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

Marya Plotkin, Dunstan Bishanga, Hussein Kidanto, Mary Jennings, Jim Ricca, Amasha Mwanamsangu, Gaudiosa Tibaijuka, Ruth Lemwayi, Benny Ngereza, Mary Drake, Jeremie Zougrana, Neena Khadka, James A. Litch, Barbara Rawlins

Research output: Contribution to journalArticle

Abstract

Background Globally, an estimated 2.7 million babies die in the neonatal period annually, and of these, about 0.7 million die from intrapartum-related events. In Tanzania 51,000 newborn deaths and 43,000 stillbirths occur every year. Approximately two-thirds of these deaths could be potentially prevented with improvements in intrapartum and neonatal care. Routine measurement of fetal intrapartum deaths and newborn deaths that occur in health facilities can help to evaluate efforts to improve the quality of intrapartum care to save lives. However, few examples exist of indicators on perinatal mortality in the facility setting that are readily available through health management information systems (HMIS). Methods From November 2016 to April 2017, health providers at 10 government health facilities in Kagera region, Tanzania, underwent refresher training on perinatal death classification and training on the use of handheld Doppler devices to assess fetal heart rate upon admission to maternity services. Doppler devices were provided to maternity services at the study facilities. We assessed the validity of an indicator to measure facility-based pre-discharge perinatal mortality by comparing perinatal outcomes extracted from the HMIS maternity registers to a gold standard perinatal death audit. Results Sensitivity and specificity of the HMIS neonatal outcomes to predict gold standard audit outcomes were both over 98% based on analysis of 128 HMIS–gold standard audit pairs. After this validation, we calculated facility perinatal mortality indicator from HMIS data using fresh stillbirths and pre-discharge newborn death as the numerator and women admitted in labor with positive fetal heart tones as the denominator. Further emphasizing the validity of the indicator, FPM values aligned with expected mortality by facility level, with lowest rates in health centers (range 0.3%– 0.5%), compared to district hospitals (1.5%– 2.9%) and the regional hospital (4.2%). Conclusion This facility perinatal mortality indicator provides an important health outcome measure that facilities can use to monitor levels of perinatal deaths occurring in the facility and evaluate impact of quality of care improvement activities.

Original languageEnglish (US)
Article numbere0201238
JournalPLoS One
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2018

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Management Information Systems
Health Information Systems
Tanzania
Perinatal Mortality
management information systems
death
Health
Stillbirth
Quality of Health Care
Health Facilities
Newborn Infant
audits
fetal death
Management information systems
neonates
Fetal Heart
Equipment and Supplies
Fetal Heart Rate
Fetal Death
District Hospitals

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Plotkin, M., Bishanga, D., Kidanto, H., Jennings, M., Ricca, J., Mwanamsangu, A., ... Rawlins, B. (2018). Tracking facility-based perinatal deaths in Tanzania: Results from an indicator validation assessment. PLoS One, 13(7), [e0201238]. https://doi.org/10.1371/journal.pone.0201238

Tracking facility-based perinatal deaths in Tanzania : Results from an indicator validation assessment. / Plotkin, Marya; Bishanga, Dunstan; Kidanto, Hussein; Jennings, Mary; Ricca, Jim; Mwanamsangu, Amasha; Tibaijuka, Gaudiosa; Lemwayi, Ruth; Ngereza, Benny; Drake, Mary; Zougrana, Jeremie; Khadka, Neena; Litch, James A.; Rawlins, Barbara.

In: PLoS One, Vol. 13, No. 7, e0201238, 01.07.2018.

Research output: Contribution to journalArticle

Plotkin, M, Bishanga, D, Kidanto, H, Jennings, M, Ricca, J, Mwanamsangu, A, Tibaijuka, G, Lemwayi, R, Ngereza, B, Drake, M, Zougrana, J, Khadka, N, Litch, JA & Rawlins, B 2018, 'Tracking facility-based perinatal deaths in Tanzania: Results from an indicator validation assessment', PLoS One, vol. 13, no. 7, e0201238. https://doi.org/10.1371/journal.pone.0201238
Plotkin, Marya ; Bishanga, Dunstan ; Kidanto, Hussein ; Jennings, Mary ; Ricca, Jim ; Mwanamsangu, Amasha ; Tibaijuka, Gaudiosa ; Lemwayi, Ruth ; Ngereza, Benny ; Drake, Mary ; Zougrana, Jeremie ; Khadka, Neena ; Litch, James A. ; Rawlins, Barbara. / Tracking facility-based perinatal deaths in Tanzania : Results from an indicator validation assessment. In: PLoS One. 2018 ; Vol. 13, No. 7.
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abstract = "Background Globally, an estimated 2.7 million babies die in the neonatal period annually, and of these, about 0.7 million die from intrapartum-related events. In Tanzania 51,000 newborn deaths and 43,000 stillbirths occur every year. Approximately two-thirds of these deaths could be potentially prevented with improvements in intrapartum and neonatal care. Routine measurement of fetal intrapartum deaths and newborn deaths that occur in health facilities can help to evaluate efforts to improve the quality of intrapartum care to save lives. However, few examples exist of indicators on perinatal mortality in the facility setting that are readily available through health management information systems (HMIS). Methods From November 2016 to April 2017, health providers at 10 government health facilities in Kagera region, Tanzania, underwent refresher training on perinatal death classification and training on the use of handheld Doppler devices to assess fetal heart rate upon admission to maternity services. Doppler devices were provided to maternity services at the study facilities. We assessed the validity of an indicator to measure facility-based pre-discharge perinatal mortality by comparing perinatal outcomes extracted from the HMIS maternity registers to a gold standard perinatal death audit. Results Sensitivity and specificity of the HMIS neonatal outcomes to predict gold standard audit outcomes were both over 98{\%} based on analysis of 128 HMIS–gold standard audit pairs. After this validation, we calculated facility perinatal mortality indicator from HMIS data using fresh stillbirths and pre-discharge newborn death as the numerator and women admitted in labor with positive fetal heart tones as the denominator. Further emphasizing the validity of the indicator, FPM values aligned with expected mortality by facility level, with lowest rates in health centers (range 0.3{\%}– 0.5{\%}), compared to district hospitals (1.5{\%}– 2.9{\%}) and the regional hospital (4.2{\%}). Conclusion This facility perinatal mortality indicator provides an important health outcome measure that facilities can use to monitor levels of perinatal deaths occurring in the facility and evaluate impact of quality of care improvement activities.",
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AU - Ricca, Jim

AU - Mwanamsangu, Amasha

AU - Tibaijuka, Gaudiosa

AU - Lemwayi, Ruth

AU - Ngereza, Benny

AU - Drake, Mary

AU - Zougrana, Jeremie

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N2 - Background Globally, an estimated 2.7 million babies die in the neonatal period annually, and of these, about 0.7 million die from intrapartum-related events. In Tanzania 51,000 newborn deaths and 43,000 stillbirths occur every year. Approximately two-thirds of these deaths could be potentially prevented with improvements in intrapartum and neonatal care. Routine measurement of fetal intrapartum deaths and newborn deaths that occur in health facilities can help to evaluate efforts to improve the quality of intrapartum care to save lives. However, few examples exist of indicators on perinatal mortality in the facility setting that are readily available through health management information systems (HMIS). Methods From November 2016 to April 2017, health providers at 10 government health facilities in Kagera region, Tanzania, underwent refresher training on perinatal death classification and training on the use of handheld Doppler devices to assess fetal heart rate upon admission to maternity services. Doppler devices were provided to maternity services at the study facilities. We assessed the validity of an indicator to measure facility-based pre-discharge perinatal mortality by comparing perinatal outcomes extracted from the HMIS maternity registers to a gold standard perinatal death audit. Results Sensitivity and specificity of the HMIS neonatal outcomes to predict gold standard audit outcomes were both over 98% based on analysis of 128 HMIS–gold standard audit pairs. After this validation, we calculated facility perinatal mortality indicator from HMIS data using fresh stillbirths and pre-discharge newborn death as the numerator and women admitted in labor with positive fetal heart tones as the denominator. Further emphasizing the validity of the indicator, FPM values aligned with expected mortality by facility level, with lowest rates in health centers (range 0.3%– 0.5%), compared to district hospitals (1.5%– 2.9%) and the regional hospital (4.2%). Conclusion This facility perinatal mortality indicator provides an important health outcome measure that facilities can use to monitor levels of perinatal deaths occurring in the facility and evaluate impact of quality of care improvement activities.

AB - Background Globally, an estimated 2.7 million babies die in the neonatal period annually, and of these, about 0.7 million die from intrapartum-related events. In Tanzania 51,000 newborn deaths and 43,000 stillbirths occur every year. Approximately two-thirds of these deaths could be potentially prevented with improvements in intrapartum and neonatal care. Routine measurement of fetal intrapartum deaths and newborn deaths that occur in health facilities can help to evaluate efforts to improve the quality of intrapartum care to save lives. However, few examples exist of indicators on perinatal mortality in the facility setting that are readily available through health management information systems (HMIS). Methods From November 2016 to April 2017, health providers at 10 government health facilities in Kagera region, Tanzania, underwent refresher training on perinatal death classification and training on the use of handheld Doppler devices to assess fetal heart rate upon admission to maternity services. Doppler devices were provided to maternity services at the study facilities. We assessed the validity of an indicator to measure facility-based pre-discharge perinatal mortality by comparing perinatal outcomes extracted from the HMIS maternity registers to a gold standard perinatal death audit. Results Sensitivity and specificity of the HMIS neonatal outcomes to predict gold standard audit outcomes were both over 98% based on analysis of 128 HMIS–gold standard audit pairs. After this validation, we calculated facility perinatal mortality indicator from HMIS data using fresh stillbirths and pre-discharge newborn death as the numerator and women admitted in labor with positive fetal heart tones as the denominator. Further emphasizing the validity of the indicator, FPM values aligned with expected mortality by facility level, with lowest rates in health centers (range 0.3%– 0.5%), compared to district hospitals (1.5%– 2.9%) and the regional hospital (4.2%). Conclusion This facility perinatal mortality indicator provides an important health outcome measure that facilities can use to monitor levels of perinatal deaths occurring in the facility and evaluate impact of quality of care improvement activities.

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