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Int J Gynaecol Obstet. 2009 Oct;107 Suppl 1:S113-21, S121-2. doi: 10.1016/j.ijgo.2009.07.011.

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

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1
MRC Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa. robert.pattinson@up.ac.za

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.

PMID:
19815206
DOI:
10.1016/j.ijgo.2009.07.011
[Indexed for MEDLINE]
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