Making Every Baby Count

1.2 Why is this guide important?
Counting the numbers more accurately, and gaining a better understanding of the causes
of death are key to tackling the burden of 2.7 million neonatal deaths (5) and 2.6 million
stillbirths that are estimated to occur each year. Many resource-poor settings lack effective
civil registration and vital statistics (CRVS) systems for counting all births and deaths and
assigning cause of death. Half of the world’s babies do not currently receive a birth certificate;
and most neonatal deaths and almost all stillbirths receive no death certificate, let
alone information on causes of death and contextual factors contributing to them (4). Many
countries have limited capacity for capturing data on neonatal deaths beyond the healthcare
facility level, especially those countries where births are not registered, and very few
countries have a system for tracking stillbirths at all, despite increasing demand for data.
National estimates of numbers and causes of death are useful, but they do not tell the
whole story (6). Examination of individual cases provides us with underlying reasons why
these deaths occurred and information about what needs to be done to prevent such
deaths in the future. The majority of stillbirths, particularly those that occur in the intrapartum
period, and three quarters of neonatal deaths are preventable (7). Applying the audit
cycle to the circumstances surrounding deaths can highlight breakdowns in clinical care at
the local level as well as breakdowns in processes at the district or national level, and ultimately
improve the CRVS system and quality of care overall (Figure 1.1).
FIGURE 1.1. Relationship between mortality audit and wider quality of care and CRVS systems
Improved quality of service
delivery and outcomes
Increased CRVS
coverage
Respond with action
Identify deaths
Mortality
audit cycle
Review deaths
Report deaths
Use of objective measures
of quality care
Ability to track
mortality trends
12 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS