Making Every Baby Count

• Which deaths do I want to collect more detailed information on? (e.g. all or a subset
of antepartum stillbirths, intrapartum stillbirths, early neonatal deaths, late neonatal
deaths, a particular range of birth weights or gestational ages, see below and Box 3.1)
• What kinds of records exist? (e.g. labour and birth registers, postnatal registers, emergency
or operating theatre records, discharge logs with status of patient, paediatric
registers)
• Are the records paper-based or electronic?
• Are all the records housed in one location, or are they scattered?
Once all the places where the data might be located have been identified, a plan for systematically
reviewing these sources may be created that includes a schedule for checking
various registers and departments.
If the burden of stillbirths and neonatal deaths is high it may not be feasible to review all
cases. Further, if human resources are limited – e.g. if there is only one data collector who
can work only part-time for the review committee – the committee may decide to select a
subset of cases for detailed review (e.g. only the cases that take place in the first week of
each month) or to take a thematic approach (e.g. for a specified number of meetings, only
deaths attributed to sepsis will be reviewed, followed by a different cause of death), or to
limit review to cases that are most likely to be preventable (e.g. intrapartum stillbirths and
neonatal deaths among near-term babies).
Step 2: Collecting information
For every death, decisions must be taken as to what information is recorded, where the
information is recorded, who records it, and who collates it on a periodic basis both for
the death review process and for reporting to other levels within the system such as facility-
and district-level administration, the national ministry of health, as well as intersectoral
systems such as CRVS. It is important to limit the data collected. Having too many difficult
or highly detailed questions with no apparent purpose alienates busy staff who are
required to fill in the forms. If a use for the data cannot be identified, then the data should
not be collected. Having a clear understanding of the data analysis plan will help with
these decisions.
Ideally, deaths are reviewed within a week of the event. Depending on the interval of the
mortality audit review meetings (e.g. biweekly or monthly), the total number of deliveries,
stillbirths and neonatal deaths during that time period is captured on a standardized data
capture form by the designated staff members. These are usually physicians or midwives,
though they can be data clerks if these cadres are available. In all cases, those entering
data should be trained on the system and the reasons for its use. Data abstraction/collection
forms may be either paper-based or computerized/electronic, but they should include
clear directions about exactly what information is to be collected. It is helpful to pilottest
and then revise these forms as needed prior to use and to allow for future review and
updates. Most of the abstracted data will be quantitative, and the form should have clearly
designated data entry fields. If items are pre-coded, all possible responses should be captured
(including missing responses) or a space should be provided for entering other
values. Because data may at times be abstracted as text, such as the description of a chain
MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS
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