title: Improving maternal and child health systems in Fiji through a perinatal mortality audit.
abstract: OBJECTIVE
  To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji.
  
  
  METHODS
  In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12. Key informant interviews identified factors influencing PMA uptake.
  
  
  RESULTS
  Overall, 141 stillbirths and neonatal deaths were analyzed (57 from hospital A and 84 from hospital B; forms from hospital C excluded because incomplete/illegible). Between-site variations in mortality were recorded on the basis of the level of tertiary care available; 28 (49%) stillbirths were recorded in hospital A compared with 53 (63%) in hospital B. Substantial health system factors contributing to preventable deaths were identified, and included inadequate staffing, problems with medical equipment, and lack of clinical skills. Leadership, teamwork, communication, and having a standardized process were associated with uptake of PMA.
  
  
  CONCLUSIONS
  The use of PMAs by health workers in Fiji and other Pacific island countries could potentially rectify gaps in maternal and neonatal service delivery.
authors: Department of Community Paediatrics, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia. Electronic address: shanti.raman@sswahs.nsw.gov.au.
authors: Shanti
authors: S
authors: Raman
authors: Discipline of International Business, University of Sydney, Camperdown, NSW, Australia.
authors: Alexandra
authors: A
authors: Iljadica
authors: College of Medicine, Nursing and Health Sciences, Lautoka Hospital, Fiji National University, Lautoka, Fiji.
authors: Rajat
authors: R
authors: Gyaneshwar
authors: College of Medicine, Nursing and Health Sciences, Lautoka Hospital, Fiji National University, Lautoka, Fiji.
authors: Rigamoto
authors: R
authors: Taito
authors: Department of Obstetrics and Gynecology, Colonial War Memorial Hospital, Suva, Fiji.
authors: James
authors: J
authors: Fong
mesh_terms: D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005367:Fiji; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008485:Medical Audit / Q000592:standards* / Q000706:statistics & numerical data; D009774:Obstetrics / Q000592:standards / Q000706:statistics & numerical data; D054238:Perinatal Mortality; D010865:Pilot Projects; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology
keywords: Clinical audit; Health systems; Low-income countries; Maternal health; Millennium Development Goals; Newborn and child health; Perinatal mortality; Service improvement