Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review

Purpose To identify approaches, enablers, barriers and outcomes of facility stillbirth neonatal death audit in low-income middle-income countries (LMICs). Data sources We searched MEDLINE, CINAHL Complete, Academic Search Index, Science Citation Complementary index Global health electronic databases. Study selection Studies were considered eligible when reporting the facility-based LMICs. extraction Two authors independently performed data using predefined templates made before extraction. Results synthesis A total 10 articles from 7 included final analysis. Facility or external multidisciplinary teams audits on a weekly monthly basis. 1018 stillbirths deaths audited. Of 18 enablers identified, nine at provider level while 23 to that identified occurred level. The facility-level cited by more than one study included: failure implement change; inadequate training; limited time; increased workload; too many cases poor documentation. Six studies reported resulted structural improvements physical structure, training, service organisation, supplies equipment wards. Five improved standard care, with showing significant improvement measured standards. One reduction newborn mortality rate 29.4% (95% CI 0.6% 2.4%; p=0.0015) perinatal 4.9% (52.8% 2007 47.9% 2008) after implementation. Conclusion Stillbirth improves structures, processes care care. There is need enhance address both levels improve process.