Quality-of-care audits and perinatal mortality in South Africa
Open accessAbstract
PROBLEM: Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa. APPROACH: We investigated perinatal mortality trends in health facilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths. LOCAL SETTING: Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change. RELEVANT CHANGES: Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29%) and increased in 52 (32%). Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54) but an increase in 35% (19/54). Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99-10.97); lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97-30.81); lack of nursing personnel (OR: 2.67; 95% CI: 1.34-5.33); fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47-5.8) and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43-5.34). LESSONS LEARNT: Quality-of-care audits were not shown to improve perinatal mortality in this study.
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The MPDSR approach is not an intervention whose efficacy can easily be proven in research studies.
“Despite the intuitive theoretical benefit of the system, the MPDSR approach is not an intervention whose efficacy can easily be proven in research studies [19].”
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 [19]
The Lessons learnt section reports that this retrospective study could not rule out other explanations for changes in perinatal mortality and was unable to demonstrate an effect of quality-of-care audits. That supports the difficulty of establishing efficacy in this study, but the paper does not make the broader claim that the entire MPDSR approach is inherently difficult to prove effective in research studies. (LLM, conf=0.82)
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References 10 · Cited by 29
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- Authors
- Allanson, E. R., & Pattinson, R. C.
- Affiliations
- The University of Western Australia (AU)
- South African Medical Research Council (ZA)
- Corresponding author
- Allanson, Emma R
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2015-03-31
- Volume
- 93
- Issue
- 6
- Pages
- 424-428
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC4450707
- OpenAlex
- W846793774
- Cited by
- 29
- References
- 10
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 5 · 2021: 1 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 2 · 2016: 6 · 2015: 1
- FWCI
- 3.66
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Women and Infants Research Foundation
- South African Medical Research Council
- 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 › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- quality of care audit, perinatal mortality, modifiable risk factors, antenatal corticosteroids, nursing shortage, fetal distress, labor progress, South Africa
- MeSH terms
- Cause of Death, Female, Humans, Infant, Newborn, Male, Medical Audit, Pregnancy, Quality of Health Care, Risk Factors, South Africa, Perinatal Care, Perinatal Mortality
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