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1. Ending preventable stillbirths and improving bereavement care: a scorecard for high- and upper-middle income countries

Author

Esti Charlotte de Graaff, Susannah Hopkins Leisher, Hannah Blencowe, Harriet Lawford, Jillian Cassidy, Paul Richard Cassidy, Elizabeth S. Draper, Alexander E. P. Heazell, Mary Kinney, Paula Quigley, Claudia Ravaldi, Claire Storey, Alfredo Vannacci, the E. P. S. in High-Resource Countries Scorecard Collaboration Group, and Vicki Flenady

Subjects
Stillbirth, High-income countries, High-resource setting, Scorecard, Equity, Stigma, Gynecology and obstetrics, RG1-991
Abstract

Abstract Background Despite progress, stillbirth rates in many high- and upper-middle income countries remain high, and the majority of these deaths are preventable. We introduce the Ending Preventable Stillbirths (EPS) Scorecard for High- and Upper Middle-Income Countries, a tool to track progress against the Lancet’s 2016 EPS Series Call to Action, fostering transparency, consistency and accountability. Methods The Scorecard for EPS in High- and Upper-Middle Income Countries was adapted from the Scorecard for EPS in Low-Income Countries, which includes 20 indicators to track progress against the eight Call to Action targets. The Scorecard for High- and Upper-Middle Income Countries includes 23 indicators tracking progress against these same Call to Action targets. For this inaugural version of the Scorecard, 13 high- and upper-middle income countries supplied data. Data were collated and compared between and within countries. Results Data were complete for 15 of 23 indicators (65%). Five key issues were identified: (1) there is wide variation in stillbirth rates and related perinatal outcomes, (2) definitions of stillbirth and related perinatal outcomes vary widely across countries, (3) data on key risk factors for stillbirth are often missing and equity is not consistently tracked, (4) most countries lack guidelines and targets for critical areas for stillbirth prevention and care after stillbirth and have not set a national stillbirth rate target, and (5) most countries do not have mechanisms in place for reduction of stigma or guidelines around bereavement care. Conclusions This inaugural version of the Scorecard for High- and Upper-Middle Income Countries highlights important gaps in performance indicators for stillbirth both between and within countries. The Scorecard provides a basis for future assessment of progress and can be used to help hold individual countries accountable, especially for reducing stillbirth inequities in disadvantaged groups.

Published
2023
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2. Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014

Author

Alexander E. P. Heazell, Hanna E. Reinebrant, Fleurisca J. Korteweg, Robert Clive Pattinson, Jan Jaap H. M. Erwich, Joy E Lawn, J. Frederik Frøen, Zheyi Teoh, Ӧzge Tunçalp, Vicki Flenady, Aleena M. Wojcieszek, Susannah Hopkins Leisher, Gordon C. S. Smith, Emma R. Allanson, Jason Gardosi, Hannah Blencowe, A Metin Gülmezoglu, Elizabeth M. McClure, Sanne J. Gordijn, Smith, Gordon [0000-0003-2124-0997], and Apollo - University of Cambridge Repository

Subjects
Male, Pediatrics, medicine.medical_specialty, Perinatal Death, Neonatal death, Reproductive medicine, MEDLINE, CINAHL, PERINATAL-MORTALITY, Cause of death, Global Health, 03 medical and health sciences, 0302 clinical medicine, Order (exchange), International Classification of Diseases, Pregnancy, 030225 pediatrics, Obstetrics and Gynaecology, medicine, Global health, Humans, INCOME COUNTRIES, 030219 obstetrics & reproductive medicine, business.industry, Infant, Newborn, Obstetrics and Gynecology, Reproducibility of Results, AUTOPSY, Stillbirth, medicine.disease, Classification, Systematic review, Disparate system, Female, Medical emergency, business, Research Article, Classification system
Abstract

Background Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths. Methods A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. Results Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. Conclusions The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1071-0) contains supplementary material, which is available to authorized users.

Published
2016
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