Translating Lessons Learnt from the Dead Babies into Action in Resource-limited Settings: Perinatal Death Audits in Sri Lanka

Background: With the reduction of infant mortality rate to a single digit (8.2 per 1000 live births) and a larger proportion (60%) of such deaths being early neonatal deaths (END), perinatal deaths (PND) emerge as a priority area in further reducing neonatal mortality in Sri Lanka -a low and middle income country in South Asia.

National Perinatal Mortality Surveillance system was implemented in 2006. All specialized hospitals (with an obstetrician/paediatrician) are required to document all PNDs, review them monthly at a hospital stakeholder meeting and send a report to Ministry of Health. Structured data collection formats, monthly reporting formats and guidelines are available.

Objective: To analyze national PND data for meaningful outcomes

Methods: In 2014, data were received from all hospitals (both government and private sector) with labour rooms from a total of 452 hospitals (74 Specialized government hospitals, 357 Non-specialized peripheral hospitals and 21 Private hospitals). Considering total live births reported by Civil Registration System (349715), coverage of live births in this study was 99.6% (n= 348362).

Results: The analysis included 1386 (46%) stillbirths and 1623 (54%) ENDs (Total 3009 PNDs). Stillbirth and early neonatal mortality rates were 4.0 per 1000 total births and 4.7 per 1000 live births respectively. The perinatal mortality rate was 8.6 per 1000 total births. Majority of PNDs (52.1%) were male. One third (35.7%) of PNDs occurred in primies. Birthweight < 1000g was reported in 20% of all PNDs. Nearly 10% of ENDs had a period of gestation.

Outcome: Lessons learnt were translated into action at hospital, district and nationallevels. Actions included; prevention strategies on premature deliveries, expansion of premature baby units, strategies on birth defects prevention, early neurodvelopmental care, neonatal retrieval systems and introducing therapeutic body cooling.

With contribution from PND surveillance, Sri Lanka targets a neonatal mortality of 2.5 by year 2025.