Making Every Baby Count

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4 Auditing deaths that occur in the community This chapter provides an overview of considerations for initiating a system for auditing stillbirths and neonatal deaths that occur in the community. Family and caregiver narratives within a traditional verbal and social autopsy interview can help identify social, behavioural and health system contributors, in addition to the biological causes of death, as a means of generating information about key delays and modifiable factors.
4.1 The importance of review and response to deaths in the community In many countries, despite high average rates of antenatal care and increasing rates of facility-based delivery, even in resource-limited settings, many births still occur at home, without any contact with health-care facilities or providers. Therefore, many stillbirths and neonatal deaths also still occur at home. Many of these families will have had contact with a health-care facility or community health worker (CHW) during pregnancy and/or delivery. Identification and review of these stillbirths and neonatal deaths occurring in the community is needed to help complete the picture of why these deaths are occurring and how they can be prevented. Identification and analysis of these deaths requires the facility-based and district-level mortality audit committee and the community to be accountable to each other for sharing information and enacting changes. Factors contributing to stillbirths and neonatal deaths in the community may be different from those contributing to facility-based deaths and may not be identified by the facilitybased mortality audit process. For example, reviews of deaths occurring in the community may identify barriers to care that may not have been faced by individuals who were able to reach and receive care at health-care facilities. Many stillbirths and neonatal deaths can be attributed, at least in part, to factors that occur in the community, such as poverty and poor access to services, poor social and nutritional status of girls and women, harmful practices around pregnancy and childbirth, and perceptions about and use of health services. Yet everyone in the community wants healthy children. Thus, whatever approach is used, it is important that the people whose lives will be affected by the findings of the review process feel that their voices will be heard when solutions are being developed. The process of setting up a system for identifying, reviewing and responding to stillbirths and neonatal deaths at the community level is also intrinsically valuable for the connections it fosters among stakeholders in the community, at health-care facilities and within the public health infrastructure. 4.2 Setting up the system There are two primary additional roles that must be competently filled when setting up a process for community mortality audits, including designated community-based “identifier-reporters” and reviewers. In addition, a mechanism for transmission of information must be in place. These three key components of the system for auditing deaths that occur in the community are discussed below. Identifier-reporters Identifier-reporters are those who will be informed of or able to identify stillbirths and neonatal deaths in the community as soon as they occur and then promptly relay information about them to the health system. These could include CHWs (who may be volunteers or salaried workers), community or village leaders, community representatives appointed or elected specifically for this purpose, or individuals employed by another existing initiative MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS 43
Page 1 and 2: Making Every Baby Count Audit and r
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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 14 and 15: Key messages of this guide • Audi
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 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
Page 64 and 65: Maternal and Perinatal Death Review
Page 66 and 67: 6 Scaling up audit for quality and
Page 68 and 69: FIGURE 6.1. Dimensions of a phased
Page 70 and 71: FIGURE 6.2. Example of data flow in
Page 72 and 73: References 1. Maternal death survei
Page 74 and 75: 39. Bradshaw D, Chopra M, Kerber K,
Page 76 and 77: Annexes Annex 1 Stillbirth and Neon
Page 78 and 79: 3.6 Fetal heart sounds on admission
Page 80 and 81: Annex 1b. Guidance for completing t
Page 82 and 83: • “unknown” if the total numb
Page 84 and 85: • If fetal heart sounds were not
Page 86 and 87: -- If a “delay 1” is present, c
Page 88 and 89: . antepartum complications Annex 2:
Page 90 and 91: Annex 2b. Guidance for completing t
Page 92 and 93: 2.1b: Cause of death - intrapartum
Page 94 and 95: Annex 3b. Guidance for collecting t
Page 96 and 97: 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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Annex 8b. Guidance for completing t
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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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Making Every Baby Count

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