Making Every Baby Count

It may be easier for an information collector/interviewer from outside the community
than for community-based reporters to obtain sensitive information. Although CHWs living
in the community may be the most reliable source of information on the occurrence
of any death in their community, they may not be able to obtain the most reliable information
about factors that may have contributed to that death if family members are hesitant
to share information about stigmatized topics with members of their own community.
Additionally, if the identifier-reporter was involved in the woman’s care, their presence during
more detailed data collection could bias the responses from the woman or her family.
Non-medical interviewers may be preferred.
It may also be more practical to designate separate information collectors/interviewers.
The most frequent method of information collection about community-based deaths is
through verbal autopsy (VA), discussed below. VA requires training, and the quality of information
gained may improve with practice. Therefore, it may be ideal to have a large cadre
of community-based death identifier-reporters and a smaller, more intensively trained and
practised cadre of VA interviewers.
(iii) What information should be collected?
VA provides a thorough, structured way to collect valuable information about stillbirths and
neonatal deaths that can be used in the context of a review of a specific perinatal death
to identify causes of death and contributing factors, and to provide data that will help to
develop strategies to prevent future deaths.
VA is a structured interview using a questionnaire administered to caregivers or family
members of the deceased (often the mother, in the case of stillbirths and neonatal deaths)
at or near the time of death to elicit information about signs and symptoms and their durations,
as well as other pertinent information about the period before the death (Annex 10).
The VA also usually includes a social autopsy which explores the social, cultural, behavioural
and health systems issues that may have contributed to the death.
Annex 10 of this guide includes a verbal and social autopsy questionnaire from a community-based
surveillance project that can be used to conduct interviews specifically related
to stillbirths and neonatal deaths. When more contextual factors are needed to examine
circumstances surrounding the time of death, social autopsy is a useful tool. The verbal
and social autopsy tool included in this guidance contains elements of both verbal and
social autopsy, including questions about the health status of the mother, details about her
labour and delivery, a structured symptom and duration checklist, an open narrative section
and detailed information about the three delays, which are described in section 2.5.
The purpose of VA is to identify the causes and contributing factors for the stillbirth or
neonatal death in the community where no higher-quality data sources or more definitive
diagnostics exist. VA can provide information to help perinatal mortality audit committees
identify factors contributing to stillbirths and neonatal deaths in the community. VA may
also be used for deaths that occurred in facilities, when additional information from caregivers
needs to be included in the review.
50 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS