Count every newborn; a measurement improvement roadmap for coverage data

Abstract

BackgroundThe Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity.MethodsIn a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout.ResultsENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care.ConclusionsThe ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda

“…In retrospective household surveys, the current widespread use of birth history alone likely underestimates stillbirths and early neonatal deaths and does not capture other important pregnancy outcomes (including spontaneous and induced abortions). These deficits have been identified as major data gaps, impeding actions towards improving maternal and newborn health [16]. To further explore the underlying issues and differences between these two approaches, we present a comparison of a population-based retrospective pregnancy history survey and the routine prospective surveillance system used in Iganga-Mayuge HDSS in eastern Uganda.…”

Evidence to inform the future for maternal and newborn health

“…Linking data to action has also been important to drive the change (4,8). However, huge inequities in coverage and quality continue, and more efforts are needed to improve the data to track specific interventions and quality of care, and then be able to use that data to close gaps in care for the poorest and most marginalised in every setting (36).…”

Measuring coverage of essential maternal and newborn care interventions: An unfinished agenda to define the data matrix for action in maternal and newborn health

“…Central to this is recognition that in-service provision as well as measurement it is essential to keep the mother and baby together as a dyad, especially around the time of birth when the majority of maternal and newborn deaths occur. Despite the considerable progress by household and facility surveys to illuminate evidence on the content of care, robust data on quality life-saving care at birth remains scarce in many settings [1][2][3], and there continues to be a need for global guidance on best measurement methods.…”