Prospective Study to Explore Changes in Quality of Care and Perinatal Outcomes After Implementation of Perinatal Death Audit in Uganda(Article)
Currently, about 2.7 million neonatal deaths and 2.6 million stillbirths occur worldwide every year. Of these, the majority occur in low-income and middle-income countries, and more than half (55%) of the global stillbirths occur in sub-Saharan Africa and South Asia.1 Uganda’s perinatal mortality is estimated to be 36 deaths per 1000 births and remains unacceptably high. Almost 50% of these are fresh stillbirths.2 The neonatal mortality rate (21 per 1000 live births) in Uganda is also high, contributing 50% of the infant mortality rate.3 It is crucial that interventions are put in place to reduce preventable neonatal deaths and stillbirths. Perinatal death audit (or review) can be used to identify areas of care which can be strengthened to improve perinatal outcomes.4 It involves reviewing cases of mortality with a view to identifying avoidable factors and implementing changes to prevent future deaths. A population-based cohort study of 943 perinatal mortalities that occurred in 90 hospitals in the Netherlands reported a decrease in substandard care (from 10% to 5%) and perinatal mortality (from 2.3 to 2.0/1000 births; p<0.00001) after the introduction of perinatal death audit.5 Similarly, in a systematic review focusing on low-income and middle-income countries, a meta-analysis of seven before-and-after studies reported a 30% (95% CI 21% to 38%) reduction in perinatal mortality after introduction of perinatal death audit in healthcare facilities.6 However, the authors considered most studies included in the review as of low quality. Thus, there is a paucity of data from low-resource settings on the use of and effectiveness of perinatal death audit to improve the quality of care provided to mothers and their babies. The systematic review recommended more research in key areas, including exploring the effect of facility-based perinatal death audit on changing the quality of care.6 The aim of this study is to assess the changes in perinatal outcomes observed after the introduction of perinatal death audit in a tertiary hospital in Uganda and to describe the changes in healthcare provided to mother and babies resulting from the perinatal death audits
Authoured by: Victoria Nakibuuka Dr.