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Table 7 Improving country level data for preterm birth – what can be done now and what are the research priorities?

From: Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data

  Opportunities Immediately Available  
Opportunities High-Income Settings Low-Income Settings Research Priorities (Focus on high mortality, low quality data settings)
Comparable case definitions and better definitions of phenotypes Use 37 completed weeks of gestation but also advance data for very preterm (<34 weeks) and moderate (34-36.9) as well as for spontaneous and medically induced preterm birth Prioritize improved collection of representative population-based data preterm prevalence as a key starting point Development of simple and feasible proxy indicators for gestational age (e.g., weight)
Mechanisms for data collection Include gestational age and birth weight data on birth certificates and perinatal death certificates. Cross-link data from vital registration and health facility surveillance. Improve vital registration systems. Use specific death certificates for stillbirths/neonatal deaths and include gestational age and birth weight data on birth certificates Validation of approaches to assess gestational age through household survey data
Cause-of-death attribution mechanisms Use vital registration specific death certificates for stillbirth and neonatal deaths.
Revise current ICD codes for preterm birth to reflect change in focus from birth weight to gestational age
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. Provide clear guidelines for when to attribute death to preterm complications. 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 for neonatal deaths and stillbirths, as well as maternal deaths
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.