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dc.contributor.authorPeven, K
dc.contributor.authorDay, LT
dc.contributor.authorRuysen, H
dc.contributor.authorTahsina, T
dc.contributor.authorKc, A
dc.contributor.authorShabani, J
dc.contributor.authorKong, S
dc.contributor.authorAmeen, S
dc.contributor.authorBasnet, O
dc.contributor.authorHaider, R
dc.contributor.authorRahman, QS-U
dc.contributor.authorBlencowe, H
dc.contributor.authorLawn, JE
dc.contributor.authorEN-BIRTH Study Group
dc.identifier.citationPeven, K., Day, L.T., Ruysen, H. et al. Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 21, 226 (2021).
dc.description.abstractBACKGROUND: An estimated >2 million babies stillborn around the world each year lack visibility. Low- and middle-income countries carry 84% of the burden yet have the least data. Most births are now in facilities, hence routine register-recording presents an opportunity to improve counting of stillbirths, but research is limited, particularly regarding accuracy. This paper evaluates register-recorded measurement of hospital stillbirths, classification accuracy, and barriers and enablers to routine recording. METHODS: The EN-BIRTH mixed-methods, observational study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017-2018). Clinical observers collected time-stamped data on perinatal care and birth outcomes as gold standard. To assess accuracy of routine register-recorded stillbirth rates, we compared birth outcomes recorded in labour ward registers to observation data. We calculated absolute rate differences and individual-level validation metrics (sensitivity, specificity, percent agreement). We assessed misclassification of stillbirths with neonatal deaths. To examine stillbirth appearance (fresh/macerated) as a proxy for timing of death, we compared appearance to observed timing of intrauterine death based on heart rate at admission. RESULTS: 23,072 births were observed including 550 stillbirths. Register-recorded completeness of birth outcomes was > 90%. The observed study stillbirth rate ranged from 3.8 (95%CI = 2.0,7.0) to 50.3 (95%CI = 43.6,58.0)/1000 total births and was under-estimated in routine registers by 1.1 to 7.3 /1000 total births (register: observed ratio 0.9-0.7). Specificity of register-recorded birth outcomes was > 99% and sensitivity varied between hospitals, ranging from 77.7-86.1%. Percent agreement between observer-assessed birth outcome and register-recorded birth outcome was very high across all hospitals and all modes of birth (> 98%). Fresh or macerated stillbirth appearance was a poor proxy for timing of stillbirth. While there were similar numbers of stillbirths misclassified as neonatal deaths (17/430) and neonatal deaths misclassified as stillbirths (21/36), neonatal deaths were proportionately more likely to be misclassified as stillbirths (58.3% vs 4.0%). Enablers to more accurate register-recording of birth outcome included supervision and data use. CONCLUSIONS: Our results show these routine registers accurately recorded stillbirths. Fresh/macerated appearance was a poor proxy for intrapartum stillbirths, hence more focus on measuring fetal heart rate is crucial to classification and importantly reduction in these preventable deaths.en_US
dc.publisherBioMed Centralen_US
dc.relation.ispartofBMC Pregnancy and Childbirth
dc.rightsCreative Commons Attribution 4.0 International License
dc.subjectHealth management information systemsen_US
dc.subjectHospital recordsen_US
dc.subjectData Accuracyen_US
dc.subjectGestational Ageen_US
dc.subjectInfant, Newbornen_US
dc.subjectLive Birthen_US
dc.subjectSensitivity and Specificityen_US
dc.subjectYoung Adulten_US
dc.titleStillbirths including intrapartum timing: EN-BIRTH multi-country validation study.en_US
dc.rights.holder© The Author(s). 2021
pubs.issueSuppl 1en_US
pubs.notesNot knownen_US
pubs.publication-statusPublished onlineen_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US

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Creative Commons Attribution 4.0 International License
Except where otherwise noted, this item's license is described as Creative Commons Attribution 4.0 International License