Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia

Abstract

BackgroundPerinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia.MethodsA retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality.ResultsField activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting.ConclusionsLocal maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to strengthen register maintenance can provide routine local area measures of perinatal mortality for health policy, and monitoring of newborn care interventions. Similar efforts are required to strengthen routine health data in all developing countries, to guide planned progress towards reduction in the local, national and international burden from perinatal mortality.

Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India

“…22 – 31 A case study in rural Indonesia demonstrated the usefulness of local maternal and child health registers as sources of information in measuring and reporting perinatal mortality and stillbirths, in combination with local vital registration systems. 32 Even in an urban area of a developed high-income country, such as the United States of America, the use of computer-assisted active surveillance revealed 14 new maternal deaths, resulting in an 88% increase in the ascertainment of maternal deaths. 33 Other innovative strategies employed to improve the reporting of deaths include record linkage, a retrospective survey among doctors, use of an interview census and confidential forms, specific inquiries on maternal deaths, a household census of birth and infant deaths, matching of hospital records with death certificates and a retrospective population-based survey.…”

“…This problem may have been exacerbated by a lack of awareness about the importance of accurate reporting and inconsistencies in community access to local health-care services. 32 Further health reforms and policy reviews may well be needed, at both district and state levels, if good data on infant and maternal deaths are to be collected in the long term. An external evaluation of the cost–effectiveness of the review system is still needed.…”

Epidemiology of stillbirth in low‐middle income countries: A Global Network Study

“…An estimated 3.2 million stillbirths occur worldwide each year with more than 98% of these in low to middle‐income countries (1,2). Stillbirth rates may be as high as 30–40 per 1 000 births in low‐income countries, especially areas of sub‐Saharan Africa and south Asia, while rates as low as 3–4 per 1 000 are reported in many high‐income countries (2–8). In low‐income countries, a gestational age of 28 weeks or a birthweight of 1 000g is often selected as the lower limit of viability (4).…”

Global Health and Neonatal Nursing

“…National policies and recommendations are present in some countries; however, healthcare professionals are often unaware or uncertain about its content (Lawn et al, 2007). Moreover, the amount of research conducted in poor countries has decreased during the last few decades (Rudan et al, 2005); the picture of health is not always clear due to absence of resources and methods for reporting (Burke et al, 2011;Malqvist, 2011;Rudan et al, 2005). Thus, there is little information on which to base interventions or draw conclusions about the country's needs.…”