Strategies for Deploying Pediatric Death Audit to Improve Quality of Care

USAID’s MOMENTUM Country and Global Leadership project examined the use of death audits and the challenges being experienced at the global level and in Nigeria, Kenya, Zambia, South Africa, and Sierra Leone, through narrative reviews and key informant discussions with those involved in or providing technical support at country level to death audit programs. We used these findings to propose options for pediatric death audit development.
We find that evidence on the effect of death audit programs on patient outcomes, such as reduced mortality, is limited; however, the complex nature of death audits as an intervention makes providing evidence for mortality effects challenging. Death audits have been used with some success as a strategy to promote health care system improvement at national and local levels. However, multiple studies have articulated the challenges encountered in implementing death audits at scale in low- and middle-income countries. Many recommendations have been made to guide effective death audit programming, including comprehensive World Health Organization guidance for introducing MPDSR. These recommendations acknowledge implementation challenges at the macro, meso, and micro levels of health systems.