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理解新生儿死亡与死产之间的错误分类:来自马拉维的实证证据。

Understanding Misclassification between Neonatal Deaths and Stillbirths: Empirical Evidence from Malawi.

作者信息

Liu Li, Kalter Henry D, Chu Yue, Kazmi Narjis, Koffi Alain K, Amouzou Agbessi, Joos Olga, Munos Melinda, Black Robert E

机构信息

Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

出版信息

PLoS One. 2016 Dec 28;11(12):e0168743. doi: 10.1371/journal.pone.0168743. eCollection 2016.

Abstract

Improving the counting of stillbirths and neonatal deaths is important to tracking Sustainable Development Goal 3.2 and improving vital statistics in low- and middle-income countries (LMICs). However, the validity of self-reported stillbirths and neonatal deaths in surveys is often threatened by misclassification errors between the two birth outcomes. We assessed the extent and correlates of stillbirths being misclassified as neonatal deaths by comparing two recent and linked population surveys conducted in Malawi, one being a full birth history (FBH) survey, and the other a follow-up verbal/social autopsy (VASA) survey. We found that one-fifth of 365 neonatal deaths identified in the FBH survey were classified as stillbirths in the VASA survey. Neonatal deaths with signs of movements in the last few days before delivery reported were less likely to be misclassified stillbirths (OR = 0.08, p<0.05). Having signs of birth injury was found to be associated with higher odds of misclassification (OR = 6.17, p<0.05). We recommend replicating our study with larger sample size in other settings. Additionally, we recommend conducting validation studies to confirm accuracy and completeness of live births and neonatal deaths reported in household surveys with events reported in a full birth history and the extent of underestimation of neonatal mortality resulting from misclassifications. Questions on fetal movement, signs of life at delivery and improved probing among older mother may be useful to improve accuracy of reported events.

摘要

提高死产和新生儿死亡计数对于追踪可持续发展目标3.2以及改善低收入和中等收入国家(LMICs)的人口动态统计至关重要。然而,在调查中自我报告的死产和新生儿死亡的有效性常常受到这两种出生结局之间错误分类误差的威胁。我们通过比较在马拉维进行的两项近期且相互关联的人口调查来评估死产被误分类为新生儿死亡的程度及其相关因素,一项是完整出生史(FBH)调查,另一项是后续的口头/社会尸检(VASA)调查。我们发现,在FBH调查中确定的365例新生儿死亡中有五分之一在VASA调查中被分类为死产。报告在分娩前最后几天有胎动迹象的新生儿死亡被误分类为死产的可能性较小(OR = 0.08,p<0.05)。发现有出生损伤迹象与更高的误分类几率相关(OR = 6.17,p<0.05)。我们建议在其他环境中以更大样本量重复我们的研究。此外,我们建议进行验证研究,以确认家庭调查中报告的活产和新生儿死亡与完整出生史中报告的事件的准确性和完整性,以及错误分类导致的新生儿死亡率低估程度。关于胎儿运动、分娩时生命体征的问题以及对年长母亲进行更好的询问可能有助于提高报告事件的准确性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9605/5193424/8aeee07332fa/pone.0168743.g001.jpg

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