OBJECTIVE To assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala .
DESIGN Interrupted time series (ITS) analysis .
SETTING Nsambya Hospital, Uganda .
PARTICIPANTS Live births and stillbirths .
INTERVENTIONS PND audit . PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. SECONDARY
OUTCOMES case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis .
RESULTS 526 PNDs were audited : 142 (27.0 %) fresh stillbirths , 125 (23.8 %) macerated stillbirths and 259 (49.2 %) early neonatal deaths . The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p <0.001), but an increase in PND (IRR (95% CI) =1.17 (1.0 to -1.34), p=0.0021) following the intervention . However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern . By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI) =1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI) =0.35 (0.22 to 0.56), p <0.001), when overdispersion was included . The CFR for prematurity showed a downward trend over time (IRR (95% CI) =0.94 (0.88 to 0.99), p=0.04) but not for the intervention . With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention .
CONCLUSION The introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections . These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.