Understanding Misclassification between Neonatal Deaths and Stillbirths: Empirical Evidence from Malawi

Liu, Li; Kalter, Henry D.; Chu, Yue; Kazmi, Narjis; Koffi, Alain K.; Amouzou, Agbessi; Joos, Olga; Munos, Melinda; Black, Robert E.

doi:10.1371/journal.pone.0168743

Cited by 70 publications

(71 citation statements)

References 24 publications

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“…[13] This figure is more closely aligned with the global estimate that 45% of under-5 deaths occur during the newborn period, [21] but may be artificially high owing to misclassification of stillbirths as neonatal death, which has been shown to occur during such surveys in other countries. [14,15] …”

Section: National Estimates Of Under-5 Deaths and Mortality Ratesmentioning

confidence: 99%

Child mortality in South Africa: Fewer deaths, but better data are needed

et al. 2018

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South Africa is committed to reducing under-5 mortality rates in line with the Sustainable Development Goal (SDG) targets. Policymakers and healthcare service managers require accurate and complete data on the number and causes of child deaths to plan and monitor healthcare service delivery and health outcomes. This study aimed to review nationally representative data on under-5 mortality and the cause of deaths among children under 5 years of age. We also reviewed systems that are currently used for generating these data. Child mortality has declined substantially in the past decade. Under-5 mortality in 2015 is estimated at 37 -40 deaths per 1 000 live births, with an estimated infant mortality rate of 27 -33 deaths per 1 000 live births. Approximately one-third of under-5 deaths occur during the newborn period, while diarrhoea, pneumonia and HIV infection remain the most important causes of death outside of the newborn period. The proportion of deaths owing to non-natural causes, congenital disorders and non-communicable diseases has increased.However, many discrepancies in data collected through different systems are noted, especially at the sub-national level. There is a need to improve the completeness and accuracy of existing data systems and to strengthen reconciliation and triangulation of data.

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Section: National Estimates Of Under-5 Deaths and Mortality Ratesmentioning

confidence: 99%

Child mortality in South Africa: Fewer deaths, but better data are needed

et al. 2018

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“…Secondly, SADHS data come from questionnaires administered to mothers in the community; therefore, it is possible that the recall of these mothers includes stillbirths. This explanation is informed by a recent Malawian study [37] that found that in contrast, 20% of neonatal deaths were wrongfully classified as stillbirths after a full birth history by the mother. StatsSA and the MRC will review the SADHS data to confirm whether the SA NMR is double the current DHIS estimates.…”

Section: Researchmentioning

confidence: 99%

Reducing neonatal deaths in South Africa: Progress and challenges

Rhoda¹,

Velaphi²,

Gebhardt³

et al. 2018

S Afr Med J

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“…As an example, a study comparing two population surveys conducted in Malawi found that one-fifth of neonatal deaths identified in the full birth history (FBH) survey were classified as stillbirths in the verbal/social autopsy (VASA) survey. 8 Moreover, verification of data quality of childbirth registers in rural hospitals in Kenya demonstrated that the list of labor and delivery variables was incorrectly and inappropriately coded, 9 and that data quality of the childbirth registers was unsatisfactory. Improvement in accounting of neonatal mortality and live births will require improved hospital-based recording and its linkage with vital registration systems.…”

Section: Introductionmentioning

confidence: 99%

The burden of and factors associated with misclassification of intrapartum stillbirth: Evidence from a large scale multicentric observational study

Berkelhamer

Gurung

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Global estimates suggest 2.6 million stillbirths and 2.5 million neonatal deaths occur annually worldwide. The majority of these deaths occur in low resource settings where analysis of health metrics and outcomes measurements may be challenging. We examined the misclassification of documented intrapartum stillbirth and factors associated with misclassification. Material and methods A prospective observational study was performed in 12 public hospitals in Nepal. Data were extracted from the medical records of all births that occurred during the 6‐month period of the study. For the study purpose, we classified birth outcome based on the presence of fetal heart sound (FHS) at admission and use of neonatal resuscitation. The health worker‐documented intrapartum stillbirths were considered potentially misclassified when there were FHS present at admission and no resuscitation initiated after birth. The association between potentially misclassified intrapartum stillbirth and complications during labor, birthweight and gestational age was assessed using Pearson’s chi‐square test, bivariate and multivariate logistic regression. Results A total of 39 562 mother‐infant dyads were enrolled in the study, all of whom had FHS at admission. Among the 391 intrapartum stillbirths recorded during the study, 180 (46.0%) of them had FHS at admission with no resuscitation initiated after birth and were considered potentially misclassified intrapartum stillbirths. Among these potentially misclassified intrapartum stillbirths, 170 (43.5%) had FHS present 15 minutes before birth and 10 had no FHS 15 minutes before birth Among the potentially misclassified intrapartum stillbirths, 23.3% had complications during labor, 93.3% had birthweight less than 2500 g and 90.0% were born preterm. The risk of intrapartum misclassification was nearly four times higher among low birthweight babies (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.8 to 7.0, P < 0.001) and five times higher among preterm babies (aOR 5.3, 95% CI 3.0 to 9.3, P < 0.001). Conclusions We estimate that 46% of intrapartum stillbirths were potentially misclassified intrapartum stillbirths. Improving quality of both FHS monitoring and neonatal resuscitation as well as measurement of the care will reduce the risk of potentially misclassified intrapartum stillbirth and consequently intrapartum stillbirth.

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Understanding Misclassification between Neonatal Deaths and Stillbirths: Empirical Evidence from Malawi

Cited by 70 publications

References 24 publications

Child mortality in South Africa: Fewer deaths, but better data are needed

Child mortality in South Africa: Fewer deaths, but better data are needed

Reducing neonatal deaths in South Africa: Progress and challenges

The burden of and factors associated with misclassification of intrapartum stillbirth: Evidence from a large scale multicentric observational study

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