Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby
Open accessAbstract
BACKGROUND: While there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking. METHODS: We reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality. RESULTS: Maternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed. CONCLUSIONS: Health workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.
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A culture of trust is nurtured by strong leadership and continuous re-assurance of a blame-free culture.
“A culture of trust is nurtured by strong leadership and continuous re-assurance of a “blame-free culture” [24].”
From Implementation of maternal and perinatal death surveillance and response (MPDSR) in humanitarian settings: insights and experiences of humanitarian health practitioners and global technical expert meeting attendees (2022) · cites this paper as [24]
The Discussion ('Getting started'; page unavailable) says leadership is critical and local leaders should nurture a conducive culture by establishing a no-blame environment. The Results ('Implementation challenges and evidence-based solutions'; page unavailable) also calls for a supportive, non-punitive culture. Neither passage specifies continuous reassurance, so that part of the claim is unsupported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn low resource settings, significant challenges have been identified in the MPDSR process, including the quality of mortality reviews and linkage to concrete actions.
“In low resource settings where the numbers of maternal and perinatal deaths are the highest, significant challenges have been identified in the MPDSR process, including the quality of mortality reviews and linkage to concrete actions [23, 24].”
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Stillbirths: ending preventable deaths by 2030
de Bernis, L., Kinney, M. V., Stones, W. R., ten Hoope‐Bender, P., Vivio, D., Leisher, S. H., Bhutta, Z. A., Gülmezoglu, M., Mathai, M., Belizán, J. M., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00954-x · Cited by 479 · see citing works
Self-citationCount every newborn; a measurement improvement roadmap for coverage data
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Self-citationCore outcomes in neonatology: development of a core outcome set for neonatal research
Webbe, J. W. H., Duffy, J. M. N., Afonso, E., Al-Muzaffar, I., Brunton, G., Greenough, A., Hall, N. J., Knight, M., Latour, J. M., Lee-Davey, C., et al. (2020) · Archives of Disease in Childhood - Fetal and Neonatal Edition · doi:10.1136/archdischild-2019-317501 · Cited by 235 · see citing works
“Relevant, standardised outcomes are also crucial for observational research (21, 22), benchmarking (23), clinical audit (24) and quality improvement studies (25).”
BackgroundMaternal influenza and birth outcomes: systematic review of comparative studies
Fell, D. B., Savitz, D. A., Ms, K., Gessner, B. D., Katz, M., Knight, M., Luteijn, M., Marshall, H. S., Bhat, N., Gravett, M., et al. (2016) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14143 · Cited by 153 · see citing works
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Self-citationDickson, K., Kinney, M. V., Moxon, S. G., Ashton, J., Zaka, N., Simen-Kapeu, A., Sharma, G., Kerber, K. J., Daelmans, B. M. E. G., Gülmezoglu, A. M., et al. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-15-s2-s1 · Cited by 120 · see citing works
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Self-citationLevels and determinants of maternal mortality in northern and southern Nigeria
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Roder-DeWan, S., Gage, A., Hirschhorn, L., Twum-Danso, N., Liljestrand, J., Asante-Shongwe, K., Rodríguez, V., Yahya, T., & Kruk, M. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002879 · Cited by 88 · see citing works
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Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women
Shakarami, A., Mirghafourvand, M., Abdolalipour, S., Jafarabadi, M. A., & Iravani, M. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-04114-8 · Cited by 92 · see citing works
Immune Regulation in Pregnancy
Bonney, E. A. (2016) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2016.07.004 · Cited by 90 · see citing works
Boah, M., Mahama, A. B., & Ayamga, E. A. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-1749-6 · Cited by 92 · see citing works
Effects of exercise therapy for pregnancy-related low back pain and pelvic pain
Hu, X., Ma, M., Zhao, X., Sun, W., Liu, Y., Zheng, Z., & Xu, L. (2020) · Medicine · doi:10.1097/md.0000000000017318 · Cited by 86 · see citing works
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“As a result, many low- and middle-income countries (LMIC) have adopted national guidelines, however, few have robust MPDSR systems (Kerber et al. 2015).”
BackgroundInfluentialComfort, H., McHugh, T. A., Schumacher, A. E., Harris, A., May, E. A., Paulson, K. R., Gardner, W. M., Fuller, J. E., Frisch, M. E., Taylor, H. J., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)01925-1 · Cited by 86 · see citing works
“40 Further insights can be gained from community-level assessments of the causes of stillbirths, allowing for focused efforts to promote maternal care and survival of newborns.”
Blanchard, A. K., Prost, A., & Houweling, T. A. J. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-001308 · Cited by 82 · see citing works
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“Incomplete health information systems are notoriously linked with poor health outcomes [3, 54].”
BackgroundClassification of causes and associated conditions for stillbirths and neonatal deaths.
Flenady, V., Wojcieszek, A., Ellwood, D., Leisher, S., Erwich, J., Draper, E., Mcclure, E., Reinebrant, H. E., Oats, J., Mccowan, L., et al. (2017) · Seminars in Fetal & Neonatal Medicine · doi:10.1016/j.siny.2017.02.009 · Cited by 70 · see citing works
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Parents’ concerns about future pregnancy after stillbirth: a qualitative study
Meaney, S., Everard, C. M., Gallagher, S., & O'Donoghue, K. (2017) · Health Expectations · doi:10.1111/hex.12480 · Cited by 77 · see citing works
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“errors in care can contribute to improvements in quality and safety of health systems [30, 31].”
BackgroundImproving geographical accessibility modeling for operational use by local health actors
Ihantamalala, F. A., Herbreteau, V., Révillion, C., Randriamihaja, M., Commins, J., Andréambeloson, T., Rafenoarimalala, F. H., Randrianambinina, A., Cordier, L., Bonds, M. H., et al. (2020) · International Journal of Health Geographics · doi:10.1186/s12942-020-00220-6 · Cited by 65 · see citing works
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Self-citationHealth-related quality of life in different trimesters during pregnancy
Wu, H., Sun, W., Chen, H., Wu, Y., Ding, W., Liang, S., Huang, X., Chen, H., Zeng, Q., Li, Z., et al. (2021) · Health and Quality of Life Outcomes · doi:10.1186/s12955-021-01811-y · Cited by 63 · see citing works
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Maternal Death Surveillance and Response Systems in driving accountability and influencing change
Bandali, S., Thomas, C., Hukin, E., Matthews, Z., Mathai, M., Dilip, T. R., Roos, N., Lawley, R., Igado, O., & Hulton, L. (2016) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2016.10.002 · Cited by 61 · see citing works
“• a supportive institutional culture at all levels fostering a learning rather than a punitive environment [21]; • multidisciplinary teams that review and communicate findings at different levels of the health system [11] and availability to those in a position to act on the evidence; • leadership and commitment of go…”
BackgroundSelf-citationAir pollution, ambient temperature, green space and preterm birth
Kloog, I. (2019) · Current Opinion in Pediatrics · doi:10.1097/mop.0000000000000736 · Cited by 60 · see citing works
Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial
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Measuring maternal, foetal and neonatal mortality: Challenges and solutions
Blencowe, H., Calvert, P., Lawn, J. E., Cousens, S., & Campbell, O. M. R. (2016) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2016.05.006 · Cited by 56 · see citing works
Self-citationCircumstances of child deaths in Mali and Uganda: a community-based confidential enquiry
Willcox, M. L., Kumbakumba, E., Diallo, D., Mubangizi, V., Kirabira, P. S., Nakaggwa, F., Mutahunga, B., Diakité, C., Dembele, E. M., Traoré, M., et al. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30215-8 · Cited by 56 · see citing works
Policy, law and post-abortion care services in Kenya
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Steenland, M. W., Robyn, P. J., Compaoré, P., Kabore, M., Tapsoba, B., Zongo, A., Diadie, H. O., & Fink, G. (2017) · SSM - Population Health · doi:10.1016/j.ssmph.2017.01.001 · Cited by 46 · see citing works
Kinney, M. V., Ajayi, G., de Graft-Johnson, J., Hill, K., Khadka, N., Om’Iniabohs, A., Mukora-Mutseyekwa, F., Tayebwa, E., Shittu, O., Lipingu, C., et al. (2020) · PLOS ONE · doi:10.1371/journal.pone.0243722 · Cited by 44 · see citing works
“Documentation of meeting provides evidence that regular meetings take place and enables reflection on the quality of the meetings [21].”
BackgroundInfluentialSelf-citationSimen-Kapeu, A., Seale, A. C., Wall, S. N., Nyange, C., Qazi, S., Moxon, S. G., Young, M., Liu, G., Darmstadt, G. L., Dickson, K., et al. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-15-s2-s6 · Cited by 43 · see citing works
Self-citationÓbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil
Rêgo, M. G. D. S., Vilela, M. B. R., de Oliveira, C. M., & do Bonfim, C. V. (2018) · Revista gaúcha de enfermagem · doi:10.1590/1983-1447.2018.2017-0084 · Cited by 42 · see citing works
Ansu-Mensah, M., Danquah, F. I., Bawontuo, V., Ansu‐Mensah, P., Mohammed, T., Udoh, R. H., & Kuupiel, D. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03701-z · Cited by 40 · see citing works
Paternal Depression Rates in Prenatal and Postpartum Periods and Affecting Factors
Top, E. D., Cetisli, N. E., Guclu, S., & Zengin, E. B. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.07.005 · Cited by 38 · see citing works
Alves‐Santos, N. H., Eshriqui, I., Franco‐Sena, A. B., Cocate, P. G., Vilela, A. A. F., Benaim, C., Vaz, J. D. S., de Castro, M. B. T., & Kac, G. (2016) · Appetite · doi:10.1016/j.appet.2016.05.027 · Cited by 36 · see citing works
Regan, A. K., Tracey, L. E., Blyth, C. C., Richmond, P., & Effler, P. V. (2016) · Vaccine · doi:10.1016/j.vaccine.2016.03.084 · Cited by 36 · see citing works
Racial/ethnic variations in gestational weight gain: a population-based study in Ontario
Guo, Y., Miao, Q., Huang, T., Fell, D. B., Dingwall‐Harvey, A. L. J., Wen, S. W., Walker, M. C., & Gaudet, L. (2019) · Canadian Journal of Public Health · doi:10.17269/s41997-019-00250-z · Cited by 36 · see citing works
Quality of Midwife-provided Intrapartum Care in Amhara Regional State, Ethiopia
Yigzaw, T., Eyowas, F. A., Belay, L., Assaye, Y., Misganaw, E., Kidane, A., Ademie, D., van Roosmalen, J., Stekelenburg, J., & Kim, Y. M. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1441-2 · Cited by 36 · see citing works
Lakew, S., Ankala, A., & Jemal, F. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-2121-6 · Cited by 35 · see citing works
Lusambili, A. M., Jepkosgei, J., Nzinga, J., & English, M. (2019) · International Journal of Human Rights in Healthcare · doi:10.1108/ijhrh-07-2018-0052 · Cited by 35 · see citing works
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Self-citationGeorge, A., Lefevre, A. E., Jacobs, T., Kinney, M., Buse, K., Chopra, M., Daelmans, B., Haakenstad, A., Huicho, L., Khosla, R., et al. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-001316 · Cited by 28 · see citing works
“Favourable policies for MPDSR are in place,(32) yet few countries have robust operational MPDSR systems,(32) and the likelihood for improvement only occurs if the audit cycle is fully implemented.(31) We examine the health systems drivers of MPDSR through service delivery, societal and systems lenses and across health…”
BackgroundImproving Rates of Early Entry Prenatal Care in an Underserved Population
Shah, J. S., Revere, L., & Toy, E. C. (2018) · Maternal and Child Health Journal · doi:10.1007/s10995-018-2569-z · Cited by 30 · see citing works
Laopaiboon, M., Lumbiganon, P., Rattanakanokchai, S., Chaiwong, W., Souza, J. P., Vogel, J. P., Mori, R., & Gülmezoglu, A. M. (2019) · BMC Pediatrics · doi:10.1186/s12887-019-1546-z · Cited by 30 · see citing works
Gutman, A., Harty, T., O’Donoghue, K., Greene, R. A., & Leitão, S. (2022) · Journal of Perinatal Medicine · doi:10.1515/jpm-2021-0363 · Cited by 32 · see citing works
“Although in the past decades 51 countries have implemented audit policies for maternal mortality and morbidity, only 17 countries have implemented similar policies for perinatal mortality and morbidity [14].”
BackgroundPaternal post-partum depression: How has it been assessed? A literature review
Pérez C., F., Brahm, P., Riquelme, S., Rivera, C., Jaramillo, K., & Eickhorst, A. (2017) · Mental Health & Prevention · doi:10.1016/j.mhp.2017.07.001 · Cited by 28 · see citing works
Adinew, Y. M., Asseffa, N. A., & Adinew, Y. M. (2018) · BioMed Research International · doi:10.1155/2018/3249786 · Cited by 28 · see citing works
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“Nonetheless, the true magnitude of stillbirths in Nigeria is difficult to estimate in the absence of standardized national policies or protocols that enjoin facilities and communities to record, audit or to review causes of stillbirth [18].”
BackgroundShogren, M. D., Harsell, C., & Heitkamp, T. (2017) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.12659 · Cited by 29 · see citing works
Community, M., Packer, J. M., Rangers, Y., Turpin, G., Ens, E. J., Venkataya, B., & Hunter, J. (2019) · Journal of Ethnobiology and Ethnomedicine · doi:10.1186/s13002-019-0348-6 · Cited by 26 · see citing works
Perinatal mortality audits and reviews: Past, present and the way forward
Helps, Ä., Leitão, S., Greene, R. A., & O’Donoghue, K. (2020) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2020.04.054 · Cited by 25 · see citing works
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Bottom-up development of national obstetric guidelines in middle-income country Suriname
Verschueren, K. J. C., Kodan, L. R., Brinkman, T. K., Paidin, R. R., Henar, S. S., Kanhai, H. H. H., Browne, J. L., Rijken, M. J., & Bloemenkamp, K. W. M. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4377-6 · Cited by 25 · see citing works
Kortekaas, J. C., Scheuer, A. C., de Miranda, E., van Dijk, A. E., Keulen, J. K. J., Bruinsma, A., Mol, B. W., Vandenbussche, F. P. H. A., & van Dillen, J. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-1973-0 · Cited by 24 · see citing works
(2023) · doi:10.1186/s12884-023-05536-2 · Cited by 21 · see citing works
“On the other hand, the establishment of a central national administrative support system, the availability of support structures and policies, training and resources (financial, human and materials) ensured smooth performance of the FMDR committees in countries such as Malaysia, the Republic of South Africa and the Un…”
BackgroundInvolvement of Male Partners in Skilled Birth Care in the North Dayi District, Ghana
Saah, F. I., Tarkang, E. E., Komesuor, J., Osei, E., Acquah, E., & Amu, H. (2019) · International Journal of Reproductive Medicine · doi:10.1155/2019/2852861 · Cited by 22 · see citing works
Waiswa, P., Wanduru, P., Okuga, M., Kajjo, D., Kwesiga, D. K., Kalungi, J., Nambuya, H., Mulowooza, J., Tagoola, A., & Peterson, S. (2021) · Global Health Science and Practice · doi:10.9745/ghsp-d-20-00156 · Cited by 22 · see citing works
“Many countries report that the implementation of recommendations is a missing link in the MPDR process.(16,17) Another key achievement was linking the MPDR to the plan-dostudy-act cycle to help devise feasible solutions to address identified bottlenecks and solve the lack of action onMPDR recommendations.”
BackgroundSilver, R. M., & Reddy, U. M. (2024) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2024.05.042 · Cited by 22 · see citing works
Mesfin, S., Dheresa, M., Fage, S. G., & Tura, A. K. (2021) · International Journal of Women s Health · doi:10.2147/ijwh.s300143 · Cited by 21 · see citing works
Musabwasoni, M. G. S., Kerr, M. S., Babenko‐Mould, Y., Nzayirambaho, M., & Ngabonzima, A. (2020) · International Journal of Nursing Education Scholarship · doi:10.1515/ijnes-2020-0010 · Cited by 19 · see citing works
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Attention to women in situation of intrauterine fetal death: experiences of health professionals
Serafim, T. C., Camilo, B. H. N., Carizani, M. R., Gervasio, M. D. G., Carlos, D. M., & Salim, N. R. (2021) · Revista gaúcha de enfermagem · doi:10.1590/1983-1447.2021.20200249 · Cited by 22 · see citing works
Accountability for improving maternal and newborn health
Scott, H. M., & DANEL, I. A. (2016) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2016.05.009 · Cited by 19 · see citing works
Johnson, M., Whelan, B., Relton, C., Thomas, K. J., Strong, M., Scott, E., & Renfrew, M. J. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1651-7 · Cited by 19 · see citing works
Vandyousefi, S., Davis, J. N., & Gunderson, E. P. (2021) · Diabetologia · doi:10.1007/s00125-020-05379-y · Cited by 26 · see citing works
Saarikko, J., Niela‐Vilén, H., Rahmani, A. M., & Axelin, A. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03689-6 · Cited by 19 · see citing works
Advances to diminish global newborn kernicterus mortality
Bhutani, V. K., Vidavalur, R., & Wong, R. J. (2023) · Journal of Perinatology · doi:10.1038/s41372-023-01862-7 · Cited by 18 · see citing works
“Indices of adverse events of EHB, such as mortality, chronic athetoid cerebral palsy by the age of 5 years, and sensorineural hearing loss at school age, have however been dif fi cult to standardize, collect, and monitor [25, 26].”
Non-maleficence and the ethics of consent to cancer screening
Elton, L. (2020) · Journal of Medical Ethics · doi:10.1136/medethics-2020-106135 · Cited by 18 · see citing works
Implementation of maternal and perinatal death reviews: a scoping review protocol
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“(2015) [41] Two definitions of community perinatal audits are described: 1) Surveillance of community births and deaths, in which trained community workers visit households following a death and conduct social and/or verbal autopsy to feed back into a local or centralised data collection system 2) Involvement in facil…”
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The remarkable stability of fertility desires during the Colombian armed conflict 2000–2016
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“The mechanism of counting and accounting for deaths in a systematic manner is important and it can provide evidence to determine changes in clinical practice and to develop guidelines and training packages for preventive measures as well [13].”
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“1001–1500 2 (14) 1 (10) 0 0 3 (7) 1501–2000 3 (21) 1 (10) 2 (12) 0 6 (13) 2001–2500 4 (29) 4 (40) 3 (18) 1 (20) 12 (26) 2501–3000 2 (14) 2 (20) 4 (24) 3 (60) 11(24) 3001–3500 1 (7) 1 (10) 5 (29) 0 7 (15)”
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- Authors
- Kerber, K. J., Mathai, M., Lewis, G., Flenady, V., Erwich, J. J. H., Segun, T., Aliganyira, P., Abdelmegeid, A., Allanson, E., Roos, N., Rhoda, N., Lawn, J. E., & Pattinson, R.
- Affiliations
- Save the Children (US)
- World Health Organization (CH)
- University College London (GB)
- The University of Queensland (AU)
- University Medical Center Groningen (NL)
- Jhpiego (US)
- The University of Western Australia (AU)
- University of Cape Town (ZA)
- South African Medical Research Council (ZA)
- Corresponding author
- Kerber, Kate J
- ORCID
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2015-09-11
- Volume
- 15
- Issue
- S2
- Pages
- S9-S9
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC4577789
- OpenAlex
- W1924529051
- Cited by
- 231
- References
- 58
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 21 · 2023: 8 · 2022: 16 · 2021: 46 · 2020: 26 · 2019: 33 · 2018: 24 · 2017: 17 · 2016: 15 · 2015: 8
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- stillbirth, neonatal death, Every Newborn Action Plan, cause of death classification, health information systems, health system leadership, avoidable causes of death, quality of care, low- and middle-income countries, health policy implementation
- MeSH terms
- Africa, Asia, Developing Countries, Female, Health Policy, Humans, Infant, Newborn, Leadership, Medical Audit, Postnatal Care, Pregnancy, Prenatal Care, Practice Guidelines as Topic, Stillbirth, Perinatal Mortality, Quality Improvement, Healthcare Financing, Health Information Systems, Maternal Death, Perinatal Death
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