Linking Facility-based Mortality Audits With Community Engagement in Gilgit-Baltistan, Pakistan

Summary

Pakistan is one of the countries in South Asia where neonatal mortality rates remain stagnant. Babies born in Pakistan encounter the highest risk of dying; of every 1,000 babies born, 46 die before the end of their first month (UNICEF, 2018). Some of the highest perinatal and neonatal mortality rates in Pakistan are found in districts of Pakistan's mountainous northern region (Bhutta ZA, 2013), where geography, climate and security risks make it challenging for women in remote communities to reach health services in a timely manner. According to 2013 PDHS, the neonatal and perinatal mortality rate in the northern area of Gilgit Baltistan was 39/1,000 and 37/1,000, respectively. In the rural area of Khyber Pakhtunkhwa, the neonatal and perinatal mortality rate was 42/1,000 and 63/1,000, respectively.

Implementation of a health facility mortality audit cycle has proved successful in reducing perinatal mortality by upto 30% in other LMICs. Meanwhile evidence suggests that the most common factors contributing to high mortality rates are due to phase-one delays (delay in the decision to seek care). This study will attempt to operationalize linkages between the community and facility to not only improve facility-based quality of care, but to bring change in the community through community-feedback meetings to mitigate phase one and two delays and improve maternal, perinatal and neonatal outcomes. Data from this study will inform MoH policy decisions about standardized mortality audits with community feedback.

Given the geographical location of Gilgit-Baltistan (GB) and accompanying constraints such as terrain and security, this study will attempt to operationalize linkages between the community and facility to not only improve facility-based quality of care, but to bring change in the community through community-feedback meetings to mitigate phase one and two delays and improve maternal, perinatal and neonatal outcomes. Data from this study will inform MoH policy decisions about standardized mortality audits with community feedback.

Conditions

• External Causes of Morbidity and Mortality
• Stillbirth
• Neonatal Death

Interventions

OTHER

Audits only

Formalized audit teams with monthly meetings at each facility.

OTHER

Audits with community feedback

This intervention will implement the audits as described in arm 1; however, key community representatives (approximately 3-5 members) will be identified to attend monthly follow-up meetings with audit team leaders to discuss the community aspects (phase one and two-delays) that could have prevented the death, near miss or severe adverse outcome. Information regarding the cause(s) of death in the community will be collected by the LHW or CMW, who reports to the health facility on a monthly basis.

Sponsors & Collaborators

• Aga Khan Foundation, Pakistan

  collaborator UNKNOWN

• Aga Khan Health Services

  collaborator OTHER

• Centre for Global Child Health, SickKids Research Institute - Toronto, Canada

  collaborator UNKNOWN

• Aga Khan Development Network - Islamabad, Pakistan

  collaborator UNKNOWN

• Department of Health Gilgit-Baltistan - Pakistan

  collaborator UNKNOWN

• Aga Khan Foundation, Canada

  collaborator UNKNOWN

• Aga Khan University

  lead OTHER

Principal Investigators

• Sajid Soofi, FCPS, MBBS · Aga Khan University

• Diego Bassani, PhD · Centre for Global Child Health, SickKids Research Institute - Toronto, Canada

• Aminah Jahangir, MBBS, HPM · Aga Khan Foundation, Pakistan

• Zulfiqar A Bhutta, PhD · Centre for Global Child Health, SickKids Research Institute - Toronto, Canada

• Gul Nawaz Khan, MA, MPH · Aga Khan University

• Suzanne E Powell, MSc · Centre for Global Child Health, SickKids Research Institute - Toronto, Canada

• Miraj Uddin, MA · Aga Khan Health Services

• Saad Y Sulaimani, MSc · Aga Khan Foundation, Pakistan

• Asma Sittar, MSc · Aga Khan Development Network - Islamabad, Pakistan

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

15 Years

Max Age

49 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2019-04-16

Primary Completion

2020-03-20

Completion

2020-05-31

Countries

• Pakistan

Study Locations