Level and Reasons for Misclassification of Very Early Neonatal Death into Stillbirth in Public Hospitals of Addis Ababa, Ethiopia.
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Date
2020-01
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Addis Abeba University
Abstract
Background- Report on stillbirth and early neonatal deaths are susceptible for misreporting,
misclassification and omission. The distinction between the two events is that the presence of
faint sign of life after delivery. The accuracy and reliability of intrapartum mortality data is very
essential for preventing deaths. There is evidence gap in knowing the exact magnitude and
reason behind misclassification of very early neonatal death.
Objective- To assess Level of and reasons for misclassification of very early neonatal death into
stillbirth from March, 2018 to March, 2019 in public hospitals of Addis Ababa, Ethiopia.
Method- Cross sectional study with qualitative and quantitative method was conducted among
stillbirths and health care providers. 410 still births datawere collected from selected hospitals
registration. Verbal autopsy was conducted among mothers who had stillbirth through household
visits. The collected data was reviewed by three coders. Disagreement on cause of death among
two initials coders were resolved by third physician’s independent assessment. In depth
interview was conducted among health care providers. The magnitude of misclassification was
defined as percentage of stillbirth reported in HMIS registration book that was later classified as
early neonatal death in verbal autopsy data. Frequency distribution and cross tabulation was done
to measure the level of misclassification. Bivariate and multivariate analysis was done to see the
association between misclassification status and health care provider characteristic. Qualitative
data was analyzed using thematic analysis.
Result: The level of misclassification of very early neonatal death into still birth was 8.54%
(35/410). Denial of safe traditional practice was significantly associated with misclassification
of very early neonatal deaths, [AOR =0.21; 95% CI =0.05-0.93]. We found that confusion in
understanding of the exact definition of perinatal loss, fear of blame, work load and medico legal
issues drive health care providers to misclassify very early neonatal death into stillbirth at health
facility level.
Conclusion and recommendation: This study shows significant number of very early neonatal
death are misclassified into stillbirth. It also describes driving factors for misclassification such
as personal, health facility and system related factor. Standard cause of death classification
training, creating culture of accountability and favorable working environment are essential to
prevent misclassification of very early neonatal death which occur immediately after birth.
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Keywords
Neonatal Death