THE MAIN TOOLS OF THE CONFIDENTIAL AUDIT OF PERINATAL MORTALITY: A REVIEW
Introduction. Perinatal mortality audits and reviews are conducted to identify preventable factors in mortality, identify weaknesses in health services, and make recommendations to improve the quality of neonatal care.
This study aimed to assess the effectiveness of confidential audit of perinatal mortality through a content analysis of the use of different confidential audit tools in various countries.
Research Strategy. Data were searched in medical databases such as Scopus, Cohrane Library, PubMed, and Embase. 50 relevant articles on the topic were selected, in addition, data from WHO and UNICEF manuals and reports.
Results. The main methods of confidential audit are verbal and social autopsy, analysis and expert evaluation of medical history and clinical cases, classification of suboptimal help, and a combination of these methods. Identification of modifiable factors is widely and effectively used in many countries. The involvement of bereaved parents in the audit process has benefits and value for parents and healthcare providers, and it has gradually been introduced into the audit process in some countries.
In the Netherlands, a decrease in perinatal mortality from 2.3 to 2.0/1000 births (p<0.00001) was observed during the audit between 2010 and 2012 [15]. A meta-analysis of 7 studies also found that perinatal mortality decreased by an average of 30% (95% confidence interval, 21 to 38%) in low- and middle-income countries following perinatal audits [42]. In Uganda, the perinatal mortality rate was 47.9 deaths per 1000 births in 2008 after the introduction of the audit, compared to 52.8 per 1000 births in 2007 [37].
Conclusions. Based on the review, it can be concluded that the main tools of confidential audit, such as identification of suboptimal care, modifiable factors, and expert assessment, are used quite effectively in different countries. According to the meta-analysis and systematic review, perinatal mortality is reduced by audits in both developed and developing countries. Perinatal mortality reviews should be continued to better understand the effectiveness of audit.
Nazerke Е. Samatova1-2, https://orcid.org/0009-0005-1548-8744
Gulnara М. Kamalbekowa1, https://orcid.org/0000-0001-9883-6321
Kulyash К. Jaxalykova1, https://orcid.org/0000-0001-5540-3331
Aiman А. Mussina1, https://orcid.org/0000-0002-4429-6240
Bekturgan Т. Karin1, https://orcid.org/0000-0002-8080-787X
1. «Об утверждении правил проведения конфиденциального аудита в медицинских организациях», Приказ Министра здравоохранения Республики Казахстан от 28 октября 2020 года № ҚР ДСМ-164/2020. Зарегистрирован в Министерстве юстиции Республики Казахстан 30 октября 2020 года № 21561. https://adilet.zan.kz/rus/docs/V2000021561. (Дата обращения: 04.02.2024)
2. «Первый отчет по результатам перинатального аудита в пилотных организациях Республики Казахстан», Отчет Unicef, Астана, 2018, https://www.unicef.org/kazakhstan/media. (Дата обращения: 04.02.2024)
3. Республиканский центр электронного здравоохранения, 2023, https://rcez.kz/ (Дата обращения: 12.01.2024)
4. Чувакова Т.К., Карин Б.Т., Азаматова Э.М., Марат А.М. Результаты первого опыта Казахстана в проведении перинатального аудита. Астана медициналық журналы. 2020, №4(106), С.198-206. .
5. Чувакова Т.К., Карин Б.Т., Джаксалыкова К.К., Жумамбаева С.М. Резервы снижения ранней неонатальной смертности в Республике Казахстан по результатам конфиденциального аудита. Наука и Здравоохранение, 2021 5 (Т.23), С.49-57, DOI 10.34689/SH.2021.23.5.006.
6. Akseer Nadia, Lawn Joy E., Keenan William, Konstantopoulos Andreas, Cooper Peter, Ismail Zulkifli, Thacker Naveen, Cabral Sergio, Bhutta Zulfiqar A. Ending preventable newborn deaths in a generation. Int J Gynaecol Obstet, 2015 Oct. 131 Suppl 1: S. 43-8, doi: 10.1016/j.ijgo.2015.03.017.
7. Baauw Ludovic, Rosman Ageeth N., van den Akker Thomas H. Lessons learned in cases of late preterm mortality in the Netherlands: Results from nationwide perinatal audits, a mixed method study. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 17, 100179, 2023, https://doi.org/10.1016/j.eurox.2023.100179 .
8. Bakhbakhi D., Burden C., Storey C., et al., Parents 2 Study: a qualitative study of the views of healthcare professionals and stakeholders on parental engagement in the perinatal mortality review from ‘bottom of the pile’’ to joint learning’. BMJ Open, 2019 Feb 22. 8(11):e023792, https://doi.org/10.1136/bmjopen-2018-023792. (Accessed: 20.04.2024)
9. Blencowe Hannah, Calvert Clara, Lawn Joy E., Cousens Dip Simon, Campbell Oona M.R. Measuring maternal, foetal and neonatal mortality: Challenges and solutions. Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 36, October 2016, 14-29, https://doi.org/10.1016/j.bpobgyn.2016.05.006. (Accessed: 21.04.2024)
10. Burden C., Bakhbakhi D., Heazell A.E, et al. Parents’ active role and engagement in the review of their stillbirth/perinatal death 2 (PARENTS 2) study: a mixed methods study of implementation. BMJ Open 11, 2021 Mar 16. 11(3):e044563. doi: 10.1136/bmjopen-2020-044563.
11. Demise A., Gebrehiwot Y., Worku B., Spector J.M. Prospective Audit of Avoidable Factors in Institutional Stillbirths and Early Neonatal Deaths at Tikur Anbessa Hospital in Addis Ababa, Ethiopia. African Journal of Reproductive Health, December 2015, 19 (4): 78-86, PMID: 27337856, https://www.jstor.org/stable/24877612. (Accessed: 20.04.2024)
12. de Barros Medeiros Poliana, Flenady Vicki, Andrews Christine, et al. Evaluation of an online education program for healthcare professionals on best practice management of perinatal deaths: IMPROVE eLearning. Aust N Z J Obstet Gynaecol 2024. 64: 63–71, DOI: 10.1111/ajo.13743.
13. Dehaene Isabelle, Roelens Kristien, Page Geert. How an extended perinatal audit may improve perinatal policy. The Journal of Maternal-Fetal & Neonatal Medicine, Volume 28, 2015 - Issue 14, P. 1669-1672, doi.org/10.3109/14767058.2014.964673.
14. Dessu Samuel, Zinabu Dawit. Perinatal Mortality and Associated Factors Among Antenatal Care Attended Pregnant Mothers at Public Hospitals in Gamo Zone, Southern Ethiopia, Front. Pediatr., 23 December 2020, Sec. Neonatology, Volume 8 - 2020 | https://doi.org/10.3389/fped.2020.586747. (Accessed: 20.04.2024)
15. Eskes Martine, Waelput Adja J.M., Erwich Jan Jaap H.M., et al. Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study. BMJ Open 2014. 4:e005652. doi:10.1136/bmjopen-2014- 005652
16. Gebhardt G.S., de Waard L. Audit as a tool for improving obstetric care in low- and middle-income countries. Best Practice & Research Clinical Obstetrics & Gynaecology 2024. 94, 102477. https://doi.org/10.1016/j.bpobgyn.2024.102477. (Accessed: 15.08.2024)
17. Ghimire Pramesh Raj, Agho Kingsley E., Renzaho Andre M. N., Nisha Monjura K., Dibley Michael, Raynes-Greenow Camille. Factors associated with perinatal mortality in Nepal: evidence from Nepal demographic and health survey 2001–2016. BMC Pregnancy and Childbirth, 2019 Mar 11.19(1):88, https://doi.org/10.1186/s12884-019-2234-6. (Accessed: 23.04.2024)
18. Gieles Noor C., Tankink Julia B., van Midde Myrthe, Düker Johannes, van der Lans Peggy, Wessels Catherina M., Bloemenkamp Kitty W. M., Bonsel Gouke, van den Akker Thomas, Goosen Simone. Maternal and perinatal outcomes of asylum seekers and undocumented migrants in Europe: a systematic review. European Journal of Public Health, 2019 Aug 1;29(4), 714–723, https://doi.org/10.1093/eurpub/ckz042. (Accessed: 21.04.2024)
19. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015, The Lancet, Volume 388, Issue 10053, 8–14 October 2016, 1725-1774, https://doi.org/10.1016/S0140-6736(16)31575-6.
20. Gordijn Sanne J., Korteweg Fleurisca J., Erwich Jan Jaap H.M., Holm Jozien P., et al. A multilayered approach for the analysis of perinatal mortality using different classification systems. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2009 Jun;144(2):99-104. doi: 10.1016/j.ejogrb.2009.01.012.
21. Gutman Arlene, Harty Tommy, O'Donoghue Keelin, Greene Richard, Leitao Sara. Perinatal mortality audits and reporting of perinatal deaths: systematic review of outcomes and barriers. J Perinat Med, 2022 Jan 26. 50(6):684-712. doi: 10.1515/jpm-2021-0363.
22. Harsha Kumar H.N., Shantaram B. Baliga, Kushtagi Pralhad, Kamath Nutan; Rao Suchetha S. Utility of Expert Panel to Identify Preventable Perinatal Deaths: Results from Audit Based Interventional Study in Two Districts of Karnataka State, India. National Journal of Community Medicine, 1 August 2023, 519-524, DOI 10.55489/njcm.140820233157.
23. Helps Aenne, Leitao Sara, Greene Richard, O'Donoghue Keelin. Perinatal mortality audits and reviews: Past, present and the way forward. European Journal of Obstetrics and Gynecology and Reproductive Biology, Volume 250, 24 – 30, doi: 10.1016/j.ejogrb.2020.04.054.
24. Helps Änne, Leitao Sara, Gutman Arlene, Greene Richard, O'Donoghue Keelin. National perinatal mortality audits and resultant initiatives in four countries. European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 267, December 2021, 111-119, DOI:10.1016/j.ejogrb.2021.10.012.
25. Kidanto Hussein L., Mogren Ingrid, Jos van Roosmalen, Thomas Angela N., Massawe Siriel N., Nystrom Lennarth, Lindmark Gunilla. Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Pregnancy and Childbirth 2009, 9:45, doi:10.1186/1471-2393-9-45.
26. Kinney Mary, Bergh Anne-Marie, Rhoda Natasha, Pattinson Robert, George Asha. Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach. BMJ Global Health 2022. 7:e009242, doi:10.1136/ bmjgh-2022-00924.
27. Kinney Mary V., George Asha S., Rhoda Natasha R., Pattinson Robert C., Bergh Anne-Marie. From Pre-Implementation to Institutionalization: Lessons From Sustaining a Perinatal Audit Program in South Africa. Glob Health Sci Pract, 2023 Apr 28. 11(2):e2200213. doi: 10.9745/GHSP-D-22-00213.
28. Kortekaas Joep C., Scheuer Anke C., Esteriek de Miranda, Aimée E. van Dijk, et al. Perinatal death beyond 41 weeks pregnancy: an evaluation of causes and substandard care factors as identified in perinatal audit in the Netherlands. 2018 Sep 20;18(1):380. doi: 10.1186/s12884-018-1973-0.
29. Levels and trends in child mortality, developed by the United Nations Inter-Agency Group for Child Mortality Estimation, WHO, 2022 report, 2023 report.
30. Making every baby count: audit and review of stillbirths and neonatal deaths: highlights from the World Health Organization 2016 audit guide (2016), WHO/RHR/16.11 WHO/MCA/16.03, 2016, https://iris.who.int/handle/10665/255034. (Accessed: 26.04.2024)
31. Marincowitz Gert J.O., Marincowitz Clara Neonatal death audits at Kgapane Hospital, Limpopo province, South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 22 December 2023, 22;65(1):e1-e5. doi: 10.4102/safp.v65i1.5815.
32. Mdoe Paschal, Katengu Sifaeli, Guga Godfrey, Daudi Vickfarajaeli, Kiligo Ibrahim Ernest, Gidabayda Joshua, Massay Catherine, Mkini Felix, Mduma Estomih. Perinatal mortality audit in a rural referral hospital in Tanzania to inform future interventions: A descriptive study. PLoS ONE 17(3):e0264904. https://doi.org/10.1371/journal.pone.0264904 (Accessed: March 11, 2022).
33. Merali H.S., Lipsitz S., Hevelone N., Gawande A.A., Lashoher A., Agrawal P. Spector J: Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review. BMC Pregnancy Childbirth 2014. 14:280–280. 10.1186/1471-2393-14-280. https://doi.org/10.1186/1471-2393-14-280. (Accessed: 23.04.2024)
34. Monmany Núria Torre, Astete Joaquín Américo, Dasarath Ramaiah, Suchitra Jyothi, Krauel Xavier, Fillol Manolo, Balasubbaiah Yadamala, Ana Alarcón, Bassat Quique. Extended Perinatal Mortality Audit in a Rural Hospital in India, 2023 Mar. 40(4):375-386, DOI: 10.1055/s-0041-1727220.
35. Musafili Aimable, Persson Lars-Åke, Baribwira Cyprien, Pafs Jessica, Mulindwa Patrick Adam, Essén Birgitta. Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis. BMC Pregnancy Childbirth, 2017 Mar 11;17(1):85. doi: 10.1186/s12884-017-1269-9.
36. Nakibuuka Kirabira Victoria, Aminu Mamuda, Dewez Juan Emmanuel, et al. Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda. 2020 Jul 8. 10(7):e027504. doi: 10.1136/bmjopen-2018-027504.
37. Nakibuuka V.K., Okong P., Waiswa P., Byaruhanga R.N. Perinatal death audits in a peri-urban hospital in Kampala. Uganda. Afr Health Sci. 2012 Dec. 12(4): 435–442. doi: 10.4314/ahs.v12i4.6.
38. Nonyane Rose, du Plessis Emmerentia, Clase Jeannette. Identifying avoidable causes of perinatal deaths in a district hospital in Lesotho. Curationis, 2024 Feb 29;47(1):e1-e8, DOI 10.4102/curationis.v47i1.2497.
39. O’Connor Emily, Leitao Sara, Fogarty Amy P., Greene Richard, O’Donoghue Keelin. A systematic review of standardised tools used in perinatal death review programmes. Women and Birth, 37, 2024, 88–97, https://doi.org/10.1016/j.wombi.2023.09.0064. (Accessed: 15.08.2024)
40. Ogola Muthoni, Njuguna Emily Mbaire, Aluvaala Jalemba, English Mike, Irimu Grace. Audit identified modifiable factors in Hospital Care of Newborns in low-middle income countries: a scoping review. BMC Pediatr, 2022 Feb 18;22(1):99. DOI:10.1186/s12887-021-02965-w. (Accessed: 21.04.2024)
41. Pattinson R.C., Say L., Makin J. D., Bastos M.H. Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity. Cochrane Database Syst Rev. 2005 Oct 19; 2005(4):CD002961, DOI:10.1002/14651858.CD002961.pub2. (Accessed: 20.04.2024)
42. Pattinson_R., Kerber_K., Waiswa_P., Day_L.T., Mussell_F., Asiruddin_S.K., et al., Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. International Journal of Gynecology & Obstetrics 2009. 107 (Suppl, S113-S122, doi: 10.1016/j.ijgo.2009.07.011.
43. Sauvegrain Priscille, Carayol Marion, Piedvache Aurélie, Guéry Esther, Bréart Gérard, Bucourt Martine, Zeitlin Jennifer. the REMIP Investigator Team, Understanding high rates of stillbirth and neonatal death in a disadvantaged, high-migrant district in France: A perinatal audit. Acta Obstet Gynecol Scand. 2020. 99:1163–1173, DOI: 10.1111/aogs.13838.
44. Standards for improving quality of maternal and newborn care in health facilities, World Health Organization, 2016, ISBN 978 92 4 151121 6 (NLM classification: WA 310).
45. van Diem Mariet Th., Timmer Albertus, Sanne Gordijn J., Bergman Klasien A., Korteweg Fleurisca J., Ravise Joke, Vreugdenhil Ellen, Erwich Jan Jaap H.M. Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system. BMC Pregnancy and Childbirth, 2015. 15:215 DOI 10.1186/s12884-015-0638-5.
46. van Diem Mariet Th., Timmer Albertus, Bergman Klasien A., Bouman Katelijne, van Egmond Nico, Stant Dennis A., Ulkeman Lida H.M., Veen Wenda B., Erwich JanJaap H.M. Erwich, The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands, BMC Health Services Research, volume 12, Article number: 195, 2012, https://doi.org/10.1186/1472-6963-12-195. (Accessed: 26.04.2024)
47. Verschuuren A.E.H., Tankink J.B., Postma I.R., Bergman K.A., Goodarzi B., Feijen-de Jong E.I., Erwich J.J. Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands, June 27, 2024. PLOS ONE https://doi.org/10.1371/journal.pone.0305764. (Accessed: 16.08.2024)
48. Walker Neff, Yenokyan Gayane, Friberg Ingrid K, Bryce Jennifer. Patterns in coverage of maternal, newborn, and child health interventions: projections of neonatal and under-5 mortality to 2035. The Lancet, 2013, Volume 382, Issue 9897, 1029 – 1038, https://doi.org/10.1016/S0140-6736(13)61748-1. (Accessed: 26.04.2024)
49. World Health Organization. Neonatal and perinatal mortality: country, regional and global estimates. Geneva: WHO; 2006.
50. Wuni Francis, Kukeba Margaret W., Yakubu Zakariah, Nyaabila Emmanuella A., Saanwie Aiden S. Contributory factors to early neonatal deaths in the Upper East Regional Hospital in Ghana. Ghana Medical Journal, 57(2): 128-133, June 2023, DOI 10.4314/gmj.v57i2.7.
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Samatova N.Е., Kamalbekova G.М., Jaxalykova К.К., Mussina А.А., Karin B.Т. The main tools of the confidential audit of perinatal mortality: a review // Nauka i Zdravookhranenie [Science & Healthcare]. 2024. Vol.26 (5), pp. 150-159. doi 10.34689/SH.2024.26.5.019Related publications:
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