Table 10 Improving country level data for stillbirths – what can be done now and what are the research priorities?

Comparable case definitions for stillbirth

Use 28 week cut-off for international comparisons and 22 week cut-off for High-Income Country comparisons. Local definitions can be used for local purposes.

Prioritize improved collection of representative population-based data for last trimester and intrapartum stillbirths.

Development of simple and feasible proxy indicators for gestational age (e.g., weight)

Mechanisms for counting all births, (including stillbirths)

Improve vital registration data by establishing specific death certificates for stillbirth and neonatal deaths. Cross-link data from vital registration and health facility surveillance.

Increase attention to training and field supervision for DHS-type household surveys which rely on retrospective reporting of all births. Consider adding stillbirth data collection to MICS surveys. Analyze existing pregnancy loss data from sentinel surveillance sites and increase the number of sentinel surveillance sites which prospectively collect stillbirth data.

Improve vital registration systems and register stillbirths. Use specific death certificates for stillbirths/neonatal deaths.

Validation of existing approaches for pregnancy loss data collection compared to pregnancy loss data from sentinel surveillance sites

Classification for stillbirth cause-of-death

Obtain consensus on a single classification system with a limited number of programmatically relevant, comparable categories, that can be distinguished in low income settings through verbal autopsy, but can also be directly incorporated into more detailed sub groups necessary in high income settings

Evaluation of validity and feasibility of a simple standard classification system for stillbirth cause-of-death

Cause-of-death attribution mechanisms

Use vital registration specific death certificates for stillbirth and neonatal deaths.

Revise current ICD codes for stillbirths to reflect changes in attribution of cause-of-death since the 1980s.

In large-scale surveys, follow-up interviews with a verbal autopsy for recent stillbirth and neonatal deaths. Use standardized verbal autopsy tool, case definitions and hierarchical attribution for cause-of-death.

Evaluation of the use and reliability of a standardized verbal autopsy tool, case definitions and hierarchy of causes of death. Development of verbal autopsy classification software which provides greater consistency and costs less than expert assessment of verbal autopsy data

Counting avoidable factors, using data in programmes

Increase the number of national audit systems .Consider confidential enquiry.

Develop or modify audit systems linking maternal/fetal and neonatal deaths. Compile national data and/or promote sentinel sites in varying health system contexts to ensure that the information is useful for policy prioritization, even if not representative of the population. Consider focusing on few indicators initially (e.g. Intrapartum Case Fatality Rate).

Use existing data (e.g., facility birth registers) for local monitoring and programmatic decision-making.

Evaluation of simple audit tools and a mechanism to maximize resultant change in policy and programs.