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Table 3 System alignment with expert-identified characteristics for an effective global classification system for causes of stillbirth and neonatal death

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

  Characteristics % consensus % systems in alignment with each characteristic
    All (81) Widely useda (27) Less used (54) Used in HIC only (36) Used in LMIC only (32) SB-only systems (15) NND-only systems (26) Combined systems (NND and SB) (40)
  Structural
1 A global system must use rules to ensure valid assignment of cause of death categories. 98 % 41 % 52 % 35 % 44 % 28 % 53 % 35 % 40 %
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 % 3 % 7 % 0 % 0 % 0 % 0 % 8 % 0 %
3 A global system must ensure cause of death categories are relevant in all settings. 96 % 10 % 30 % 0 % 0 % 0 % 7 % 15 % 8 %
4 A global system must require associated factors to be recorded and clearly distinguished from causes of death. 94 % 14 % 19 % 11 % 17 % 13 % 7 % 8 % 20 %
5 A global system must distinguish between antepartum and intrapartum conditions. 90 % 20 % 19 % 20 % 22 % 16 % 20 % 0 % 33 %
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 % 9 % 19 % 4 % 19 % 0 % 7 % 4 % 13 %
7 A global system must have multiple levels of causes of death, with a small number of main categories. 82 % 40 % 33 % 43 % 33 % 44 % 33 % 42 % 40 %
8 A global system must include a sufficiently comprehensive list of categories to result in a low proportion of deaths classified as “other”. 80 % 48 % 52 % 46 % 53 % 53 % 27 % 65 % 45 %
  Functional
9 A global system must be easy to use, and produce data that are easily understood and valued by users. 100 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
10 A global system must have clear guidelines for use and definitions for all terms used. 100 % 17 % 15 % 19 % 17 % 16 % 20 % 19 % 15 %
11 A global system must produce data that can be used to inform strategies to prevent perinatal deaths. 96 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
12 A global system must require neonatal deaths to be clearly distinguished from stillbirths. 94 % 5 % 7 % 4 % 0 % 9 % 0 % 0 % 10 %
13 A global system must have high inter- and intra-rater reliability. 94 % 7 % 11 % 6 % 8 % 6 % 7 % 0 % 13 %
14 A global system must be available in different formats including inexpensive ehealth and mhealth options, and in multiple languages. 92 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 %
15 A global system must allow easy access to the data by the end-users. 92 % 10 % 11 % 9 % 14 % 6 % 0 % 12 % 13 %
16 A global system must incorporate both stillbirths and neonatal deaths. 86 % 49 % 48 % 50 % 56 % 44 % 0 % 0 % 100 %
17 A global system must require the single most important factor leading to the death to be recorded. 86 % 47 % 52 % 44 % 50 % 41 % 33 % 50 % 50 %
  1. a“Widely used”: systems used in more than one country and/or to classify 1000 or more deaths