Making Every Baby Count: Audit and review of stillbirths and neonatal deaths

While many countries have been implementing maternal death surveillance and response (a mortality audit cycle to address the contributing factors of maternal deaths from local to national levels and ultimately improve quality of care), less attention has been given to stillbirths and neonatal deaths despite babies sharing the same periods of risk as their mothers. This publication by the World Health Organizatio (WHO) gives guidance on conducting a mortality audit system to investigate the modifiable factors in perinatal deaths and prevent similar causes of events.

This guide follows the release of the WHO application of the International Classification of Diseases-10 (ICD-10) to deaths during the perinatal period: ICD-PM that provides a way of classifying all stillbirths and neonatal deaths that is comparable across all settings and can be linked to contributing maternal conditions. Making Every Baby Count is intended to be used at various levels of a health system, from a small programme in a health facility to a national system.  The publication includes tools that offer a simpler version of the ICD-PM to help introduce mortality audits in low-resource settings.

In this publication, the term ‘perinatal’ refers to antepartum (before birth) and intrapartum (during birth) stillbirths, and early neonatal deaths (from live birth to seven full days after birth) as defined by the ICD-10, but also includes deaths occurring within eight and 28 days of life (late neonatal deaths) as these events may be influenced by circumstances from the perinatal period.

The publication comprises of six chapters that provide guidance on establishing an audit (or review) system for stillbirths and neonatal deaths. The content includes:

  • The purpose of the guide, who it is intended for and what does it include
  • Definitions for the outcomes of stillbirths and neonatal deaths, and ways to classify causes of deaths and modifiable factors
  • Processes to set up a facility-level audit system with a six-step approach to initiating an audit cycle i.e. identifying cases, collecting information, analysing findings/data, proposing solutions, carrying out changes, and evaluating/refining the system
  • Suggestions on how to initiate an audit system in the community, using methods such as verbal and social autopsy, to uncover the three delays to seeking care and modifiable factors (the authors present the same six steps of the audit cycle with different approaches tailored to the community level to guide the community-audit process)
  • Recommendations for a supportive environment to conduct audits (or reviews) without the fear of blame, including good leadership and supervision, legal and ethical frameworks, and training models that enable quality improvements
  • Guidance on how to build an audit system from local facilities to a regional or national network that includes linking the audit system to established data structures such as civil registration and vital statistics, and community surveillance

In this guide, there are tools and forms to be used by those implementing audits that can be adapted to local settings.

This guide can be accessed freely here.

To browse the ICD-PM for free, click here.

To read the third WHO report, Time to respond: a report on the global implementation of maternal death surveillance and response (MDSR), click here.

To browse the WHO news release, click here.

To read the comment in the Lancet on the three WHO publications for free after registration, click here.

To download the Every Newborn Action Plan for free, click here.

Reference: World Health Organization (WHO). (2016). Making every baby count: audit and review of stillbirths and neonatal deaths. Geneva: WHO