Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda.



Kirabira, Victoria Nakibuuka, Aminu, Mamuda ORCID: 0000-0002-2335-7147, Dewez, Juan Emmanuel, Byaruhanga, Romano, Okong, Pius and van den Broek, Nynke
(2020) Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda. BMJ open, 10 (7). e027504 - ?.

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Abstract

<h4>Objective</h4>To assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.<h4>Design</h4>Interrupted time series (ITS) analysis.<h4>Setting</h4>Nsambya Hospital, Uganda.<h4>Participants</h4>Live births and stillbirths.<h4>Interventions</h4>PND audit.<h4>Primary and secondary outcome measures</h4>Primary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate.<h4>Secondary outcomes</h4>case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.<h4>Results</h4>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.<h4>Conclusion</h4>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.

Item Type: Article
Uncontrolled Keywords: Humans, Infant Mortality, Prospective Studies, Pregnancy, Infant, Newborn, Uganda, Female, Stillbirth, Perinatal Mortality, Perinatal Death
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 09 Jun 2021 10:12
Last Modified: 05 Oct 2022 20:49
DOI: 10.1136/bmjopen-2018-027504
Open Access URL: http://doi.org/10.1136/bmjopen-2018-027504
URI: https://livrepository.liverpool.ac.uk/id/eprint/3125702