Feasibility of community neonatal death audits in rural Uttar Pradesh, India

Medical audit is a widely promoted strategy in hospitals but experience within community settings is scant. Community neonatal death audit is a form of audit which involves a systematic analysis of the quality of care provided in the home danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh India to investigate the feasibility and cultural acceptability of community neonatal death audits. During November-December 2004 we conducted three in-depth interviews with family members of deceased neonates and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes involving the community to identify avoidable factors in a particular death and discuss solutions. Carried out in a culturally sensitive and non-punitive manner community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members and stimulated sharing of views leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified. Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes. (authors)