Abstract
BackgroundTo reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system.MethodsEighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic.ResultsNone of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %).ConclusionsThere is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with “ease of use” among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1040-7) contains supplementary material, which is available to authorized users.
Highlights
To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical
A system which meets the needs of users would have the potential to become the first truly globally effective classification system
Classification of the causes of the 5.3 million perinatal deaths that occur each year is critical to reducing these deaths; it increases our understanding of underlying causes and enables comparison of causes within and between countries [1, 2]
Summary
To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. Classification of the causes of the 5.3 million perinatal deaths (stillbirths and neonatal deaths) that occur each year is critical to reducing these deaths; it increases our understanding of underlying causes and enables comparison of causes within and between countries [1, 2]. We describe a systematic review which identified 81 classification systems for causes of stillbirth and neonatal death (in addition to the World Health Organization (WHO) International Classification of Diseases 10th revision (ICD-10)) that were created, modified, and/or used between 2009 and 2014, all with widely varying characteristics. The majority of systems were used only in the regions (high- or low/medium-income countries) where they had been developed
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