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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

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.

Related collections

Most cited references 15

Record: found
Abstract: found
Article: found

Is Open Access

Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data

Joy E. Lawn, Michael G. Gravett, Toni Nunes … (2010)

Introduction This is the first of seven articles from a preterm birth and stillbirth report. Presented here is an overview of the burden, an assessment of the quality of current estimates, review of trends, and recommendations to improve data. Preterm birth Few countries have reliable national preterm birth prevalence data. Globally, an estimated 13 million babies are born before 37 completed weeks of gestation annually. Rates are generally highest in low- and middle-income countries, and increasing in some middle- and high-income countries, particularly the Americas. Preterm birth is the leading direct cause of neonatal death (27%); more than one million preterm newborns die annually. Preterm birth is also the dominant risk factor for neonatal mortality, particularly for deaths due to infections. Long-term impairment is an increasing issue. Stillbirth Stillbirths are currently not included in Millennium Development Goal tracking and remain invisible in global policies. For international comparisons, stillbirths include late fetal deaths weighing more than 1000g or occurring after 28 weeks gestation. Only about 2% of all stillbirths are counted through vital registration and global estimates are based on household surveys or modelling. Two global estimation exercises reached a similar estimate of around three million annually; 99% occur in low- and middle-income countries. One million stillbirths occur during birth. Global stillbirth cause-of-death estimates are impeded by multiple, complex classification systems. Recommendations to improve data (1) increase the capture and quality of pregnancy outcome data through household surveys, the main data source for countries with 75% of the global burden; (2) increase compliance with standard definitions of gestational age and stillbirth in routine data collection systems; (3) strengthen existing data collection mechanisms—especially vital registration and facility data—by instituting a standard death certificate for stillbirth and neonatal death linked to revised International Classification of Diseases coding; (4) validate a simple, standardized classification system for stillbirth cause-of-death; and (5) improve systems and tools to capture acute morbidity and long-term impairment outcomes following preterm birth. Conclusion Lack of adequate data hampers visibility, effective policies, and research. Immediate opportunities exist to improve data tracking and reduce the burden of preterm birth and stillbirth.

0 comments Cited 255 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

Ulrika Byrskog, Pia Olsson, Birgitta Essén … (2015)

Background Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. Results The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Conclusion Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

0 comments Cited 174 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths.

Joy E. Lawn, Kenji Shibuya, Claudia Stein (2005)

Fewer than 3% of 4 million annual neonatal deaths occur in countries with reliable vital registration (VR) data. Global estimates for asphyxia-related neonatal deaths vary from 0.7 to 1.2 million. Estimates for intrapartum stillbirths are not available. We aimed to estimate the numbers of intrapartum-related neonatal deaths and intrapartum stillbirths in the year 2000. Sources of data on neonatal death included: vital registration (VR) data on neonatal death from countries with full (> 90%) VR coverage (48 countries, n = 97,297); studies identified through literature searches (> 4000 abstracts) and meeting inclusion criteria (46 populations, 30 countries, n = 12,355). A regression model was fitted to cause-specific proportionate mortality data from VR and the literature. Predicted cause-specific proportions were applied to the number of neonatal deaths by country, and summed to a global total. Intrapartum stillbirths were estimated using median cause-specific mortality rate by country (73 populations, 52 countries, n = 46,779) or the subregional median in the absence of country data. Intrapartum-related neonatal deaths were estimated at 0.904 million (uncertainty 0.65-1.17), equivalent to 23% of the global total of 4 million neonatal deaths. Country-level model predictions compared well with population-based data sets not included in the input data. An estimated 1.02 million intrapartum stillbirths (0.66-1.48 million) occur annually, comprising 26% of global stillbirths. Intrapartum-related neonatal deaths account for almost 10% of deaths in children aged under 5 years. Intrapartum stillbirths are a huge and invisible problem, but are potentially preventable. Programmatic attention and improved information are required.

0 comments Cited 123 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Jacobus P. van Wouwe: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 28 December 2016

Publication date Collection: 2016

Volume: 11

Issue: 12

Electronic Location Identifier: e0168743

Affiliations

[1 ]Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

[2 ]The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

[3 ]Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

TNO, NETHERLANDS

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceptualization: REB LL HDK.
Data curation: YC NK.
Formal analysis: LL YC.
Funding acquisition: REB.
Investigation: HDK AK AA OJ MM.
Methodology: LL YC.
Project administration: YC.
Resources: HDK AK AA OJ MM.
Software: YC LL.
Supervision: REB.
Validation: LL YC.
Visualization: YC NK.
Writing – original draft: LL YC.
Writing – review & editing: LL HDK YC NK AK AA OJ MM REB.

* E-mail: lliu26@ 123456jhu.edu

Article

Publisher ID: PONE-D-16-28243

DOI: 10.1371/journal.pone.0168743

PMC ID: 5193424

PubMed ID: 28030594

SO-VID: aa317f08-9b01-481e-b431-815b3f86e265

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 14 July 2016

Date accepted : 5 December 2016

Page count

Figures: 1, Tables: 4, Pages: 11

Funding

Funded by: Canadian Department of Foreign Affairs Trade and Development

The project was funded by Foreign Affairs, Trade and Development Canada ( http://www.international.gc.ca/international/index.aspx?lang=eng) through the Real-Time Results Tracking grant (#7056791) under the Catalytic Initiative to Save a Million Lives. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Data used in the analysis of this study are available on Johns Hopkins Institute for International Programs website at http://www.jhsph.edu/research/centers-and-institutes/institute-for-international-programs/current-projects/maternal-child-epidemiology-estimation/maternal-newborn-and-child-cause-of-death/. More data from the RMM study could be accessed at http://dx.doi.org/10.7281/T1F769G3 along with their associated documentation. More data from the verbal/social autopsy study in Malawi could be required by contacting Alain Koffi at akoffi1@ 123456jhu.edu .

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

Read this article at

Abstract

Related collections

UN Sustainable Development Goals

Most cited references 15

Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data

Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 106

Cited by 44

Most referenced authors 979