Table 2.
Widely used classification systems for causes of stillbirth and neonatal death, 2009–2014: Selected characteristics
| Country of origina | Region and countries of use (2009–2014)b | # deaths classified (2009–2014)b | Hier | IP vs AP | SB vs NND cats | Single cause | # causes | # levels | Ass'd factors | Ass'd factors vs causes | Defs | Rules | Max % unex | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Systems classifying both SB and NND | ||||||||||||||
| CMACE 2010-maternal & fetal [36] | UK | HIC (UK) | 6,804 | No | Yes | No | No | 13 | 2 | Yes | No | Some | Yes | 39 % |
| CMACE 2011-maternal & fetal [46] | UK | HIC (UK, Wales) | 9,786 | No | Yes | No | Yes | 12 | 3 | Yes | No | No | No | 51 % |
| Cole 1986 [26] | UK | Both (Nigeria, Netherlands) | 345 | Partly | No | No | Yes | 10 | 2 | No | n/a | Yes | Yes | 55 % |
| Engmann 2012 [39] | USA | LMIC (Guatemala, DRC, Zambia, Pakistan) | 252 | No | Partial | Yes, all | Yes | 7.5c | 1 | No | n/a | No | No | 12 % |
| Flenady 2009-PSANZ-PDC [28] | Australia | Both (Australia, Vietnam, New Zealand, Madagascar) | 13,416 | Partly | Partial | No | Yes | 7 | 4 | Yes | Yes | Some | Yes | 54 % |
| Frøen 2009-Codac [11] | Norway | HIC (Norway, Italy, Wales) | 872 | Partly | Yes | Some | Yes | 10 | 3 | Yes | Yes | Some | Yes | 53 % |
| Korteweg 2006-Tulip [35] | Neth. | HIC (Neth.) | 3,603 | No | No | No | Yes | 6 | 3 | Yes | Yes | Some | Yes | 23 % |
| Manandhar 2010 [47] | Nepal | LMIC (Nepal) | 1,272 | Unclear | Yes | Yes, all | Yes | 9c | 1 | No | n/a | Yes | No | 10 % |
| National Services Scotland 2013-FIGO [27] | Scotland | HIC (Scotland) | 1,249 | No | No | Yes, all | Yes | 4 | 1 | No | n/a | No | No | 100%d |
| MRC 2002-PPIP [48] | South Africa | LMIC (South Africa) | 47,238 | No | Partial | Some | Unclear | 9.5c | 1 | Yes | Yes | Some | No | 35 % |
| Wigglesworth 1980 [7] | UK | Both (Turkey, Bangladesh, UK, Ireland, Nepal, Pakistan, Brazil) | 4,558 | No | Partial | Some | Yes | 5 | 1 | No | n/a | Some | Yes | 56 % |
| Winbo 1998-NICE [31] | Sweden | LMIC (Tanzania) | 2,494 | Yes | No | Some | Yes | 13 | 1 | No | n/a | Yes | No | 46 % |
| Wood 2012 [49] | UK | HIC (Scotland) | 8,332 | No | Yes | Some | Yes | 2 | 2 | No | n/a | Yes | No | 60 % |
| Systems classifying SB only | ||||||||||||||
| Dudley 2010-INCODE [34] | USA | HIC (Canada, USA) | 1,075 | No | Partial | n/a | No | 7 | 4 | No | n/a | Some | Yes | n/ae |
| Gardosi 2005-ReCoDe [37] | UK | Both (Italy, UK, France, Portugal, New Zealand, Germany, Brazil) | 25,779 | Yes | Partial | n/a | No | 9 | 2 | Yes | No | Some | Yes | 26 % |
| Seaton 2012 [50] | UK | HIC (UK) | 21,352 | No | Partial | n/a | Yes | 9 | 1 | No | n/a | Yes | No | 41 % |
| Varli 2008-Stockholm [33] | Sweden | HIC (Sweden) | 1,089 | No | No | n/a | Yes | 17 | 2 | Yes | No | Yes | Yes | 19 % |
| Systems classifying NND only | ||||||||||||||
| Black 2010-CHERG [51] | USA | Global | >1 million | No | n/a | n/a | Yes | 8 | 1 | No | n/a | Some | Yes | 23 % |
| CMACE 2010-neonatal [36] | UK | HIC (UK, Ireland) | 7,717 | No | n/a | n/a | No | 10 | 2 | Yes | No | Some | Yes | 6 % |
| Cole 1989-ICE [52] | UK | HIC (Canada, USA) | 38,692 | No | n/a | n/a | Yes | 8 | 1 | No | n/a | Yes | Yes | 15 % |
| Flenady 2009-PSANZ-NDC [28] | Australia | HIC (Australia, New Zealand) | 3,449 | No | n/a | n/a | Yes | 11 | 3 | Yes | Yes | Some | Yes | n/af |
| Lawn 2006-CHERG [53] | South Africa | Both (sub-Saharan Africa, Laos, Uganda); also global | >1 million | Yes | n/a | n/a | Yes | 7 | 1 | No | n/a | Yes | Yes | 23 % |
| Lawn 2012 [54] | South Africa | Global | >1 million | No | n/a | n/a | Yes | 5 | 1 | No | n/a | No | No | n/af |
| Lawn 2010 [55] | South Africa | Global | >1 million | No | n/a | n/a | Yes | 5 | 1 | No | n/a | No | No | n/af |
| Rocha 2011 [56] | Brazil | LMIC (Brazil) | 2,893 | No | n/a | n/a | Unclear | 6 | 2 | No | n/a | No | No | 20 % |
| Smith 2010 [57] | UK | HIC (UK) | 18,524 | Yes | n/a | n/a | Yes | 10 | 1 | No | n/a | No | No | 5 % |
| Winter 2013-Rwanda [58] | Rwanda | LMIC (Bhutan, Rwanda) | 628 | No | n/a | n/a | Yes | 7 | 1 | No | n/a | No | No | n/af |
Hier Hierarchical or not, IP vs AP Requires distinguishing antepartum from intrapartum stillbirth, SB vs NND cats Includes separate categories for stillbirths and neonatal deaths, Single cause Requires single cause to be identified, # causes Number of causes at top level, Ass’d factors Allows associated factors to be recorded, Ass’d factors vs causes Requires associated factors and causes to be distinguished from one another, Defs Includes definitions for all causes, Rules Includes guidelines for assigning cause of death, Max % unex Maximum percent of deaths classified as “unexplained” (see Additional file 10 for more detail)
NOTE: All data other than region/countries of use and number of deaths classified was taken from reference papers for included systems, which are cited in the first column. “Widely used” is defined as used to classify >1000 deaths and/or in 2+ countries between 2009 and 2014
aDefined as country of first affiliation of first author of reference paper
bRegion and countries of use and numbers of deaths classified all taken exclusively from included papers between 2009 and 2014 that reported use of the included systems
cAverage taken when there was more than one set of levels (e.g. one for stillbirths and one for neonatal deaths)
dThe system only allocates stillbirths to one of two “causes”, both of which are considered to be “unexplained”; see Additional file 10 for more detail
e The system has a category for “unexplained” but there was no data reported
f These systems have no category for “unexplained”