Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

Area of Science:

• Public Health
• Demography
• Epidemiology

Background:

• Household surveys are vital for stillbirth data but suffer from omission and misclassification.
• Accurate reporting of vital status at birth, gestational age, and birthweight is essential for classifying adverse pregnancy outcomes as stillbirths.
• Further categorization by sex or timing aids in understanding and preventing stillbirths.

Purpose of the Study:

• To evaluate the completeness and accuracy of stillbirth data collected through household surveys.
• To identify barriers to reporting key stillbirth indicators like birthweight.

Main Methods:

• A cross-sectional population-based survey was conducted in five sites across Bangladesh, Ethiopia, Ghana, Guinea-Bissau, and Uganda (2017-2018).
• Women of reproductive age completed either a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH).
• Additional stillbirth-specific questions and focus group discussions were used to assess data quality and reporting barriers.

Main Results:

• Completeness for vital status and gestational age (months) was high (>99%), but discordance in reporting vital status was common.
• Availability of gestational age (weeks) (58.1%) and birthweight (13.2%) data for stillbirths was low, with frequent heaping.
• Reporting of stillbirth sex was high (93.9%), but timing data varied significantly by question and site.

Conclusions:

• Enhancing stillbirth data requires improved measurement of vital status, gestational age, and birthweight by healthcare providers.
• Effective communication with women and addressing reporting barriers are critical for improving data quality.
• Better stillbirth data is essential for reducing the burden of preventable stillbirths.