IJCM_38A: Impact of perinatal death audit on healthcare delivery in two districts of Karnataka- A health system intervention research

Abstract

Background: Perinatal mortality is a sensitive indicator of maternal and child health care. However, there is no universal perinatal death (PND) audit system in India. Objective: To identify the impact of the proposed model of PND audit on health care delivery in two districts of Karnataka. Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK- high performing) and Koppal (low performing) districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. The healthcare delivery system was analyzed in both districts. A PND audit system was designed. All neonatal deaths during the study period were analyzed by an expert committee (Local senior pediatricians and obstetricians). Following variables were studied: (i) Documentation and reporting systems in these hospitals; (ii) Role of health care personnel in documentation and reporting (iii) Existing system of audit, if any. Doctors feedback, in-depth interviews, death certification analysis, risk analysis, PND reporting format, expert committee feedback, medical social worker feedback, data from district health office were recorded and analysed. The changes in documentation, information yield, reporting of PND, time taken for submitting death report and changes in infrastructure in facilities in the two time periods of 6 months was analysed. Results: Significant changes were recorded in documentation of care delivered in the facility specially in Koppal district. There was an increase in reporting of PND in the second half. The PND audit assisted in preventability of death assertion. Improved data resulted in better performance of expert committee, thereby reducing the proportion of unclassified segment of neonatal deaths. There was significant improvement in infrastructure in the health facilities. Conclusion: Auditing perinatal deaths had a positive impact at point of care resulting in improved documentation, reporting and infrastructure upgradation.