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Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths

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Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths Making Every Baby Count Audit and review of stillbirths and neonatal deaths WHO Library Cataloguing-in-Publication Data Making every baby count: audit and review of stillbirths and neonatal deaths. 1.Perinatal Death. 2.Stillbirth. 3.Infant Mortality. 4.Infant, Newborn. 5.Epidemiological Monitoring. I.World Health Organization. ISBN 978 92 4 151122 3 (NLM classification: WQ 225) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (http:// www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/ licensing/copyright_form/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed by the WHO Document Production Services, Geneva, Switzerland Designed by Inís Communication – www.iniscommunication.com Making Every Baby Count Audit and review of stillbirths and neonatal deaths Contents Acronyms and abbreviations 1 Acknowledgements 2 Foreword 4 Executive summary 5 Chapter 1. Getting started 10 1.1 What is this guide about?. 11 1.2 Why is this guide important? . .12 . 1.3 Who is this guide for? . 13 . 1.4 What does this guide aim to achieve?. 13 1.5 What does this guide include? . .14 . Chapter 2. Definitions and classification 16 2.1 Notes on terminology . 17 2.2 Mortality outcome definitions . .18 . Definition and timing of stillbirths . 18. Definition and timing of neonatal deaths . 19 . 2.3 Medical causes of death . 20. Classifying causes of stillbirths and neonatal deaths . .21 . 2.4 Collection of a minimum set of perinatal indicators . .23 . 2.5 Modifiable factors . 25. Chapter 3. Auditing deaths that occur at the health-care facility 28 3.1 Setting up the system . 29 3.2 The six-step mortality audit cycle . 31. Step 1: Identifying cases . 31. Step 2: Collecting information . 33. Step 3: Analysing information . 35. Step 4: Recommending solutions . 37. Step 5: Implementing changes . 38. Step 6: Evaluating and refining . 40 Chapter 4. Auditing deaths that occur in the community 42 4.1 The importance of review and response to deaths in the community. 43 4.2 Setting up the system . 43 Identifier-reporters . 43. Reviewers . 44 Transmission of information . .45 . 4.3 The six-step mortality audit cycle from the community perspective. 46 Step 1: Identifying cases for review. 46 Step 2: Collecting information . 49. Step 3: Analysing information . 51. Step 4: Recommending solutions . 52. Steps 5 and 6: Implementing changes, evaluating and refining. 52 Chapter 5. Creating an enabling environment for change 54 5.1 Creating an enabling environment to effect change . 55. 5.2 Legal and ethical issues . 55 Legal protection . 55. Access to information. 56 Use of the results. 56 Ethical considerations . 56. 5.3 Developing and disseminating policy and guidelines . .57 . 5.4 Staff training, ongoing supervision and leadership . 57 Chapter 6. Scaling up audit for quality and health care improvement 60 6.1 Moving from single facilities to regional and national levels . 61 6.2 Collating data and linking to existing information infrastructure . 63 6.3 Ensuring appropriate resources and logistical support . .65 . Conclusion 65 References 66 Annexes 70 Annex 1: Stillbirth and Neonatal Death Case Review Form (and guidance for completion) . 71 Annex 2: Births and Deaths Summary Form (and guidance for completion). 82 Annex 3: Minimum set of perinatal indicators to collect for all births and perinatal deaths (and guidance for completion) . .87 . Annex 4: Approaches for classifying modifiable factors . .92 . Annex 5: Setting up a mortality audit steering committee . 97. Annex 6: Sample audit meeting code of practice declaration . 98. Annex 7: Sample calculations for reporting . 99 Annex 8: Stillbirth and Neonatal Mortality Audit – Meeting Minutes and Action Items Form. 100 Annex 9: Steps for establishing a mortality audit for stillbirths and neonatal deaths . 103 Annex 10: Verbal and social autopsy tool for stillbirth and neonatal death audits in the community . .105 . Acronyms and abbreviations CHW community health worker CRVS civil registration and vital statistics ENAP Every Newborn Action Plan HMIS health management information system ICD-10 International Statistical Classification of Disease and Related Health Problems, 10th revision ICD-MM The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium (ICD-Maternal Mortality) (WHO publication) ICD-PM The WHO application of ICD-10 to deaths during the perinatal period (ICD-Perinatal Mortality) (WHO publication) MDSR maternal death surveillance and response PPIP Perinatal Problem Identification Programme SDG Sustainable Development Goals SMGL Saving Mothers, Giving Life VA verbal autopsy WHA World Health Assembly WHO World Health Organization MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS 1 Acknowledgements The World Health Organization (WHO) acknowledges with thanks the contributions of technical experts and agency representatives Kate Kerber prepared the first draft of this guide for audit and review of stillbirths and neonatal deaths, and provided support during the process of reviews, revisions and finalization Evelyn Twentyman, Florina Serbanescu and Diane Morof from the United States Centers for Disease Control and Prevention (CDC) drafted Chapter 4 on auditing stillbirths and neonatal deaths that occur in the community, and the verbal and social autopsy tool (Annex 10) WHO gratefully acknowledges the contributions of the experts invited to review this guide and related tools at the technical consultation held in September 2015 in Montreux, Switzerland: Emma Allanson, Mamuda Aminu, Anthony Costello, Louise Day, Luc De Bernis, Joseph De Graft-Johnson, Ashok Deorari, Kim Dickson, Pablo Duran, J J Erwich, Karima Gholzbhouri, Priya Mannava, Matthews Mathai, Jiji Elizabeth Mathews, Rintaro Mori, Naho Morisaki, Assumpta Muriithi, Victoria Nakibuuka, Pius Okong, Bob Pattinson, Cynthia Pileggi Castro, Neena Raina, Nathalie Roos, Hattie Ruysen, Heather Scott, Florina Serbanescu, João Paulo Souza, Nguyen Thi Luong, Niranjan Thomas, Evelyn Twentyman, Nynke Van Den Broek, Donna Vivio and Martin Weber WHO is also grateful to the following experts who provided input to subsequent drafts of the guide and tools: Hannah Blencowe, Eckhart Buchmann, Alexandre Dumont, Vicky Flenady, Joy Lawn, Gwyneth Lewis, Diane Morof, Natasha Rhoda and Özge Tuncalp Mingard The draft guide was tested in four countries to evaluate its efficacy, effectiveness and user- friendliness WHO acknowledges the helpful feedback received from participants at the pilot-testing sites: • Bhutan: National Referral Hospital, Thimphu; Phuentsholing General Hospital, Chukha; and Paro Hospital, Paro; • Nigeria: Federal Medical Centre, Lokoja, Ebonyi State; Federal Teaching Hospital, Abakaliki, Ebonyi State; ECWA Hospital, Egbe; Maitama District Hospital, Abuja; and University of Abuja Teaching Hospital, Gwagwalada; • Moldova: Municipality of Chisinau perinatal care centre and three regional perinatal care centres in Balti, Cahul and Orhei; • Uganda: Fort Portal Regional Referral Hospital; Kabarole Hospital; Virika Hospital; Kyenjojo Hospital; Kakumiro Health Centre IV (Kibaale Region); Kakindo Health Centre IV (Kibaale Region); Kagadi Hospital (Kibaale Region); and Kibaale Health Centre IV (Kibaale Region) 2 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS In addition, valuable inputs were received from participants at the 35th Annual Priorities in Perinatal Care Conference in Bela Bela, Limpopo, South Africa, in March 2016 WHO also acknowledges the inputs received from the CDC, Save the Children, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) Financial support received from the United States Agency for International Development (USAID) is gratefully acknowledged Development of this guide was coordinated within WHO by Matthews Mathai and Nathalie Roos, with inputs from Emma Allanson, Larisa Boderscova, Anthony Costello, Pablo Duran, Karima Gholbuzairi, Priya Mannava,
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