Simon Kasasa1,2,3, Davis Natukwatsa4,5, Hannah Blencowe6, Dan Kajungu4,5, Edward Galiwango4,5, Tryphena Nareeba4,5, Collins Gyezaho4,5, Ane Baerent Fisker7,8,9, Mezgebu Yitayal Mengistu10,11, Francis Dzabeng12, M Moinuddin Haider13, Judith Yargawa6, Joseph Akuze6,14,15, Angela Baschieri6, Claudia Cappa16, Debra Jackson6,16,17, Joy E Lawn6. 1. IgangaMayuge Health and Demographic Surveillance System, Makerere University Centre for Health and Population Research, Iganga, Uganda. skasasa@musph.ac.ug. 2. Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda. skasasa@musph.ac.ug. 3. Makerere University Centre for Health and Population Research, Makerere, Uganda. skasasa@musph.ac.ug. 4. IgangaMayuge Health and Demographic Surveillance System, Makerere University Centre for Health and Population Research, Iganga, Uganda. 5. Makerere University Centre for Health and Population Research, Makerere, Uganda. 6. Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK. 7. Bandim Health Project, Bissau, Guinea-Bissau. 8. Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark. 9. Departmet of Clinical Research, Open Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark. 10. Dabat Research Centre Health and Demographic Surveillance System, Dabat, Ethiopia. 11. Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia. 12. Kintampo Health Research Centre, Kintampo, Ghana. 13. Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh. 14. Departent of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda. 15. Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda. 16. United Nations Children's Fund (UNICEF), New York, USA. 17. School of Public Health, University of the Western Cape, Cape Town, South Africa.
Abstract
BACKGROUND: Birth registration is a child's first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. METHODS: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. RESULTS: Almost all women, irrespective of their baby's survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4-5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27-1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37-5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. CONCLUSIONS: Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems.
BACKGROUND: Birth registration is a child's first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. METHODS: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. RESULTS: Almost all women, irrespective of their baby's survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4-5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27-1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37-5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. CONCLUSIONS: Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems.
Authors: Leonard K Atuhaire; Elizabeth Nansubuga; Olivia Nankinga; Helen Namirembe Nviiri; Benard Odur Journal: PLoS One Date: 2022-03-04 Impact factor: 3.240