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Feasibility of community neonatal death audits in rural Uttar Pradesh, India
1Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Insights
Community neonatal death audits are feasible and culturally acceptable in India. This approach involves community members in identifying and addressing factors affecting neonatal health outcomes.
Area of Science:
- Public Health
- Neonatal Care
- Health Services Research
Background:
- Medical audit is a common hospital strategy, but its use in community settings is limited.
- Community neonatal death audit systematically analyzes home care quality, danger sign recognition, and care-seeking for neonatal illness.
Purpose of the Study:
- To investigate the feasibility and cultural acceptability of community neonatal death audits in Uttar Pradesh, India.
Main Methods:
- Conducted three in-depth interviews and six focus group discussions with family and community members.
- Evaluated three distinct approaches for conducting community neonatal death audits.
- Approaches involved interactive community participation to identify avoidable factors and discuss solutions.
Main Results:
- Community neonatal death audits were found to be acceptable and feasible when conducted sensitively and non-punitively.
- Community engagement led to self-discovery of amplified perceptions regarding neonatal deaths.
- The presence of educated community members or health workers acted as a catalyst for the audit process.
Conclusions:
- Community neonatal death audit is a promising and acceptable intervention for improving neonatal health outcomes.
- The audit process encourages community members to formally investigate and discuss factors contributing to neonatal mortality.
Objective:
Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits.
Study Design:
During November-December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions.
Result:
Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified.
Conclusion:
Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.
