dc.contributor.author | Peven, K | |
dc.contributor.author | Day, LT | |
dc.contributor.author | Ruysen, H | |
dc.contributor.author | Tahsina, T | |
dc.contributor.author | Kc, A | |
dc.contributor.author | Shabani, J | |
dc.contributor.author | Kong, S | |
dc.contributor.author | Ameen, S | |
dc.contributor.author | Basnet, O | |
dc.contributor.author | Haider, R | |
dc.contributor.author | Rahman, QS-U | |
dc.contributor.author | Blencowe, H | |
dc.contributor.author | Lawn, JE | |
dc.contributor.author | EN-BIRTH Study Group | |
dc.date.accessioned | 2021-07-30T14:29:10Z | |
dc.date.available | 2021-07-30T14:29:10Z | |
dc.date.issued | 2021-03-26 | |
dc.identifier.citation | Peven, K., Day, L.T., Ruysen, H. et al. Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 21, 226 (2021). https://doi.org/10.1186/s12884-020-03238-7 | en_US |
dc.identifier.uri | https://qmro.qmul.ac.uk/xmlui/handle/123456789/73328 | |
dc.description.abstract | BACKGROUND: 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.language | eng | |
dc.publisher | BioMed Central | en_US |
dc.relation.ispartof | BMC Pregnancy and Childbirth | |
dc.rights | Creative Commons Attribution 4.0 International License | |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.subject | Birth | en_US |
dc.subject | Health management information systems | en_US |
dc.subject | Hospital records | en_US |
dc.subject | Maternal | en_US |
dc.subject | Neonatal | en_US |
dc.subject | Stillbirth | en_US |
dc.subject | Survey | en_US |
dc.subject | Validity | en_US |
dc.subject | Adolescent | en_US |
dc.subject | Adult | en_US |
dc.subject | Bangladesh | en_US |
dc.subject | Data Accuracy | en_US |
dc.subject | Female | en_US |
dc.subject | Gestational Age | en_US |
dc.subject | Hospitals | en_US |
dc.subject | Humans | en_US |
dc.subject | Infant, Newborn | en_US |
dc.subject | Live Birth | en_US |
dc.subject | Nepal | en_US |
dc.subject | Pregnancy | en_US |
dc.subject | Registries | en_US |
dc.subject | Sensitivity and Specificity | en_US |
dc.subject | Stillbirth | en_US |
dc.subject | Tanzania | en_US |
dc.subject | Young Adult | en_US |
dc.title | Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study. | en_US |
dc.type | Article | en_US |
dc.rights.holder | © The Author(s). 2021 | |
dc.identifier.doi | 10.1186/s12884-020-03238-7 | |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/33765942 | en_US |
pubs.issue | Suppl 1 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published online | en_US |
pubs.volume | 21 | en_US |
rioxxterms.funder | Default funder | en_US |
rioxxterms.identifier.project | Default project | en_US |