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Table 1 Summary of how alignment was assessed

From: Classification systems for causes of stillbirth and neonatal death, 2009–2014: an assessment of alignment with characteristics for an effective global system

  Characteristics Weight Variables used to assess alignment Aligned if Judgment of variable accuracy as a measure of alignment
  Structural characteristics     
1 A global system must use rules to ensure valid assignment of cause of death categories .98 Rules available? Yes Strong
2 A global system must be able to work with all levels of data (from both low-income and high-income countries), including minimal levels .98   Yes for all three variables  
    Used in both HIC and LMIC?   Strong
    Used with verbal autopsy?   Strong
    Used in >1 LMIC?   Weak
3 A global system must ensure cause of death categories are relevant in all settings .96 Used in both HIC and LMIC? Yes Weak
4 A global system must require associated factors to be recorded and clearly distinguished from causes of death .94   Yes for both variables below  
    Associated factors included?   Strong
    Distinguishes associated factors from causes?   Strong
5 A global system must distinguish between antepartum and intrapartum conditions .90 Distinguishes IP from AP? Yes Strong
6 A global system should record the level of data available to assign the cause of death (e.g. verbal autopsy only, placental histology, autopsy, etc.) .86 Records type of data used? Yes Strong
7 A global system must have multiple levels of causes of death, with a small number of main categories .82   As below  
    Number of causes ≤10 Strong
    Number of levels 2+ Strong
8 A global system must include a sufficiently comprehensive list of categories to result in a low proportion of deaths classified as “other” .80 % “other” Max <20 % Weak
  Functional characteristics     
9 A global system must be easy to use, and produce data that are easily understood and valued by users 1   As below  
    # deaths classified/# countries of use 500+ cases and/or 2+ countries Weak
    Definitions available? Yes Weak
    Rules available? Yes Weak
    National? Yes Weak
10 A global system must have clear guidelines for use and definitions for all terms used 1   Yes for both variables below  
    Definitions available?   Strong
    Rules available?   Strong
11 A global system must produce data that can be used to inform strategies to prevent perinatal deaths .96   As below  
    IP vs AP? Yes Weak
    % “other” Max <20 % Weak
    National? Yes Weak
12 A global system must require neonatal deaths to be clearly distinguished from stillbirths .94   Yes for both variables below  
    Distinguishes SB and NND?   Strong
    Separate categories for SB and NND?   Strong
13 A global system must have high inter- and intra-rater reliability .94 Reliability testing? Yes; min ≥0.60 Strong
14 A global system must be available in different formats including inexpensive ehealth and mhealth options, and in multiple languages .92   Yes for both variables below  
    E-format?   Strong
    >1 language?   Weak
15 A global system must allow easy access to the data by the end-users .92 Accessible data? Yes Weak
16 A global system must incorporate both stillbirths and neonatal deaths .86 Both SB and NND? Yes Strong
17 A global system must require the single most important factor leading to the death to be recorded .86   As below  
    Hierarchical? No or partially Weak
    Only 1 cause allowed? Yes Strong
    Includes FGR/IUGR/SGA? No Strong
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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