Abstract
Background Facility-based death review committee (DRC) of neonatal deaths and stillbirths can encourage stakeholders to enhance the quality of care during the antenatal period and labour to improve birth outcomes. To understand the benefits and impact of the DRCs, this study was aimed at exploring the DRC members' perception about the role and benefits of the newly developed facility-based DRCs in five pilot hospitals in Jordan, to assess women empowerment, decision-making process, power dynamics, culture and genderism as contributing factors for deaths, and impact of COVID-19 lockdown on births. Methods A descriptive study of a qualitative design—using focus group discussions—was conducted after one year of establishing DRCs in 5 pilot large hospitals. The number of participants in each focus group ranged from 8 to10, and the total number of participants was 45 HCPs (nurses and doctors). Questions were consecutively asked in each focus group. The moderator asked the main questions from the guide and then used probing as needed. A second researcher observed the conversation and took field notes. Results Overall, there was an agreement among the majority of DRC members across all hospitals that the DRC was successful in identifying the exact cause of neonatal deaths and stillbirths as well as associated modifiable factors. There was also a consensus that the DRC contributed to an improvement in health services provided for pregnant women and newborns as well as protecting human rights and enabling women to be more interdependent in taking decisions related to family planning. Moreover, the DRC agreed that a proportion of the neonatal deaths and stillbirths occurring in the hospitals could have been prevented if adequate antenatal care was provided and some traditional harmful practices were avoided. Conclusions Facility-based neonatal death review audit is practical and can be used to identify exact causes of maternal and neonatal deaths and is a valuable tool for hospital quality indicators. It can also change the perception and practice of health care providers, which may be reflected in improving the quality of provided healthcare services.
Highlights
Accurate rates of neonatal deaths and stillbirths are insufficiently calculated and documented in low- and middleincome countries
All quotes mentioned by the death review committee (DRC) members in this article reflect real observations as well as actions and interventions made since the establishment of these committees
After establishing a new DRC within each of the five hospitals, DRC members met regularly and utilized the data entered into the Jordan Stillbirths and Neonatal Deaths (JSANDS) system to help in identifying the root causes of stillbirths and neonatal deaths as well as contributing modifiable factors and delays
Summary
Accurate rates of neonatal deaths and stillbirths are insufficiently calculated and documented in low- and middleincome countries. Rates and causes of neonatal mortality and stillbirths lack precise estimations in Jordan [3,4,5], where the majority of such deaths can be avoided or at least minimized if adequate and comprehensive quality intrapartum and postpartum care provided [3]. It is a secure on-line system to collect, organize, analyse, and disseminate trustworthy data on neonatal deaths, stillbirths, and associated causes and modifiable factors. Facilitybased neonatal death review audit is practical and can be used to identify exact causes of maternal and neonatal deaths and is a valuable tool for hospital quality indicators It can change the perception and practice of health care providers, which may be reflected in improving the quality of provided healthcare services
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