title: Global network for women's and children's health research: a system for low-resource areas to determine probable causes of stillbirth, neonatal, and maternal death.
abstract: BACKGROUND
  Determining cause of death is needed to develop strategies to reduce maternal death, stillbirth, and newborn death, especially for low-resource settings where 98% of deaths occur. Most existing classification systems are designed for high income settings where extensive testing is available. Verbal autopsy or audits, developed as an alternative, are time-intensive and not generally feasible for population-based evaluation. Furthermore, because most classification is user-dependent, reliability of classification varies over time and across settings. Thus, we sought to develop classification systems for maternal, fetal and newborn mortality based on minimal data to produce reliable cause-of-death estimates for low-resource settings.
  
  
  RESULTS
  In six low-resource countries (India, Pakistan, Guatemala, DRC, Zambia and Kenya), we evaluated data which are collected routinely at antenatal care and delivery and could be obtained with interview, observation, or basic equipment from the mother, lay-health provider or family to inform causes of death. Using these basic data collected in a standard way, we then developed an algorithm to assign cause of death that could be computer-programmed. Causes of death for maternal (trauma, abortion, hemorrhage, infection and hypertensive disease of pregnancy), stillbirth (birth trauma, congenital anomaly, infection, asphyxia, complications of preterm birth) and neonatal death (congenital anomaly, infection, asphyxia, complications of preterm birth) are based on existing cause of death classifications, and compatible with the World Health Organization International Classification of Disease system.
  
  
  CONCLUSIONS
  Our system to assign cause of maternal, fetal and neonatal death uses basic data from family or lay-health providers to assign cause of death by an algorithm to eliminate a source of inconsistency and bias. The major strengths are consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. This system will be an important contribution to determining cause of death in low-resource settings.
authors.affiliation: RTI International, Durham, NC USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Bose
authors.affiliation: FANCAP, Guatemala City, Guatemala.
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.affiliation: Moi University Medical Teaching Hospital, Eldoret, Kenya.
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.affiliation: Latta Medical Research Foundation, Indira Gandhi Medical School, Nagpur, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.affiliation: University of Zambia, Lusaka, Zambia.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.affiliation: Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.affiliation: KLE University's JN Medical College, Belgaum, India.
authors.forename: Bhalchandra S
authors.initials: BS
authors.lastname: Kodkany
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Christiana Health Care, Newark, DE USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Massachusetts General Hospital, Boston, MA USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.affiliation: Indiana University, Indianapolis, IN USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.affiliation: University of Colorado, Denver, CO USA.
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hambidge
authors.affiliation: University of Colorado, Denver, CO USA.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.affiliation: UNC Chapel Hill, Chapel Hill, NC USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bauserman
authors.affiliation: Perinatology and Pregnancy Branch, NICHD, Bethesda, MD USA.
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.affiliation: RTI International, Durham, NC USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.affiliation: RTI International, Durham, NC USA.
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Wallace
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, OH USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Jobe
authors.affiliation: Columbia University Medical Center, New York, NY USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
keywords: Cause of death classification; Low-income Countries; Maternal mortality; Neonatal mortality; Stillbirth