Abstract
A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons.
Highlights
A classification and its purpose Classification is described as a passive construct systematically arranging similar entities with established criteria or differing characteristics[1,2]
This information is vital for many purposes, including health care policy development, surveillance and international comparisons, clinical services and research, and it is crucial that a classification is useful for all these aims
The Codac system Based on the requirements discussed above, we propose the Codac classification – developed to code the cause of death (COD), aided by two associated conditions (AC) to preserve essentials of the narrative
Summary
A classification and its purpose Classification is described as a passive construct systematically arranging similar entities with established criteria or differing characteristics[1,2]. The purpose of classification, is information management: including information capture, storage, and retrieval. Classification of perinatal deaths is primarily the systematic arrangement of deaths in categories based on information known about them to aid in the process of information management. This information is vital for many purposes, including health care policy development, surveillance and international comparisons, clinical services and research, and it is crucial that a classification is useful for all these aims. There is a need to scale up efforts to collect data on causes of death in stillbirths in developing countries
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