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Quality-of-care audits and perinatal mortality in South Africa

Overview of attention for article published in Bulletin of the World Health Organization, March 2015
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Title
Quality-of-care audits and perinatal mortality in South Africa
Published in
Bulletin of the World Health Organization, March 2015
DOI 10.2471/blt.14.144683
Pubmed ID
Authors

Emma R Allanson, Robert C Pattinson

Abstract

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. 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. 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. 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). Quality-of-care audits were not shown to improve perinatal mortality in this study.

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Mendeley readers

The data shown below were compiled from readership statistics for 114 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Tanzania, United Republic of 1 <1%
Unknown 113 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 32 28%
Student > Ph. D. Student 13 11%
Lecturer 9 8%
Student > Bachelor 8 7%
Other 6 5%
Other 21 18%
Unknown 25 22%
Readers by discipline Count As %
Medicine and Dentistry 30 26%
Nursing and Health Professions 24 21%
Social Sciences 10 9%
Business, Management and Accounting 6 5%
Psychology 4 4%
Other 12 11%
Unknown 28 25%