title: Quality-of-care audits and perinatal mortality in South Africa.
abstract: OBJECTIVE
  Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa.
  
  
  METHODS
  We investigated perinatal mortality trends in health facilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths.
  
  
  METHODS
  Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change.
  
  
  RESULTS
  Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29%) and increased in 52 (32%). Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54) but an increase in 35% (19/54). Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99-10.97); lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97-30.81); lack of nursing personnel (OR: 2.67; 95% CI: 1.34-5.33); fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47-5.8) and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43-5.34).
  
  
  CONCLUSIONS
  Quality-of-care audits were not shown to improve perinatal mortality in this study.
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia .
authors.forename: Emma R
authors.initials: ER
authors.lastname: Allanson
authors.affiliation: South African Medical Research Council, Maternal and Infant Health Care Strategies Unit, Cape Town, South Africa .
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pattinson
mesh_terms: D002423:Cause of Death; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D018743:Perinatal Care; D054238:Perinatal Mortality; D011247:Pregnancy; D011787:Quality of Health Care; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology