Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

Kirabira, Victoria Nakibuuka, Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Dewez, Juan, Byaruhanga, Romano, Okong, Pius and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2020) 'Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda'. BMJ Open, Vol 10, Issue 7, e027504.

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Abstract

Objective To assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.

Design Interrupted time series (ITS) analysis.

Setting Nsambya Hospital, Uganda.

Participants Live births and stillbirths.

Interventions PND audit.

Primary and secondary outcome measures Primary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.

Results 526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.

Conclusion The introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjopen-2018-027504
Depositing User:	Stacy Murtagh
Date Deposited:	10 Jul 2020 13:28
Last Modified:	10 Jul 2020 13:28
URI:	https://archive.lstmed.ac.uk/id/eprint/15007

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