Validity of verbal autopsy for ascertaining the causes of stillbirth

Aggarwal, Arun Kumar; Jain, Vanita; Kumar, Rajesh

doi:10.2471/blt.10.076828

Cited by 28 publications

(20 citation statements)

References 19 publications

(25 reference statements)

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“…Twenty‐one clinical classification systems were used in 41 of the 85 reports (LIC, 15 reports covering 30% of stillbirths; MIC, 6 reports covering 5% of stillbirths; HIC, 20 reports covering 27% of stillbirths). The ICD was used more frequently in HIC (14 reports covering 72% of stillbirths) and MIC (7 reports covering 94% of stillbirths) than LIC (3 reports covering 2% of stillbirths) (Table ).…”

Section: Resultsmentioning

confidence: 99%

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Reinebrant

Leisher

Coory

et al. 2017

BJOG

151

138

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Background Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD‐PM) aims to improve data on stillbirth to enable prevention. Objectives To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD‐PM. Search strategy We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016. Selection criteria Reports of stillbirth causes in unselective cohorts. Data collection and analysis Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD‐PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC). Main results Eighty‐five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD‐PM. All stillbirth causes mapped to ICD‐PM. In a subset from HIC, mapping obscured major causes. Conclusions There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well‐resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings. Funding HR, SH, SHL, and AW were supported by an NHMRC‐CRE grant (APP1116640). VF was funded by an NHMRC‐CDF (APP1123611). Tweetable abstract Urgent need to improve data on causes of stillbirths across all settings to meet global targets. Plain Language Summary Background and methodsNearly three million babies are stillborn every year. These deaths have deep and long‐lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high‐, middle‐, and low‐income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths. FindingsWe found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low‐, middle‐, and high‐income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low‐income countries, stillbirths were often attribute...

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Section: Resultsmentioning

confidence: 99%

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Reinebrant

Leisher

Coory

et al. 2017

BJOG

151

138

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“…In some studies, this proxy has correlated well with hospital data, 61,62 but other studies suggest that verbal autopsy might systematically overestimate the intrapartum proportion. 78 Categories with enormous public health relevance, such as intrapartum events, might be identifi ed through maternal history in verbal autopsy, but other important causes such as syphilis cannot be recognised in this manner. Advances in verbal autopsy methods and categorisation for neonatal causes of death over the past 5 years have resulted in increased data and improved comparability of data for national estimates, 53 and the same advances are needed for stillbirth data.…”

Section: Improving Stillbirth Causal Data For Programmatic Actionmentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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for The Lancet's Stillbirths Series steering committee* Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classifi cation systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specifi c perinatal certifi cates and revised International Classifi cation of Disease codes, are needed. A simple, programme-relevant stillbirth classifi cation that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment. Why don't stillbirths count?Stillbirths are invisible in many societies and on the worldwide policy agenda, but are very real to families who experience a death. Despite 30 years of attention to child survival interventions, 1,2 more than 20 years of attention to safe motherhood, 3,4 and increasing recent attention to survival of newborn babies, 5-7 the focus worldwide has remained on survival after livebirth. Stillbirths remain mostly ignored, not counting on policy, programme, and investment agendas, both internationally and often also at the national level. 8 The importance of neonatal deaths has risen on the worldwide policy agenda, mainly because of the Millennium Development Goals (MDGs) and recognition of the increasing proportion of child deaths that happen in the fi rst month of life-from 37% in 2000 7 to 41% in 2008. 9 A baby who dies just after birth counts in the MDG tracking, but a baby who dies in the third trimester or even during labour does not. Neither the MDGs nor the Global Burden of Disease metrics mention stillbirths, and stillbirth data are not routinely compiled by the UN. Even when stillbirths are recorded in surveys, the data are frequently combined with early neonatal deaths and reported as perinatal mortality, a combination that reduces visibility and might mask reporti...

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“…However, FBH is not always a reliable source for stillbirth and neonatal death estimates. [3, 4] First, stillbirths and neonatal deaths have many causes in common such as asphyxia and prematurity and are sometimes hard to distinguish [5, 6], and sometimes the cause of death classification systems wouldn’t distinguish causes for stillbirths versus neonatal period. [7] Second, babies born with limited signs of life, such as crying, breathing, and movement, who died shortly after birth may be mistakenly or intentionally reported as stillbirths.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Improving the counting of stillbirths and neonatal deaths is important to tracking Sustainable Development Goal 3.2 and improving vital statistics in low- and middle-income countries (LMICs). However, the validity of self-reported stillbirths and neonatal deaths in surveys is often threatened by misclassification errors between the two birth outcomes. We assessed the extent and correlates of stillbirths being misclassified as neonatal deaths by comparing two recent and linked population surveys conducted in Malawi, one being a full birth history (FBH) survey, and the other a follow-up verbal/social autopsy (VASA) survey. We found that one-fifth of 365 neonatal deaths identified in the FBH survey were classified as stillbirths in the VASA survey. Neonatal deaths with signs of movements in the last few days before delivery reported were less likely to be misclassified stillbirths (OR = 0.08, p<0.05). Having signs of birth injury was found to be associated with higher odds of misclassification (OR = 6.17, p<0.05). We recommend replicating our study with larger sample size in other settings. Additionally, we recommend conducting validation studies to confirm accuracy and completeness of live births and neonatal deaths reported in household surveys with events reported in a full birth history and the extent of underestimation of neonatal mortality resulting from misclassifications. Questions on fetal movement, signs of life at delivery and improved probing among older mother may be useful to improve accuracy of reported events.

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Validity of verbal autopsy for ascertaining the causes of stillbirth

Cited by 28 publications

References 19 publications

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Making stillbirths visible: a systematic review of globally reported causes of stillbirth

Stillbirths: Where? When? Why? How to make the data count?

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

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