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Matern Health Neonatol Perinatol. 2015 May 4;1:11. doi: 10.1186/s40748-015-0012-7. eCollection 2015.

Global network for women's and children's health research: a system for low-resource areas to determine probable causes of stillbirth, neonatal, and maternal death.

Author information

1
RTI International, Durham, NC USA.
2
University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
3
FANCAP, Guatemala City, Guatemala.
4
Moi University Medical Teaching Hospital, Eldoret, Kenya.
5
KLE University's JN Medical College, Belgaum, India.
6
Latta Medical Research Foundation, Indira Gandhi Medical School, Nagpur, India.
7
University of Zambia, Lusaka, Zambia.
8
Aga Khan University, Karachi, Pakistan.
9
Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
10
University of Alabama at Birmingham, Birmingham, AL USA.
11
Christiana Health Care, Newark, DE USA.
12
Massachusetts General Hospital, Boston, MA USA.
13
Indiana University, Indianapolis, IN USA.
14
University of Colorado, Denver, CO USA.
15
UNC Chapel Hill, Chapel Hill, NC USA.
16
Perinatology and Pregnancy Branch, NICHD, Bethesda, MD USA.
17
Cincinnati Children's Hospital, Cincinnati, OH USA.
18
Columbia University Medical Center, New York, NY USA.

Abstract

BACKGROUND:

Determining cause of death is needed to develop strategies to reduce maternal death, stillbirth, and newborn death, especially for low-resource settings where 98% of deaths occur. Most existing classification systems are designed for high income settings where extensive testing is available. Verbal autopsy or audits, developed as an alternative, are time-intensive and not generally feasible for population-based evaluation. Furthermore, because most classification is user-dependent, reliability of classification varies over time and across settings. Thus, we sought to develop classification systems for maternal, fetal and newborn mortality based on minimal data to produce reliable cause-of-death estimates for low-resource settings.

RESULTS:

In six low-resource countries (India, Pakistan, Guatemala, DRC, Zambia and Kenya), we evaluated data which are collected routinely at antenatal care and delivery and could be obtained with interview, observation, or basic equipment from the mother, lay-health provider or family to inform causes of death. Using these basic data collected in a standard way, we then developed an algorithm to assign cause of death that could be computer-programmed. Causes of death for maternal (trauma, abortion, hemorrhage, infection and hypertensive disease of pregnancy), stillbirth (birth trauma, congenital anomaly, infection, asphyxia, complications of preterm birth) and neonatal death (congenital anomaly, infection, asphyxia, complications of preterm birth) are based on existing cause of death classifications, and compatible with the World Health Organization International Classification of Disease system.

CONCLUSIONS:

Our system to assign cause of maternal, fetal and neonatal death uses basic data from family or lay-health providers to assign cause of death by an algorithm to eliminate a source of inconsistency and bias. The major strengths are consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. This system will be an important contribution to determining cause of death in low-resource settings.

KEYWORDS:

Cause of death classification; Low-income Countries; Maternal mortality; Neonatal mortality; Stillbirth

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