Pradesh, India (Table 2).…”

“…Delay in recognizing the seriousness of the problem and arranging for transport and funds were identified as major contributors of neonatal deaths and to be targeted for behavior change by the community mobilizers. Another study to examine the feasibility of community audit was undertaken in Shivgarh, Uttar Pradesh, India involved in-depth interviews with family members of deceased neonates, and focus group with family and community members [38]. Approaches involved the community in identifying avoidable factors in each death and discussing solutions.…”

“…Community-level audit can be part of a dialogue between the broader health system, involving health facilities and communities [38]. Similarly, community involvement has been identified as a crucial component of improving facility-based care and a feedback mechanism for communicating patient-related modifiable factors [44].…”

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

“…Furthermore, most of these neonatal deaths occur at the community level and are, therefore, not recorded and their exact causes not elucidated. Verbal autopsy is a method that aims to identify the causes and factors that contribute to these deaths when they occur outside a health facility [4]. This method is an alternative to medical audit, in the context of low accessibility to health services, in order to determine the avoidable factors of death and take appropriate corrective measures.…”