Making Every Baby Count

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Key messages of this guide • Auditing stillbirths and neonatal deaths requires capturing basic information on all births and deaths, as well as a more in-depth analysis of the critical factors involved in selected cases, with the aim of identifying and implementing ways to improve the quality of maternal and newborn care. • The true burden of stillbirths and neonatal deaths has been unknown and thus silenced for too long. Improving measurement is the first step to understanding where action is needed. • It is possible to establish a system to assess the burden of stillbirths and neonatal deaths, including trends in numbers and causes of death, and the data must be linked to action at the relevant level. • These data can be used to provide accountability for results and compel decisionmakers to pay due attention and respond to the problem of stillbirths and neonatal deaths. Champions and local leaders are required to lead the review and audit process and translate this information into effective action. • In addition to leadership, appropriate protections, legal and otherwise, must be in place to create an enabling environment in which critical review of practices can take place. • There is no long list of requirements needed to initiate a death review. Users only need to decide to learn from the experience and adapt the approach as needed. 8 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS
MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS 9
Page 1 and 2: Making Every Baby Count Audit and r
Page 3: Making Every Baby Count Audit and r
Page 6 and 7: 4.3 The six-step mortality audit cy
Page 8 and 9: Acknowledgements The World Health O
Page 10 and 11: Foreword Pregnancy is a time of gre
Page 12 and 13: in the future. The process of routi
Page 16 and 17: 1 Getting started
Page 18 and 19: 1.2 Why is this guide important? Co
Page 20 and 21: Importantly, it is not sufficient t
Page 22 and 23: 2 Definitions and classification Th
Page 24 and 25: There are also numerous ways to app
Page 26 and 27: TABLE 2.1. Mortality rate definitio
Page 28 and 29: application of ICD-10 to deaths dur
Page 30 and 31: Box 2.1. Background and contextual
Page 32 and 33: • Family- or patient-related: e.g
Page 34 and 35: 3 Auditing deaths that occur at the
Page 36 and 37: Within each facility, at least two
Page 38 and 39: compared to the actual numbers of r
Page 40 and 41: of events that led to death, text b
Page 42 and 43: • the number of antepartum (or ma
Page 44 and 45: Possible actions include interventi
Page 46 and 47: Step 6: Evaluating and refining The
Page 48 and 49: 4 Auditing deaths that occur in the
Page 50 and 51: (e.g. individuals who conduct routi
Page 52 and 53: The most effective mechanism for in
Page 54 and 55: Step 1.2: Notification and reportin
Page 56 and 57: It may be easier for an information
Page 58 and 59: Geospatial analyses may be very ben
Page 60 and 61: 5 Creating an enabling environment
Page 62 and 63: will help facilitate the process fo
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Maternal and Perinatal Death Review
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6 Scaling up audit for quality and
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FIGURE 6.1. Dimensions of a phased
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FIGURE 6.2. Example of data flow in
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References 1. Maternal death survei
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39. Bradshaw D, Chopra M, Kerber K,
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Annexes Annex 1 Stillbirth and Neon
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3.6 Fetal heart sounds on admission
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Annex 1b. Guidance for completing t
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• “unknown” if the total numb
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• If fetal heart sounds were not
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-- If a “delay 1” is present, c
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. antepartum complications Annex 2:
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2.1b: Cause of death - intrapartum
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Annex 3b. Guidance for collecting t
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3) If there is no gestational age e
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Annex 4. Approaches for classifying
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There are multiple tools available
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to their occurrence - are entered o
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Annex 6. Sample mortality audit mee
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Annex 8: Stillbirth and Neonatal Mo
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Steps 1. Understand the steps of th
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INFORMED CONSENT FORM (INTERVIEWEE
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SEQUENTIAL NUMBER SECTION 1. INTER
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SECTION 3. INFORMATION ON THE DECEA
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ASK THE RESPONDENT: What do you thi
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4.4.2 Before the woman became pregn
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4.16.2 During the last 3 months of
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5.5 How many hours or days passed b
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5.18 Would you say the baby’s siz
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5.33 Did the baby ever move, even a
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SECTION 6. NEONATAL ILLNESS HISTORY
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6.17 Did the baby have a swollen st
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SECTION 7. HISTORY OF INJURIES/ACCI
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8.7 What were the reasons the baby
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8.15.2 What difficulties did you ha
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SECTION 9. DATA ABSTRACTED FROM REC
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VA Supervisor comments and observat
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