Evaluation of criterion-based audit in improving quality of neonatal birth asphyxia care at Balaka district hospital in Malawi

Abstract

Background Birth asphyxia remains one of the leading causes of neonatal deaths worldwide with a higher incidence in resource limited countries such as Malawi. At Balaka district hospital, Birth asphyxia is the primary cause of neonatal mortality accounting for 37.3% of the district’s neonatal deaths. Although various quality improvement initiatives on birth asphyxia such as Helping Babies Breathe have been documented in Malawi, there is limited information on use of criterion based audit (CBA) to enhance the care of neonates with birth asphyxia. This study aimed to evaluate the effectiveness of criterion-based audit in improving quality of neonatal birth asphyxia care at Balaka district hospital in Malawi. Methods A CBA on the care of babies born with birth asphyxia was conducted at Balaka district hospital in Malawi. The care practices were assessed through a retrospective review of 110 cases notes and compared with a locally established standards, by a multidisciplinary team, based on the Malawi guidelines on care of the infant and newborn and World Health Organization manuals. The gaps in current practice were identified, reasons discussed, and recommendations made and implemented. A re-audit was conducted on 110 case notes six months after the initial audit. Results The re-audit showed significant improvements in many of the set criteria for quality care: Checking of vital signs (80% vs. 98.2%; p = 0.000), appropriate investigations check (0.9% vs. 74%; p = 0.000), Thermal support (82.7% vs. 91.8%; p = 0.041), Correct diagnosis (60% vs. 81%; p = 0.001), Correct treatment (18.7% vs. 81%; p = 0.000), Correct Feeding (12.7% vs. 56.4%; p = 0.000), Clinicians’ ward rounds (0% vs. 72%; p = 0.000), and Daily weight check (49.1% vs. 93%; p = 0.000). Additionally, neonatal death decreased from 11% in initial audit to 5% in the re-audit. Conclusion CBA is a low-cost tool that can significantly improve the care of neonates with birth asphyxia in resource-limited countries.