Case review of perinatal deaths with application of a three delays analysis at hospitals in Kigali, Rwanda
(English)Manuscript (preprint) (Other academic)
Background: Perinatal audit and the three delays model are increasingly employed to analyse barriers to perinatal health, both at community and fa-cility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals.Methods: Perinatal audit was carried out at two main urban hospitals, one at district and the other at tertiary level, located in Kigali, Rwanda, from July 2012 to May 2013. Stillbirths and early neonatal deaths aged 22 completed weeks of gestation or more or weighing at least 500 g were included in the study. Factors contributing to mortality and potentially avoidable deaths, given the local resources and feasibility, were identified using a three delays model.Results: Out of 8424 births there were 269 perinatal deaths (106 macerated stillbirths, 63 fresh stillbirths, 100 early neonatal deaths) corresponding to a stillbirth rate of 20/1000 births and a perinatal mortality rate of 32/1000 births. In total, 250 perinatal deaths were available for audit. Factors con-tributing to mortality were ascertained in 79% of deaths. Delay in care-seeking was identified in 39% of deaths, delay to arrive at health facility in 10%, and provision of suboptimal care at health facility in 37%. Delay in seeking adequate care was commonly characterized by the difficulties in recognition or reporting of pregnancy-related danger signs. Lack of money was the major cause of delay in reaching a health facility. Delay in referrals, diagnosis and management of emergency obstetric cases were most promi-nent contributors affecting the provision of appropriate and timely care by healthcare providers. Half of the perinatal deaths were judged to be poten-tially avoidable and 70% of these preventable deaths were fresh stillbirths and early neonatal deaths.Conclusions: Factors contributing to delays underlying perinatal mortality were identified in more than three quarters of deaths. Half of the perinatal deaths were considered likely preventable and mainly related to modifiable maternal inadequate health-seeking behaviours and intrapartum suboptimal care. Strengthening the current roadmap strategy for accelerating the reduc-tion of maternal and neonatal morbidity and mortality is needed for im-proved perinatal survival.
Perinatal audit, three delays model, urban hospitals, Rwanda
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-259480OAI: oai:DiVA.org:uu-259480DiVA: diva2:844333