Tracking facility-based perinatal deaths in Tanzania: Results from an indicator validation assessment

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Public Health

Background:

• Neonatal mortality remains a significant global challenge, with millions of deaths annually, many preventable.
• Intrapartum-related events contribute substantially to neonatal deaths, highlighting the need for improved intrapartum care.
• Tanzania faces high rates of newborn deaths and stillbirths, with potential for significant reduction through enhanced care.

Purpose of the Study:

• To develop and validate a reliable indicator for measuring facility-based perinatal mortality.
• To assess the feasibility of using routine Health Management Information Systems (HMIS) data for monitoring perinatal deaths.
• To provide a tool for health facilities to evaluate the impact of quality improvement initiatives on intrapartum and neonatal care.

Main Methods:

• Health providers received training on perinatal death classification and Doppler device use for fetal heart rate assessment.
• A facility perinatal mortality indicator was developed using HMIS maternity register data.
• The indicator's validity was assessed by comparing HMIS data to a gold standard perinatal death audit.

Main Results:

• The HMIS indicator demonstrated high sensitivity and specificity (over 98%) in predicting gold standard audit outcomes.
• Calculated facility perinatal mortality (FPM) rates aligned with expected mortality across different facility levels.
• Lowest FPM rates were observed in health centers, followed by district and regional hospitals.

Conclusions:

• The developed facility perinatal mortality indicator is a valid and valuable tool for monitoring perinatal deaths in healthcare facilities.
• This indicator can empower facilities to track outcomes and assess the effectiveness of quality improvement interventions.
• Routine use of this indicator can contribute to reducing preventable newborn deaths and stillbirths.