Criteria for assigning cause of death for stillbirths and neonatal deaths in research studies in low-middle income countries

Abstract

Accurate knowledge regarding cause of death (COD) for stillbirths and neonatal deaths is crucial, especially in low-income countries, in order for public health and medical officials to choose appropriate interventions likely to reduce these deaths. To date, many of the COD studies in these areas have relied only on obstetric or neonatal clinical information and the determination of COD is likely to be inaccurate. Information related to infectious COD is especially lacking. Thus, without more sophisticated testing, data as currently collected only provide a very weak approximation of the COD and may well lead to adoption of interventions of limited usefulness. In this commentary, we propose recommendations regarding the type of data needed to determine with reasonable accuracy the COD for stillbirths and neonatal deaths in low-resource settings. Using these data, and a method to determine the degree of certainty, we then propose definitions for the most common COD. Our goal is to reduce subjectivity and provide more specificity for the tests used in existing classification systems so that the methodology of COD determination is transparent and able to be replicated over time and from location to location.

Thoughts on assigning cause of death for stillbirth and neonatal death: a commentary

“…Knowing why fetuses and newborns die is an important first step in developing and implementing interventions to reduce these deaths. Currently in LMICs, the cause of death is not routinely determined for stillbirths, and limited information has been available to determine the cause of neonatal deaths . When a cause of death is identified at all, it is often ascertained by a physician or other health professional based on clinical information, and therefore is, at best, an educated guess.…”

“…Results of special testing such as karyotype or red cell antibodies (if performed) should also be available. Using this framework, we considered the minimal data necessary to determine each common cause of death and have used that process to help define data to be abstracted for the panel review …”

“…Having a standardised method of collecting, organising and presenting relevant data is crucial. We also believe that using a carefully created set of guidelines for assigning cause of death will reduce many of the inconsistencies in perinatal cause‐of‐death reporting from previous reports …”

“…Using this framework, we considered the minimal data necessary to determine each common cause of death and have used that process to help define data to be abstracted for the panel review. 2 For the PURPOSE study, separate programmes extract relevant data for stillbirths and neonatal deaths. An example of the case reports developed for the panel is appended (Figure 1).…”

“…We also believe that using a carefully created set of guidelines for assigning cause of death will reduce many of the inconsistencies in perinatal causeof-death reporting from previous reports. 2 Although we believe the process described above is the best method currently available for assigning the cause of death for stillbirths and neonatal deaths, it still requires substantial resources, and is not likely to be sustainable in many areas. Therefore, we believe it is crucial to use data from continuing studies and determinations from a panel of experts to define the minimal data needed for cause-of-death determinations for a population.…”