In a 3-month period, May to August 2000, the perinatal mortality rate at Omdurman Maternity Hospital (OMH), Sudan, was 8.2%. Two groups of perinatal deaths, intrapartum deaths of non-malformed infants and neonatal deaths of mature infants above 34 weeks, both considered to be potentially avoidable by improved care, were in excess when compared with other regions. It was therefore decided to perform in-depth assessment of cases in these two groups. An interdisciplinary internal audit was designed in collaboration with two external obstetricians. The audit activity was preceded by a 2-day workshop at the hospital. Individual assessments based on 43 detailed narratives were followed by regular consensus meetings. This structure seemed useful for interdisciplinary discussions, and the audit process resulted in several specific suggestions for quality improvement in data collection, interdisciplinary collaboration, and obstetric and neonatal care. The present audit activity is not very resource demanding and therefore a good starting point for quality assurance in a developing country. However, since adverse outcome audit only focuses on selected cases and may encourage interventions without considering the full impact on the population, it should not stand alone. Audit of perinatal deaths should be combined with other quantitative and qualitative quality assessment activities for improvement of perinatal care.
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http://dx.doi.org/10.1093/heapol/17.3.296 | DOI Listing |
Environ Res
December 2024
Univ Rennes, CHU Rennes, Inserm, Irset (Research Institute for Environmental & Occupational Health) UMR 1085, Rennes, France.
Sudden unexpected deaths in infancy (SUDI) is defined as the unexpected death of an infant in the first year of life, including explained and unexplained death (SIDS). Risk factors, such as sleeping position and passive smoking, have been identified but few studies have addressed the influence of exposure to chemicals in the environment. Pesticides are ubiquitous but little is known about their impact on infant mortality.
View Article and Find Full Text PDFHealth Place
December 2024
Department of Epidemiology, Emory University Rollins School of Public Health, USA.
Goal: Housing insecurity is associated with poor perinatal outcomes. However, we lack information on whether supportive housing policies improve perinatal health. Our goal was to estimate the effect of expiration of a state-level eviction moratoria on adverse maternal and infant outcomes among Medicaid insured individuals residing in states with a state-level moratorium in place at conception in the United States.
View Article and Find Full Text PDFPLoS One
December 2024
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States of America.
Objective: Predicting neonatal survival is essential for targeting interventions to reduce neonatal mortality. Pacific Islanders have been underrepresented in existing prediction tools and have unique, maternal obesity-related risk factors for both preterm birth and neonatal mortality. Using neonatal sex, birth weight, and gestational age, we developed a graphical tool for neonatal survival among Pacific Islander singletons in the United States.
View Article and Find Full Text PDFArch Dis Child Fetal Neonatal Ed
December 2024
Nuffield Department of Population Health, University of Oxford National Perinatal Epidemiology Unit, Oxford, UK.
Objective: Babies born between 27 and 31 weeks of gestation contribute substantially towards infant mortality and morbidity. In England, their care is delivered in maternity services colocated with highly specialised neonatal intensive care units (NICU) or less specialised local neonatal units (LNU). We investigated whether birth setting offered survival and/or morbidity advantages to inform National Health Service delivery.
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