Community-Based Documentation of Perinatal Mortality: Evaluating the Classification of Adverse Pregnancy Outcomes Captured by Health Surveillance Assistants

Olga Helena Joos, Johns Hopkins University
Kingsley Laija, National Statistical Office, Malawi
Luke Mullany, Johns Hopkins University

Measurement of perinatal mortality is often limited by lack of good quality data. Since January 2010, the Institute for International Programs and the Malawi National Statistics Office collaborated to support Real Time Mortality Monitoring, a community-based vital event reporting project among 160 randomly selected Health Surveillance Assistants (HSAs) in two districts. HSAs received continuing education on correct classification of adverse pregnancy outcomes (APOs): abortions, miscarriage, stillbirth, and neonatal death. The project data editor conducted phone-based verification of each APO and results were used as the verification source. Among the 125 HSAs (78%) who reported at least one APO, 24% misclassified the event. Among the 38 APOs misclassified by HSAs, 55% were miscarriage and 29% were abortions. Initial results show that HSAs are capable of correctly classifying perinatal mortality. Understanding the patterns of error can inform HSA training on APO classification for improved data quality.