Describes the key components in establishing national, sub-national and facility level child mortality and morbidity audit and review systems.

This operational guide provides guidance for establishing and conducting a paediatric death audit and review as part of the overall quality of care improvement at the health facility. Death reviews and mortality audits are a means of documenting the causes of a death and the factors that contributed to it, identifying factors that could be modified and actions that could prevent future deaths, putting the actions into place and reviewing the outcomes. The objective of audit and review is to determine whether patient care is consistent with evidence-based best practices, and to provide feedback to health workers to improve health care practices. It helps in identifying patterns of morbidity, mortality, modifiable factors and interventions to improve the quality of care and outcomes in health care facilities.

The guide describes the key components in establishing national, sub-national and facility level mortality and morbidity audit and review systems. It outlines the principles for conducting facility-based child death audit and review in hospitals, and the six steps in the audit cycle: (i) identifying cases; (ii) collecting information; (iii) identifying the causes of death and potentially modifiable factors; (iv) recommending solutions or actions; (v) implementing an action plan and making changes; and (vi) monitoring and evaluating the process and the outcomes and refining practice, as necessary. The annexes provide simplified International Classification Disease (ICD) 11 codes for child death audits and reviews, and examples of standard reporting forms that can be adapted to local and national contexts.

This document complements the audit and review of stillbirths and neonatal deaths guide by providing guidance on review and auditing of paediatric deaths, adverse events, near-misses and other paediatric clinical cases of interest.