East Africa preterm birth initiative birth register data (March 2016 - October 2016)

Abstract Objective: Preterm birth is the primary driver of neonatal
mortality worldwide, but it is defined by gestational age (GA) which is
challenging to accurately assess in low-resource settings. In a commitment
to reducing preterm birth while reinforcing and strengthening facility,
routine data sources, the East Africa Preterm Birth Initiative (PTBi-EA)
chose eligibility criteria that combined GA and birth weight. This
analysis evaluated the quality of the GA data as recorded in maternity
registers in PTBi-EA study facilities and the validity of the PTBi-EA
eligibility criteria. Methods: We conducted a retrospective analysis of
maternity register data from March – September 2016. GA data from 23 study
facilities in Migori, Kenya and the Busoga Region of Uganda were evaluated
for completeness (variable present), consistency (recorded versus
calculated GA), and plausibility (falling within the 3rd and 97th birth
weight percentiles for GA of the INTERGROWTH-21st Newborn Birth Weight
Standards). Preterm birth rates were calculated using: 1) recorded GA
<37 weeks, 2) recorded GA <37 weeks, excluding implausible
GAs, 3) birth weight <2500g, and 4) PTBi-EA eligibility criteria of
<2500g and between 2500g and 3000g if the recorded GA is <37
weeks. Results: In both countries, GA was the least recorded variable in
the maternity register (77.6%). Recorded and calculated GA (Kenya only)
were consistent in 29.5% of births. Implausible GAs accounted for 11.7% of
births. The four preterm birth rates were 1) 14.5%, 2) 10.6%, 3) 9.6%, 4)
13.4%. Conclusions: Maternity register GA data presented quality concerns
in PTBi-EA study sites. The PTBi-EA eligibility criteria of <2500g
and between 2500g and 3000g if the recorded GA is <37 weeks
adjusted for these concerns by using both birth weight and GA, balancing
issues of accuracy and completeness with practical
applicability.