Birthweight: EN-BIRTH multi-country validation study

Abstract

Background Accurate birthweight is critical to inform clinical care at the individual level and tracking progress towards national/global targets at the population level. Low birthweight (LBW) < 2500 g affects over 20.5 million newborns annually. However, data are lacking and may be affected by heaping. This paper evaluates birthweight measurement within the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. Methods The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017–2018). Clinical observers collected time-stamped data (gold standard) for weighing at birth. We compared accuracy for two data sources: routine hospital registers and women’s report at exit interview survey. We calculated absolute differences and individual-level validation metrics. We analysed birthweight coverage and quality gaps including timing and heaping. Qualitative data explored barriers and enablers for routine register data recording. Results Among 23,471 observed births, 98.8% were weighed. Exit interview survey-reported weighing coverage was 94.3% (90.2–97.3%), sensitivity 95.0% (91.3–97.8%). Register-reported coverage was 96.6% (93.2–98.9%), sensitivity 97.1% (94.3–99%). Routine registers were complete (> 98% for four hospitals) and legible > 99.9%. Weighing of stillbirths varied by hospital, ranging from 12.5–89.0%. Observed LBW rate was 15.6%; survey-reported rate 14.3% (8.9–20.9%), sensitivity 82.9% (75.1–89.4%), specificity 96.1% (93.5–98.5%); register-recorded rate 14.9%, sensitivity 90.8% (85.9–94.8%), specificity 98.5% (98–99.0%). In surveys, “don’t know” responses for birthweight measured were 4.7%, and 2.9% for knowing the actual weight. 95.9% of observed babies were weighed within 1 h of birth, only 14.7% with a digital scale. Weight heaping indices were around two-fold lower using digital scales compared to analogue. Observed heaping was almost 5% higher for births during the night than day. Survey-report further increased observed birthweight heaping, especially for LBW babies. Enablers to register birthweight measurement in qualitative interviews included digital scale availability and adequate staffing. Conclusions Hospital registers captured birthweight and LBW prevalence more accurately than women’s survey report. Even in large hospitals, digital scales were not always available and stillborn babies not always weighed. Birthweight data are being captured in hospitals and investment is required to further improve data quality, researching of data flow in routine systems and use of data at every level.

Kangaroo mother care: EN-BIRTH multi-country validation study

“…Readmissions to KMC ward/corners could inflate KMC coverage and this needs further consideration. Defining the denominator for routine HMIS tracking will be critical, especially since LBW rate (≤2499 g) is already a core 100 health indicator but the KMC clinical need definition is currently ≤2000 g. Also the subtle definition differences of excluding babies weighing exactly 2500 g for LBW indicator, yet including those weighing 2000 g for KMC indicator adds a dimension of measurement complexity from aggregated routine data [30]. In Tanzania the national policy for KMC includes all LBW babies and in our study hospitals' KMC wards we found 3% of our sample had admission weights > 2000 g. We collected KMC ward/corner admission weight for consistency, but notably mean age of admission varied by hospital, affecting the relationship between birth and admission weight.…”

“…Disaggregating by admission weight may be complex due to regaining of weight that newborns lose immediately after birth. Birthweight may not be available for outborns or be heaped for inborns [30]. Individual longitudinal data linking KMC monitoring of outcome, nutrition and development is already a reality in the most established KMC national programmes [34].…”

Count every newborn: EN-BIRTH study improving facility-based coverage and quality measurement in routine information systems

“…Women's survey-report performed fairly well for birthweight, although with more heaping than in register data [24]. EN-BIRTH shows for the first time that such surveys may be a useful tool for capturing information on contact indicators, such as admission to a neonatal unit [23] or KMC ward.…”

“…Subsequent papers detail findings for the following maternal and newborn coverage indicators: uterotonics to prevent postpartum haemorrhage [18], immediate newborn care including breastfeeding practices [19], chlorhexidine for umbilical cord care [20], neonatal resuscitation [21], KMC [22], neonatal infection antibiotic management [23]. Two papers assess validity and data quality for the outcomes of birthweight [24] and stillbirth [25]. Measurement of respectful maternal and newborn care is assessed in one site (Nepal) [26].…”

“…Regarding neonatal resuscitation, most non-breathing newborns were observed to receive bag-mask-ventilation, but overall only 1% within the recommended 1 min after birth [21]. Whilst nearly all babies were weighed within 1 h of birth (97%), only 16% were weighed using digital scales [24]. Most stillbirths were weighed, apart from one site [25].…”