{"id":9906,"date":"2013-07-01T00:00:00","date_gmt":"2013-07-01T00:00:00","guid":{"rendered":"http:\/\/www.healthynewbornnetwork.org\/resource\/perinatal-mortality-audit-counting-accountability-and-overcoming-challenges-in-scaling-up-in-low-and-middle-income-countries\/"},"modified":"2017-08-21T18:27:40","modified_gmt":"2017-08-21T22:27:40","slug":"perinatal-mortality-audit-counting-accountability-and-overcoming-challenges-in-scaling-up-in-low-and-middle-income-countries","status":"publish","type":"resource","link":"https:\/\/www.healthynewbornnetwork.org\/resource\/perinatal-mortality-audit-counting-accountability-and-overcoming-challenges-in-scaling-up-in-low-and-middle-income-countries\/","title":{"rendered":"Perinatal mortality audit: Counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries"},"content":{"rendered":"

Background: 
<\/strong>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. <\/o_p><\/p>\n

<\/p>\n

Objectives: <\/strong>
To present a systematic review of facility-based perinatal mortality audit in low- and middle- income countries, and review information regarding community audit. <\/o_p><\/p>\n

Results: <\/strong>
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. <\/o_p><\/p>\n

Conclusion: <\/strong>
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.<\/o_p><\/span><\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

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.<\/p>\n

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The Every Newborn Action Plan Measurement Improvement Roadmap details the challenges in measurement and provides a multi-year, multi-partner pathway to improving metrics, including testing and standardizing indicator definitions and developing new tools.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">71\r\n<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1513274052338{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of newborn deaths that are preventable with access to quality health care\r\n<\/span><\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">1<\/span>\/<span class=\"ticker\">3<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1517246179677{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">babies do not have a birth certificate by their first\u00a0birthday<\/span><\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-blue\" width=\"1\/3\"][vc_column_text]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">10<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1456360643415{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">number of priority Every Newborn indicators identified<\/span><\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_separator][vc_column_text]\r\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our\u00a0<a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a>\u00a0page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_text_separator title=\"More information\"][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]See <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> for more newborn health specific epidemiology including rates, trends, and causes of death.\r\n\r\nEpidemiology is the \u201cstudy of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.\u201d Epidemiology examines how health conditions are distributed among a population and seeks to understand the risks or causes associated with those conditions.[\/vc_column_text][vc_column_text]The numbers of stillbirths and neonatal deaths, and the causes, are generated through modeled estimates using information from national civil registration databases, household surveys, surveillance systems, and special studies. High-quality, universal birth and death registration are required to provide nationally representative, timely data, and to signify a shift in social norms to value counting every newborn baby and stillbirth. Increasing global momentum to improve the data is important, and highlights the human face of those who are counted the least\u2014newborn babies and stillbirths.[\/vc_column_text][vc_text_separator title=\"Key resources\"][\/vc_column][\/vc_row][vc_row][vc_column width=\"1\/2\"][vc_column_text]\r\n<ul>\r\n \t<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/Every-Newborn-Metrics-Cards_3.pdf\" target=\"_blank\" rel=\"noopener\">Every Newborn Metrics Report Cards<\/a><\/li>\r\n \t<li><a href=\"http:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/supplements\/volume-15-supplement-2\" target=\"_blank\" rel=\"noopener\">Count every newborn, a measurement improvement roadmap for coverage data<\/a><\/li>\r\n \t<li><a href=\"http:\/\/www.thelancet.com\/series\/everynewborn\" target=\"_blank\" rel=\"noopener\">The Lancet Every Newborn Series (2014)<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/every-newborn-action-plan\/\" target=\"_blank\" rel=\"noopener\">The Every Newborn Action Plan<\/a><\/li>\r\n<\/ul>\r\n[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\"][vc_column_text]\r\n<ul>\r\n \t<li><a href=\"https:\/\/apps.who.int\/iris\/handle\/10665\/184225\" target=\"_blank\" rel=\"noopener\">The WHO Technical consultation on newborn health indicators<\/a><\/li>\r\n \t<li><a href=\"https:\/\/apps.who.int\/iris\/handle\/10665\/153544\" target=\"_blank\" rel=\"noopener\">Strategies toward ending preventable maternal mortality (EPMM)<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.healthdatacollaborative.org\/fileadmin\/uploads\/hdc\/Documents\/the-roadmap-for-health-measurement-and-accountability.pdf\" target=\"_blank\" rel=\"noopener\">The Roadmap for Health Measurement and Accountability<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.who.int\/teams\/maternal-newborn-child-adolescent-health-and-ageing\/epidemiology-monitoring-and-evaluation\/maternal-health\" target=\"_blank\" rel=\"noopener\">WHO Maternal, Newborn, Child and Adolescent Health and Ageing (Maternal and newborn health monitoring)<\/a><\/li>\r\n<\/ul>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"Epidemiology","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"data-epidemiology","to_ping":"","pinged":"","post_modified":"2022-10-19 17:59:04","post_modified_gmt":"2022-10-19 21:59:04","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=120","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"},{"ID":131,"post_author":"7211","post_date":"2015-10-21 15:20:16","post_date_gmt":"2015-10-21 15:20:16","post_content":"[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453403441710{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]\r\n<h2>Access to reliable and timely data about the causes of death is essential for planning and implementing health services.<\/h2>\r\nA systematic analysis of mortality trends and events leading to deaths can help identify system breakdowns and address deficiencies in service delivery. This process shows a greater impact on practices and outcomes than other quality improvement strategies, particularly in settings where the audit process includes an action plan and clear targets. By establishing a multidisciplinary and no-blame environment, common problems and solutions can be identified.\r\n\r\nThe need to better understand why stillbirths and neonatal deaths occur, and what can be done to prevent them, has led to the development of <i><a href=\"http:\/\/www.who.int\/maternal_child_adolescent\/documents\/stillbirth-neonatal-death-review\/en\/\">Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths<\/a><\/i>. It provides the\u00a0methodology and tools for developing a mortality audit system with links to surveillance, civil registration and vital statistics, with instruction on counting, classifying and investigating stillbirths and neonatal deaths in order to prevent future avoidable deaths, in facilities and communities. There is also\u00a0guidance on establishing a legal and ethical\u00a0environment in which to create quality improvement\u00a0processes, without fear of blame or punitive actions.\u00a0Many countries already use the <a href=\"https:\/\/www.who.int\/teams\/maternal-newborn-child-adolescent-health-and-ageing\/maternal-health\/maternal-and-perinatal-death-surveillance-and-response\">Maternal Death\u00a0Surveillance and Response\u00a0process<\/a> as a strategy for\u00a0addressing maternal mortality. This new WHO guide will enable countries to build on Maternal Death Surveillance and Response platforms in order to improve care for babies, within an overall framework of quality of care\u00a0improvement and aligned with <a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/standards-improving-quality-maternal-newborn-care-health-facilities\/\">WHO\u2019s quality of care initiative.<\/a>[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">81<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1666046345167{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of countries <a href=\"https:\/\/www.who.int\/teams\/maternal-newborn-child-adolescent-health-and-ageing\/maternal-health\/maternal-and-perinatal-death-surveillance-and-response\">reported a national policy or guideline<\/a> requiring notification all of maternal deaths within 24 hours.\u00a0<\/span><\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">67<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1666046356459{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of\u00a0countries <a href=\"https:\/\/www.who.int\/teams\/maternal-newborn-child-adolescent-health-and-ageing\/maternal-health\/maternal-and-perinatal-death-surveillance-and-response\">reported a national policy or guideline<\/a> for review of neonatal deaths.\u00a0<\/span><\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-blue\" width=\"1\/3\"][vc_column_text]\r\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">44<\/span><\/strong><\/h1>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1666046368034{padding-top: 10px !important;padding-bottom: 10px !important;}\"]\r\n<h3 style=\"text-align: center;\">percentage of countries that <a href=\"https:\/\/www.who.int\/teams\/maternal-newborn-child-adolescent-health-and-ageing\/maternal-health\/maternal-and-perinatal-death-surveillance-and-response\">reported a national policy or guideline<\/a> requiring review of stillbirths.<\/h3>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_column_text]\r\n<h6 style=\"text-align: center;\"><span style=\"font-style: italic;\">All data on this page represents the most recent data available, unless otherwise noted. Please visit our\u00a0<\/span><a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\"><span style=\"font-style: italic;\">Newborn Numbers<\/span><\/a><span style=\"font-style: italic;\">\u00a0page and download the Excel spreadsheet to explore the data further.<\/span><\/h6>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" css=\".vc_custom_1452696349804{margin-top: 30px !important;margin-bottom: 30px !important;background-color: #f6f6f4 !important;}\"][vc_column][vc_text_separator title=\"More information\" color=\"custom\" accent_color=\"#cccccc\"][vc_row_inner equal_height=\"yes\"][vc_column_inner width=\"1\/2\"][vc_column_text]One of the key actions recommended in both the Every Newborn Action Plan (ENAP) and the Ending Preventable Maternal Mortality (EPMM) strategy is the institutionalization of maternal and perinatal death surveillance and response systems to enable a country\u2019s use of audit data to track and prevent maternal and early newborn deaths as well as stillbirths.\r\n\r\nThe process of routine identification and timely notification of deaths is a continuous action cycle, ideally linking quality improvement from the local to the national level. Although women and their babies share the same period of highest risk, often with the same health workers present, there has been little movement towards capturing information for stillbirths and neonatal deaths. Basic information for every birth and death is needed, along with a critical review of selected deaths. [\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/2\"][vc_column_text]Mortality audit can have multiple entry points into the health system, ranging from a single hospital to a nationally mandated program covering the community and facility levels. Generally, deaths that occur in facilities have more information available compared to those in communities, and future cases may be easier to identify and prevent. However, we\u00a0need to ensure all births and deaths are counted, no matter where they occur. We also\u00a0need strategies to determine\u00a0the number and causes of death among the 50 million births that take place in communities each year.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_text_separator title=\"Key Resources\" color=\"custom\" accent_color=\"#cccccc\"][vc_column_text]\r\n<ul>\r\n \t<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/maternal-and-perinatal-death-and-surveillance-and-response\/\">Maternal and perinatal death and surveillance and response<\/a> (2021)<\/li>\r\n \t<li><a href=\"https:\/\/www.up.ac.za\/centre-for-maternal-fetal-newborn-and-child-healthcare\/article\/2871749\/the-perinatal-problem-identification-programme\" target=\"_blank\" rel=\"noopener\">South Africa's Perinatal Problem Identification Programme<\/a><\/li>\r\n \t<li><a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.12904\/pdf\" target=\"_blank\" rel=\"noopener\">Towards greater effectiveness of perinatal death audit in low- and middle-income countries<\/a><\/li>\r\n \t<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4577789\/\" target=\"_blank\" rel=\"noopener\">Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789241511223\">Making Every Baby Count WHO audit guide<\/a><\/li>\r\n \t<li><a href=\"\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/MCSP-PNDA-Brief_8.12.16.pdf\">Making Every Baby Count policy brief<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=cZ6L53EYXgQ\">Making Every Baby Count Video. Audit and Review of Stillbirths and Neonatal Deaths<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=aus5n0qQFgk\">Setting up a Death Review Committee Video<\/a><\/li>\r\n<\/ul>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"Mortality audit","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"mortality-audits","to_ping":"","pinged":"","post_modified":"2022-10-18 15:30:09","post_modified_gmt":"2022-10-18 19:30:09","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=131","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"}],"additional_authors":"Robert Pattinson, Kate Kerber, Peter Waiswa, Louise T. Day, Felicity Mussell, Sk Asiruddin, Hannah Blencowe, Joy E. Lawn","authors":[{"ID":767,"user_firstname":"","user_lastname":"","nickname":"Eraree Wrebyi","user_nicename":"eraree-wrebyi","display_name":"ErareeWrebyi","user_email":"ErareeWrebyi@gmail.com","user_url":"","user_registered":"2011-04-19 15:12:00","user_description":"","user_avatar":"<img alt='' src='https:\/\/secure.gravatar.com\/avatar\/ca83b8b619f0b9389a91a6e199bb9803?s=96&d=mm&r=g' srcset='https:\/\/secure.gravatar.com\/avatar\/ca83b8b619f0b9389a91a6e199bb9803?s=192&d=mm&r=g 2x' class='avatar avatar-96 photo' height='96' width='96' decoding='async'\/>"},{"ID":2219,"user_firstname":"Jessamyn","user_lastname":"Wead","nickname":"jwead","user_nicename":"jessamyn-wead","display_name":"Jessamyn Wead","user_email":"jwead@vitaminangels.org","user_url":"","user_registered":"2011-11-04 19:19:00","user_description":"","user_avatar":"<img alt='' src='https:\/\/secure.gravatar.com\/avatar\/63eccc75450104fea021f5e6fb688433?s=96&d=mm&r=g' srcset='https:\/\/secure.gravatar.com\/avatar\/63eccc75450104fea021f5e6fb688433?s=192&d=mm&r=g 2x' class='avatar avatar-96 photo' height='96' width='96' decoding='async'\/>"}],"other_organizations":"FIGO","language":["en"],"type":"articles","external_links":[{"link":"http:\/\/download.journals.elsevierhealth.com\/pdfs\/journals\/0020-7292\/PIIS0020729209003622.pdf"}],"files":[{"file":"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/Perinatal-Mortality-Audit_FIGO.pdf"}],"regions":[],"countries":[],"partners":[]},"_links":{"self":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/resource\/9906"}],"collection":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/resource"}],"about":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/types\/resource"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/users\/7211"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/comments?post=9906"}],"version-history":[{"count":0,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/resource\/9906\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media\/9908"}],"wp:attachment":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media?parent=9906"}],"wp:term":[{"taxonomy":"toolkit","embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/toolkit?post=9906"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}