Saving children--an audit system to assess under-5 health care.
OBJECTIVE
To develop and pilot an audit system usable by medical officers in peripheral hospitals for deaths of children under 5 years to: (i) identify and classify all causes of deaths; and (ii) to identify substandard care and missed opportunities for intervention and to classify these as modifiable factors.


METHODS
The four public sector hospitals in Mafikeng health region in North West province.


METHODS
An action research methodology was used. The system for classifying under-5 deaths was based on the International Classification of Diseases 10 (ICD-10), but modified for practical application in peripheral hospitals. Each death was analysed at a mortality meeting and factors related to the family, administration or actions or omissions by health care workers that could have contributed to the death were recorded. These factors were later grouped and categorised. During the last month of the pilot participating health care workers evaluated the audit system and completed a semi-structured questionnaire.


METHODS
1 November 2000-31 October 2001.


RESULTS
Two hundred and thirty-nine under-5 deaths occurred and were discussed during 61 mortality meetings. A workable system to identify and classify causes of deaths and modifiable factors occurring within the health system was developed and tested. A simple, user-friendly one-page data sheet encompassing the whole audit was developed. Overall the health care workers were positive about the mortality meetings and were confident that the classification systems developed could be applied in other peripheral hospitals.


CONCLUSIONS
The audit system (called the Under-5 Health Care Problem Identification Programme (U5PIP)), was piloted under normal service conditions and is usable and acceptable for peripheral hospitals.
Krug
A
A
North West Department of Health, Central Region, Mafikeng.
Pattinson
R C
RC
Power
D J
DJ
D002662:Child Health Services / Q000592:standards* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality / Q000639:trends*; D006779:Hospitals, Public / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D008485:Medical Audit / Q000379:methods*; D010865:Pilot Projects; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D012680:Sensitivity and Specificity; D013019:South Africa / Q000453:epidemiology