Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Open
Abstract
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.
Description
Keywords
Prospective study, Perinatal outcomes, Perinatal death audit, Uganda
Citation
Kirabira VN, Aminu M, Dewez JE, et al. Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda. BMJ Open 2020;10:e027504. doi:10.1136/ bmjopen-2018-027504