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Feasibility of community neonatal death audits in rural Uttar Pradesh, India



Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits.

Study Design:

During November–December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions.


Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified.


Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.

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We are grateful to the families and community members in Shivgarh for their willing participation, and to the members of the field team of the parent study in Shivgarh whose experience and dedication made this study possible. This work was supported by, the Office of Health, Infectious Diseases and Nutrition, Global Health Bureau, United States Agency for International Development (USAID) under the terms of Award GHS-A-00-03-00019-00, Global Research Activity Cooperative Agreement; the USAID India (New Delhi) Mission; and the Saving Newborn Lives initiative of Save the Children-US, through a grant from the Bill and Melinda Gates Foundation.

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Correspondence to G L Darmstadt.

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Patel, Z., Kumar, V., Singh, P. et al. Feasibility of community neonatal death audits in rural Uttar Pradesh, India. J Perinatol 27, 556–564 (2007).

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