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Strengthening Neonatal Mortality Audits in Zaatari and Azraq Refugee Camps in Jordan - Mid-year/2019

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Report of Neonatal Deaths and Stillbirths Audit among Syrian from Zatari and Azraq Refugee Camps, Jordan.

1st January–30th June 2019

GHD and EMPHNET: Working together for better health

Global Health Development (GHD) is a regional initiative created to support countries in the Eastern Mediterranean Region (EMR) and to strengthen their health systems to respond to public health challenges and threats. GHD was initiated to advance the work of the Eastern Mediterranean Public Health Network (EMPHNET) by building coordinating mechanisms with Ministries of Health, International Organizations and other institutions to improve population health outcomes. As an implementing arm to EMPHNET, GHD aligns its strategies with national policies and directions. Serving as a collaborative platform, GHD/EMPHNET is dedicated to serve the region by supporting national efforts to promote public health policies, strategic planning, sustainable financing, resource mobilization, public health programs, and other related services.


Neonatal death is defined as any death that occurs in the first 28 days of life, currently account for approximately 44% of all deaths of children under five years of age in low-middle income countries. Stillbirth is defined as Birthweight ≥1000g, or if missing, ≥24 completed weeks gestation, or if missing, body length ≥35cm.

The ICD definition of Stillbirth is birthweight ≥1000g; or if missing ≥24 completed weeks; or if missing body length ≥35cm. the WHO international comparison definition of Stillbirth is Birthweight ≥1000g, or if missing, ≥28 completed weeks gestation, or if missing, body length ≥35cm. A joint meeting between UNHCR, UNFPA and EMPHNET early Jan 2019 took place in order to agree on the used definition in Jordan context. It was agreed to use the WHO definition with the exception of GA completed 24 weeks. As the already used cut off point for abortion is 24 weeks so in order to not miss cases between 24 and 28 weeks of gestation.

Neonatal death and stillbirth audits are the process of systematically capturing information on the number and causes of all neonatal deaths and stillbirths and the potential avoidable factors linked to deaths, to affect change. These are conducted in a no-blame, interdisciplinary setting to improve the care provided to all mothers and babies. Neonatal deaths and stillbirth reviews provide opportunities to examine the circumstances surrounding, as well as the immediate and contributing factors leading to a neonatal death and stillbirths and inform the delivery of health services and quality of health care for women and babies during pregnancy and delivery, and ultimately to prevent future morbidity and mortality. Neonatal mortality and stillbirth audits are particularly important as care often falls short between different providers and even between different departments or units. However, audit alone cannot improve the quality of care and outcomes; unless the recommendations contained within the audit process are effectively implemented, maternal and neonatal outcomes will not improve.

Neonatal mortality rate is the number of neonatal deaths in the camp dying at age of 28 days and less, divided by the number of live births in the same camp & same period, multiplied by 1000.
Stillbirth rate is the number of stillbirths (Any fetal death after 24 weeks and/or <1000) divided by the number of total births in the camp for the same period, multiplied by 1000.

In line with UNHCR’s global strategy; UNHCR Jordan established a NN death audit system in camps in collaboration with Centers for Disease Control (CDC). Since June 2016,
EMPHNET was selected through a tendering process to start conducting the audits in Zatari camp and in April 2016 in Azraq camp, stillbirth audits started at July 2018. The main objective of this audit is to decrease the neonatal mortality and stillbirths, among Syrian refugees through conducting the following activities:

  • Conduct periodic review meetings with stakeholders about the findings and recommendations in a manner that is acceptable to all.

  • Investigate possible causes of death/ and factors affecting the coverage and quality of babies’ care.

  • Improve neonatal care in refugee camps and to prioritize action to save lives of babies.

  • Revision of the audit forms took place in late 2017 and 2019 in order to capture more significant data; questions were added to highlight challenges in transportation for the mother in addition to the baby. More questions added to specify treatment protocols used for anemia during pregnancy.