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


Pattinson, R; Kerber, K; Waiswa, P; Day, LT; Mussell, F; Asiruddin, SK; Blencowe, H; Lawn, JE; (2009) Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. International journal of gynaecology and obstetrics, 107 Suppl 1. S113-21, S121-2. ISSN 0020-7292 DOI: https://doi.org/10.1016/j.ijgo.2009.07.011

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Abstract

BACKGROUND: In high-income countries, national mortality audits are associated with improved quality of care, but there has been no previous systematic review of perinatal audit in low- and middle-income settings. OBJECTIVES: To present a systematic review of facility-based perinatal mortality audit in low- and middle-income countries, and review information regarding community audit. RESULTS: Ten low-quality evaluations with mortality outcome data were identified. Meta-analysis of 7 before-and-after studies indicated a reduction in perinatal mortality of 30% (95% confidence interval, 21%-38%) after introduction of perinatal audit. The consistency of effect suggests that audit may be a useful tool for decreasing perinatal mortality rates in facilities and improving quality of care, although none of these evaluations were large scale. Few of the identified studies reported intrapartum-related perinatal outcomes. Novel experience of community audit and social autopsy is described, but data reporting mortality outcome effect are lacking. There are few examples of wide-scale, sustained perinatal audit in low-income settings. Two national cases studies (South Africa and Bangladesh) are presented. Programmatic decision points, challenges, and key factors for national or wide scale-up of sustained perinatal mortality audit are discussed. As a minimum standard, facilities should track intrapartum stillbirth and pre-discharge intrapartum-related neonatal mortality rates. CONCLUSION: The effect of perinatal audit depends on the ability to close the audit loop; without effectively implementing the solutions to the problems identified, audit alone cannot improve quality of care.

Item Type: Article
Keywords: Developing Countries, Female, Fetal Death/ epidemiology/prevention & control, Humans, Maternal Health Services/organization & administration, Medical Audit/ organization & administration, Obstetric Labor Complications/ epidemiology/prevention & control, Perinatal Care/organization & administration, Perinatal Mortality, Pregnancy, Developing Countries, Female, Fetal Death, epidemiology, prevention & control, Humans, Maternal Health Services, organization & administration, Medical Audit, organization & administration, Obstetric Labor Complications, epidemiology, prevention & control, Perinatal Care, organization & administration, Perinatal Mortality, Pregnancy
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 19815206
Web of Science ID: 271178200007
URI: http://researchonline.lshtm.ac.uk/id/eprint/2315

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