Shanti Raman1, Alexandra Iljadica2, Rajat Gyaneshwar3, Rigamoto Taito3, James Fong4. 1. Department of Community Paediatrics, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia. Electronic address: shanti.raman@sswahs.nsw.gov.au. 2. Discipline of International Business, University of Sydney, Camperdown, NSW, Australia. 3. College of Medicine, Nursing and Health Sciences, Lautoka Hospital, Fiji National University, Lautoka, Fiji. 4. Department of Obstetrics and Gynecology, Colonial War Memorial Hospital, Suva, Fiji.
Abstract
OBJECTIVE: To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji. METHODS: In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12. Key informant interviews identified factors influencing PMA uptake. RESULTS: Overall, 141 stillbirths and neonatal deaths were analyzed (57 from hospital A and 84 from hospital B; forms from hospital C excluded because incomplete/illegible). Between-site variations in mortality were recorded on the basis of the level of tertiary care available; 28 (49%) stillbirths were recorded in hospital A compared with 53 (63%) in hospital B. Substantial health system factors contributing to preventable deaths were identified, and included inadequate staffing, problems with medical equipment, and lack of clinical skills. Leadership, teamwork, communication, and having a standardized process were associated with uptake of PMA. CONCLUSION: The use of PMAs by health workers in Fiji and other Pacific island countries could potentially rectify gaps in maternal and neonatal service delivery.
OBJECTIVE: To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji. METHODS: In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12. Key informant interviews identified factors influencing PMA uptake. RESULTS: Overall, 141 stillbirths and neonatal deaths were analyzed (57 from hospital A and 84 from hospital B; forms from hospital C excluded because incomplete/illegible). Between-site variations in mortality were recorded on the basis of the level of tertiary care available; 28 (49%) stillbirths were recorded in hospital A compared with 53 (63%) in hospital B. Substantial health system factors contributing to preventable deaths were identified, and included inadequate staffing, problems with medical equipment, and lack of clinical skills. Leadership, teamwork, communication, and having a standardized process were associated with uptake of PMA. CONCLUSION: The use of PMAs by health workers in Fiji and other Pacific island countries could potentially rectify gaps in maternal and neonatal service delivery.
Keywords:
Clinical audit; Health systems; Low-income countries; Maternal health; Millennium Development Goals; Newborn and child health; Perinatal mortality; Service improvement
Authors: Alyce N Wilson; Pele Melepia; Rose Suruka; Priscah Hezeri; Dukduk Kabiu; Delly Babona; Pinip Wapi; Naomi Spotswood; Meghan A Bohren; Joshua P Vogel; Angela Kelly-Hanku; Alison Morgan; James G Beeson; Christopher Morgan; Lisa M Vallely; Edward J Waramin; Michelle J L Scoullar; Caroline S E Homer Journal: BMC Pregnancy Childbirth Date: 2022-06-01 Impact factor: 3.105
Authors: A N Wilson; N Spotswood; G S Hayman; J P Vogel; J Narasia; A Elijah; C Morgan; A Morgan; J Beeson; C S E Homer Journal: Lancet Reg Health West Pac Date: 2020-09-23