Linking Facility-based Mortality Audits With Community Engagement in Gilgit-Baltistan, Pakistan
External Causes of Morbidity and Mortality, Stillbirth, Neonatal Death
About this trial
This is an interventional other trial for External Causes of Morbidity and Mortality focused on measuring Facility-based, Mortality, Audits, Community engagement, Gilgit-Baltistan, Pakistan
Eligibility Criteria
Inclusion Criteria:
- Women aged 15-49 years who have had a pregnancy in the last 12 months who reside in the five targeted districts. Public and private health facilities in five districts in GB that offer obstetric and postnatal care, and respective catchment areas are supported by LHWs, Lady Health Volunteers (LHVs), CMWs, and CHWs will be included in the study. Data for all maternal 'near misses', perinatal and neonatal mortality and morbidity outcomes will be recorded for all women and newborns who deliver at home (through LHW, LHV, CMW monthly reports) and who contact the health facility within 42 days post-delivery, regardless of whether or not they delivered in the health facility.
Exclusion Criteria:
- Women aged 15-49 years who have not had a pregnancy in the last 12 months, who reside in the five targeted districts. Health facilities in five districts of GB that do not provide any obstetric and postnatal care and are not affiliated with any LHWs, or CMWs will be excluded.
Sites / Locations
- Government and AKHSP Health Facilities in Gilgit-Baltistan
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
No Intervention
Audits only
Audits with community feedback
Control
Formalized audit teams with monthly meetings at each facility. Audit Intervention phases: Identification of facility leadership (i.e physicians or leading health care providers) to be trained on best practices in obstetric and perinatal care in the implementation of the audits. Training of identified audit leaders (main investigator is typically a physician) a. 5-day training workshop to include: i. Day 1: maternal death and near misses, perinatal, neonatal deaths and morbidity outcomes ii. Day 2: 'Three-delay' framework and identifying modifiable factors iii. Day 3: data collection and setting up the audit system iv. Days 4-5: mentoring on the identification of the audit teams and initiating audit implementation Creating audit team (composed of at least two obstetricians, 2 pediatricians plus the main investigator) Establishing and launching the audit cycle (monthly meetings) Annual re-certification of audit leaders
This intervention will implement the audits as described in arm 1; however, key community representatives (approximately 3-5 members) will be identified to attend monthly follow-up meetings with audit team leaders to discuss the community aspects (phase one and two-delays) that could have prevented the death, near miss or severe adverse outcome. Information regarding the cause(s) of death in the community will be collected by the LHW or CMW, who reports to the health facility on a monthly basis.
Monthly outcome data will be collected from health facilities where no audits will be conducted. Data from this group will help evaluate the effectiveness of the intervention arms on perinatal and neonatal mortality.