An interrupted time series analysis to assess the impact of implementing the clinical audit process for stillbirths and neonatal deaths in Morocco

Abstract

Objectives

This article aims to evaluate the clinical audit process for stillbirths and neonatal deaths and its impact on reducing neonatal mortality at the Hassan I Hospital, Tiznit, Morocco. This process was initially implemented in Morocco in 2017.

Methods

The clinical audit process was evaluated using a semi-structured interview with the managers monitoring the clinical audit of stillbirths and neonatal deaths. The impact of the clinical audit on reducing neonatal mortality rates was assessed by analysing neonatal mortality rates using interrupted time series analysis (ITSA).

Results

A study of the interrupted time series showed that there was a slight downward trend in the monthly neonatal mortality rate before implementation of the clinical audit (estimate - 0.20, CI 95 %: 0.23–0.16, P < 0.001) with a very significant drop just at the time of performance of the clinical audit (assessment - 11, CI 95 %: 15.1–8.87, P < 0.001)The monthly neonatal mortality rates recorded, which are similar to the recommended international standards, stabilised after the clinical audit was implemented (estimate 0.16, CI 95 %:0.11–0.21, P < 0.001) with an improvement in the care of newborns through the availability of human resources, materials and equipment.

Conclusion

The audit of stillbirths and neonatal deaths reduced neonatal mortality by improving the mother-newborn couple's management quality. In addition, the study highlighted the need to introduce several community participation mechanisms that could be adapted and piloted to establish a more comprehensive and effective audit practice.