Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review
Purpose To identify approaches, enablers, barriers and outcomes of facility stillbirth and neonatal death audit in low-income and middle-income countries (LMICs).Data sources We searched MEDLINE, CINAHL Complete, Academic Search Index, Science Citation Index, Complementary index and Global health el...
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doaj-5e44918683c549c09242f28002d298cc2021-04-22T10:00:58ZengBMJ Publishing GroupBMJ Open Quality2399-66412021-03-0110110.1136/bmjoq-2020-001266Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic reviewStephen Allen0Mamuda Aminu1Mtisunge Joshua Gondwe2John Michael Mhango3Nicola Desmond4Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UKCentre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UKDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UKDepartment of Monitoring and Evalaution, Nurses and Midwives Council of Malawi, Lilongwe, MalawiBehaviour and Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, MalawiPurpose To identify approaches, enablers, barriers and outcomes of facility stillbirth and neonatal death audit in low-income and middle-income countries (LMICs).Data sources We searched MEDLINE, CINAHL Complete, Academic Search Index, Science Citation Index, Complementary index and Global health electronic databases.Study selection Studies were considered eligible when reporting the approaches, enablers, barriers and outcomes of facility-based stillbirth and neonatal death audit in LMICs.Data extraction Two authors independently performed the data extraction using predefined templates made before data extraction.Results of data synthesis A total of 10 articles from 7 countries were included in the final analysis. Facility or external multidisciplinary teams performed death audits on a weekly or monthly basis. A total of 1018 stillbirths and neonatal deaths were audited. Of 18 audit enablers identified, nine were at the health provider level while 18 of 23 barriers to audit that were identified occurred at the facility level. The facility-level barriers cited by more than one study included: failure to implement change; inadequate training; limited time; increased workload; too many cases and poor documentation. Six studies reported that death audits resulted in structural improvements in physical structure, training, service organisation, supplies and equipment in the wards. Five studies reported that death audits improved the standard of care, with one study showing a significant improvement in measured standards. One study reported a significant reduction in newborn mortality rate of 29.4% (95% CI 0.6% to 2.4%; p=0.0015) and one study a reduction in perinatal mortality of 4.9% (52.8% in 2007 to 47.9% in 2008) before and after perinatal audit implementation.Conclusion Stillbirth and neonatal death audit improves facility structures, processes of care and health outcomes in neonatal care. There is a need to enhance enablers and address barriers identified at both health provider and facility levels to improve the audit process.https://bmjopenquality.bmj.com/content/10/1/e001266.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stephen Allen Mamuda Aminu Mtisunge Joshua Gondwe John Michael Mhango Nicola Desmond |
spellingShingle |
Stephen Allen Mamuda Aminu Mtisunge Joshua Gondwe John Michael Mhango Nicola Desmond Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review BMJ Open Quality |
author_facet |
Stephen Allen Mamuda Aminu Mtisunge Joshua Gondwe John Michael Mhango Nicola Desmond |
author_sort |
Stephen Allen |
title |
Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review |
title_short |
Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review |
title_full |
Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review |
title_fullStr |
Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review |
title_full_unstemmed |
Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review |
title_sort |
approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in lmics: a systematic review |
publisher |
BMJ Publishing Group |
series |
BMJ Open Quality |
issn |
2399-6641 |
publishDate |
2021-03-01 |
description |
Purpose To identify approaches, enablers, barriers and outcomes of facility stillbirth and neonatal death audit in low-income and middle-income countries (LMICs).Data sources We searched MEDLINE, CINAHL Complete, Academic Search Index, Science Citation Index, Complementary index and Global health electronic databases.Study selection Studies were considered eligible when reporting the approaches, enablers, barriers and outcomes of facility-based stillbirth and neonatal death audit in LMICs.Data extraction Two authors independently performed the data extraction using predefined templates made before data extraction.Results of data synthesis A total of 10 articles from 7 countries were included in the final analysis. Facility or external multidisciplinary teams performed death audits on a weekly or monthly basis. A total of 1018 stillbirths and neonatal deaths were audited. Of 18 audit enablers identified, nine were at the health provider level while 18 of 23 barriers to audit that were identified occurred at the facility level. The facility-level barriers cited by more than one study included: failure to implement change; inadequate training; limited time; increased workload; too many cases and poor documentation. Six studies reported that death audits resulted in structural improvements in physical structure, training, service organisation, supplies and equipment in the wards. Five studies reported that death audits improved the standard of care, with one study showing a significant improvement in measured standards. One study reported a significant reduction in newborn mortality rate of 29.4% (95% CI 0.6% to 2.4%; p=0.0015) and one study a reduction in perinatal mortality of 4.9% (52.8% in 2007 to 47.9% in 2008) before and after perinatal audit implementation.Conclusion Stillbirth and neonatal death audit improves facility structures, processes of care and health outcomes in neonatal care. There is a need to enhance enablers and address barriers identified at both health provider and facility levels to improve the audit process. |
url |
https://bmjopenquality.bmj.com/content/10/1/e001266.full |
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