ABSTRACT

Objective:  To evaluate the completeness and timeliness of registration of stillbirths and under-five deaths and the validity of the certification and coding process.

Subjects and Methods: Registered stillbirths and under-five deaths occurring in 2008 were compared to hospital, police, forensic pathologist and coroner’s records. Missed cases and new information such as birthweight, gestation and date of birth were added to the database. A 10% random sample was evaluated to measure the quality of certification and coding.  

Results: Of 646 stillbirths [≥ 1000 g] and 933 under-five deaths, 69% and 79%, respectively were registered by December 31, 2009, for inclusion in the 2008 final demographic returns. Non-reporting of stillbirths was associated with infant gender, region and place of death [seven of 21 public hospitals accounted for 96% of unregistered stillbirths).  Among under-five deaths, age at death, region, place and cause of death were important. Injury and community deaths increased with age. Registration delays including non-registration were associated with coroner’s inquests.  Most (80%) stillbirth certificates lacked usable cause of death data. Neonatal deaths due to prematurity and perinatal asphyxia were often misclassified by coders. The stillbirth (≥ 1000 g), infant and under-five mortality rates were 15, 20 and 22/1000 births/live births, respectively.

Conclusions: While registration of stillbirths and under-five deaths improved between 1998 and 2008, persistent under-reporting reduced official rates by 20–31%.  A new perinatal death certificate documenting maternal and fetal causes of death and risk factors such as birthweight, gestation and age at death would improve stillbirth and neonatal death (0–28 days) data quality.