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

Leisher, Susannah Hopkins, Teoh, Zheyi, Reinebrant, Hanna, Allanson, Emma, Blencowe, Hannah, Erwich, Jan Jaap, Froen, J. Frederik, Gardosi, Jason, Gordijn, Sanne, Gulmezoglu, A. Metin, Heazell, Alexander E. P., Korteweg, Fleurisca, Lawn, Joy, McClure, Elizabeth M., Pattinson, Robert, Smith, Gordon C. S., Tuncalp, Ӧzge, Wojcieszek, Aleena M. and Flenady, Vicki (2016) Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system. BMC Pregnancy and Childbirth, 16 1: . doi:10.1186/s12884-016-1040-7


Author Leisher, Susannah Hopkins
Teoh, Zheyi
Reinebrant, Hanna
Allanson, Emma
Blencowe, Hannah
Erwich, Jan Jaap
Froen, J. Frederik
Gardosi, Jason
Gordijn, Sanne
Gulmezoglu, A. Metin
Heazell, Alexander E. P.
Korteweg, Fleurisca
Lawn, Joy
McClure, Elizabeth M.
Pattinson, Robert
Smith, Gordon C. S.
Tuncalp, Ӧzge
Wojcieszek, Aleena M.
Flenady, Vicki
Title Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system
Journal name BMC Pregnancy and Childbirth   Check publisher's open access policy
ISSN 1471-2393
Publication date 2016-09-15
Sub-type Article (original research)
DOI 10.1186/s12884-016-1040-7
Open Access Status DOI
Volume 16
Issue 1
Total pages 16
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Background: To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system.

Methods: Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic.

Results: None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %).

Conclusions: There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with "ease of use" among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system.
Keyword Cause
Classification
Classification system
Neonatal death
Perinatal death
Stillbirth
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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