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Am J Perinatol 2023; 40(07): 731-740
DOI: 10.1055/s-0041-1730434
Original Article

Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits

Mohammad S. Alyahya
1   Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Yousef S. Khader
2   Medical Education and Biostatistics, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Nihaya A Al-Sheyab
3   Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
,
Khulood K. Shattnawi
4   Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
,
Omar F. Altal
5   Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Anwar Batieha
6   Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
› Author Affiliations Funding This work was supported by the International Development Research Centre of Canada and the United Nations Children's Emergency Fund, Jordan.
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Abstract

Objective This study employed the “three-delay” model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan.

Study Design A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected.

Results During the study period (August 1, 2019–February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths.

Conclusion The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors.

Key Points

  • Death review committees play key roles in identifying critical delays and modifiable factors.

  • The “three-delay” model was successful in identifying preventable neonatal deaths and stillbirths.

  • Death review committees are central in developing actions to reduce preventable deaths.

Keywords

death auditing - death review - delays - modifiable factors - neonatal deaths - stillbirths

Note

This study was approved by ethics committees at Jordan University of Science and Technology (number: 20170033) and Ministry of Health.




Publication History

Received: 08 December 2020

Accepted: 19 April 2021

Article published online:
31 May 2021

© 2021. Thieme. All rights reserved.

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