Table 3.
System alignment with expert-identified characteristics for an effective global classification system for causes of stillbirth and neonatal death
| Characteristics | % consensus | % systems in alignment with each characteristic | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| All (81) | Widely useda (27) | Less used (54) | Used in HIC only (36) | Used in LMIC only (32) | SB-only systems (15) | NND-only systems (26) | Combined systems (NND and SB) (40) | |||
| Structural | ||||||||||
| 1 | A global system must use rules to ensure valid assignment of cause of death categories. | 98 % | 41 % | 52 % | 35 % | 44 % | 28 % | 53 % | 35 % | 40 % |
| 2 | A global system must be able to work with all levels of data (from both low-income and high-income countries), including minimal levels. | 98 % | 3 % | 7 % | 0 % | 0 % | 0 % | 0 % | 8 % | 0 % |
| 3 | A global system must ensure cause of death categories are relevant in all settings. | 96 % | 10 % | 30 % | 0 % | 0 % | 0 % | 7 % | 15 % | 8 % |
| 4 | A global system must require associated factors to be recorded and clearly distinguished from causes of death. | 94 % | 14 % | 19 % | 11 % | 17 % | 13 % | 7 % | 8 % | 20 % |
| 5 | A global system must distinguish between antepartum and intrapartum conditions. | 90 % | 20 % | 19 % | 20 % | 22 % | 16 % | 20 % | 0 % | 33 % |
| 6 | A global system should record the level of data available to assign the cause of death (e.g. verbal autopsy only, placental histology, autopsy, etc.). | 86 % | 9 % | 19 % | 4 % | 19 % | 0 % | 7 % | 4 % | 13 % |
| 7 | A global system must have multiple levels of causes of death, with a small number of main categories. | 82 % | 40 % | 33 % | 43 % | 33 % | 44 % | 33 % | 42 % | 40 % |
| 8 | A global system must include a sufficiently comprehensive list of categories to result in a low proportion of deaths classified as “other”. | 80 % | 48 % | 52 % | 46 % | 53 % | 53 % | 27 % | 65 % | 45 % |
| Functional | ||||||||||
| 9 | A global system must be easy to use, and produce data that are easily understood and valued by users. | 100 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % |
| 10 | A global system must have clear guidelines for use and definitions for all terms used. | 100 % | 17 % | 15 % | 19 % | 17 % | 16 % | 20 % | 19 % | 15 % |
| 11 | A global system must produce data that can be used to inform strategies to prevent perinatal deaths. | 96 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % |
| 12 | A global system must require neonatal deaths to be clearly distinguished from stillbirths. | 94 % | 5 % | 7 % | 4 % | 0 % | 9 % | 0 % | 0 % | 10 % |
| 13 | A global system must have high inter- and intra-rater reliability. | 94 % | 7 % | 11 % | 6 % | 8 % | 6 % | 7 % | 0 % | 13 % |
| 14 | A global system must be available in different formats including inexpensive ehealth and mhealth options, and in multiple languages. | 92 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % | 0 % |
| 15 | A global system must allow easy access to the data by the end-users. | 92 % | 10 % | 11 % | 9 % | 14 % | 6 % | 0 % | 12 % | 13 % |
| 16 | A global system must incorporate both stillbirths and neonatal deaths. | 86 % | 49 % | 48 % | 50 % | 56 % | 44 % | 0 % | 0 % | 100 % |
| 17 | A global system must require the single most important factor leading to the death to be recorded. | 86 % | 47 % | 52 % | 44 % | 50 % | 41 % | 33 % | 50 % | 50 % |
a“Widely used”: systems used in more than one country and/or to classify 1000 or more deaths